What is bulimia nervosa?

Bulimia nervosa is an eating disorder, commonly referred to simply as bulimia. It’s a serious condition that can be life-threatening.

It’s generally characterized by binge eating followed by purging. Purging can occur through forced vomiting, excessive exercise, or by taking laxatives or diuretics.

People with bulimia purge, or display purge behaviors, and follow a binge-and-purge cycle. Purge behaviors also include other strict methods to maintain weight like fasting, exercise, or extreme dieting.

People with bulimia often have an unrealistic body image. They are obsessed with their weight and are intensely self-critical. Many people with bulimia are of normal weight or even overweight. This can make bulimia hard to notice and diagnose.

Research indicates that roughly 1.5 percent of women and .5 percent of men will experience bulimia at some point during their life. It is most common in women, and especially common during the teenage and early adult years.

Up to 20 percent of college-age women report symptoms of bulimia. Performers are also at greater risk for eating disorders, as are athletes whose bodies and weights are closely monitored. And dancers, models, and actors may also be at a higher risk.

The most common symptoms of bulimia include:

  • long-term fear of gaining weight
  • comments about being fat
  • preoccupation with weight and body
  • a strongly negative self-image
  • binge eating
  • forceful vomiting
  • overuse of laxatives or diuretics
  • use of supplements or herbs for weight loss
  • excessive exercise
  • stained teeth (from stomach acid)
  • calluses on the back of the hands
  • going to the bathroom immediately after meals
  • not eating in front of others
  • withdrawal from normal social activities

Complications from bulimia can include:

  • kidney failure
  • heart problems
  • gum disease
  • tooth decay
  • digestive issues or constipation
  • dehydration
  • nutrient deficiencies
  • electrolyte or chemical imbalances

Women may experience the absence of a menstrual period. Also, anxiety, depression, and drug or alcohol abuse can be common in people with bulimia.

Bulimia has no known cause. However, there are a couple of factors that can influence its development.

People with mental health conditions or a distorted view of reality are at higher risk. The same is true for people with a strong need to meet social expectations and norms. Those who are highly influenced by the media may be at risk as well. Other factors include:

  • anger issues
  • depression
  • perfectionism
  • impulsiveness
  • past traumatic event

Some research suggests that bulimia is hereditary, or could be caused by a serotonin deficiency in the brain.

Your doctor will use a variety of tests to diagnose bulimia. First, they will conduct a physical examination. They may also order blood or urine tests. And a psychological evaluation will help determine your relationship with food and body image.

Your doctor will also use criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 is a diagnostic tool that uses standard language and criteria to diagnose mental disorders. The criteria used to diagnose bulimia includes:

  • recurrent binge eating
  • regular purging through vomiting
  • persistent purging behaviors, like excessive exercising, misuse of laxatives, and fasting
  • deriving self-worth from weight and body shape
  • bingeing, purging, and purging behaviors that happen at least once a week for three months on average
  • not having anorexia nervosa

The severity of your bulimia can be determined by how often, on average, you exhibit bingeing, purging, or purging behaviors. The DSM-5 categorizes bulimia from mild to extreme:

  • mild: 1 to 3 episodes per week
  • moderate: 4 to 7 episodes per week
  • severe: 8 to 13 episodes per week
  • extreme: 14 or more episodes per week

You may need further tests if you’ve had bulimia for a long period of time. These tests can check for complications that could include problems with your heart or other organs.

Treatment focuses not just on food and nutrition education but also mental health treatment. It requires development of a healthy view of the self and a healthy relationship with food. Treatment options include:

  • antidepressants, like fluoxetine (Prozac), which is the only antidepressant approved by the U.S. Food and Drug Administration (FDA) to treat bulimia
  • psychotherapy, also called talk therapy, can include cognitive behavioral therapy, family-based therapy, and interpersonal psychotherapy
  • dietitian support and nutrition education, which means learning about healthy eating habits, forming a nutritious meal plan, and possibly a controlled weight loss program
  • treatment for complications, which may include hospitalization for severe cases of bulimia

Successful treatment usually involves an antidepressant, psychotherapy, and a collaborative approach between your doctor, mental healthcare provider, and family and friends.

Some eating disorder treatment facilities offer live-in or day treatment programs. Patients participating in live-in programs at treatment facilities receive around-the-clock support and care.

Patients can take classes, attend therapy, and eat nutritious meals. They may also practice gentle yoga to increase body awareness.

If you don’t already have a therapist, you can browse doctors in your area through the Healthline FindCare tool.

Bulimia can be life threatening if it’s left untreated or if treatment fails. Bulimia is both a physical and psychological condition, and it may be a lifelong challenge to control it.

However, bulimia can be overcome with successful treatment. The earlier bulimia is detected the more effective treatment will be.

Effective treatments focus on food, self-esteem, problem solving, coping skills, and mental health. These treatments help patients maintain healthy behaviors in the long-term.