Bulimia nervosa is a life-threatening eating disorder characterized by binge-eating a large amount of food, usually in a small time frame, followed by extreme measures to prevent weight gain.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) lists criteria for bulimia nervosa as having recurring episodes of binge eating objectively large quantities of food, typically within a two-hour time frame. The affected person may feel that binge behavior is compulsive and uncontrollable. Other criteria include the disproportionate measures a person takes to compensate for the intake of food. These “purging” behaviors may self-induced vomiting, misuse of laxatives and diuretics, fasting or excessive exercise. The diagnosis of bulimia also considers a person’s self-image. The self worth of someone suffering from bulimia often relies heavily on his or her physical appearance.

Who is at Risk for Bulimia?

Bulimia occurs most commonly during adolescence and young adulthood. It affects individuals across all genders, races, and socioeconomic backgrounds. Over a lifetime, between 0.5% of men and 1.5% of women report suffering from bulimia at some point. These percentages convert to about 1.5 million men and 4.7 million women in the United States.

While no group is excluded, some groups will have higher rates of exposure to this eating disorder than others. Athletes who partake in sports that have a preference for lean body-types or weight classes — for example, gymnasts, wrestlers, or dancers — are at greater risk of developing eating disorders than other groups. 

Like other eating disorders, bulimia is also often associated with co-occurring psychological conditions or personality disorders, such as depression. An inability to process emotions and manage them effectively is a common risk factor for disordered eating. Likewise, anxiety is another condition closely related to eating disorders like bulimia. An individual may not know how to cope with feelings of anxiety in healthy ways, and he or she may use bulimia as a way of providing a sense of control in an environment that, otherwise, feels very chaotic.  

Effects of Bulimia

In the short-term, a person suffering from bulimia may exhibit fluctuations in weight, strict adherence to an exercise regimen, withdrawal from social activities, and a reluctance to eat in front of others. Alternatively, some may eat a large amount of food socially, while making excuses about the quantity, referring to their excessive exercise of a missed meal. Over time, those who suffer often find ways to conceal their behaviors, and because many maintain close to a normal weight, the disorder may be difficult for friends and family to catch.

Long-term, the effects of bulimia are life-threatening. Dehydration and electrolyte imbalance from purging can lead to dizziness, fatigue, low blood pressure, and low heart rate. Other effects from regularly vomiting include a sore throat, tooth decay, gum disease, and stomach ulcers. Women who use bulimia to reduce their weight below healthy levels may experience a lack of menstruation and hormonal imbalance that can lead to hair loss and chronic fatigue. It is important to know that in the long-term, this illness is deadly. Nearly 4% of people with bulimia will not survive. This rate excludes the higher rates of suicide in people who suffer with eating disorders as a whole.

For Friends & Family

If you suspect that a loved one suffers from bulimia, there are some other signs, aside from the physical side effects, to which you can pay close attention.

Your loved one may appear uncomfortable eating around other people, disappear after eating a meal, or frequently use mouthwash or chewing gum. He or she may also have an intense concern with physical appearance, demonstrate fluctuating mood swings, or have difficulty concentrating.

Other noticeable signs include feeling cold a majority of the time, contract illnesses frequently, or having a wound that takes a longer time than normal to heal.  

Suffering from a stressful eating disorder has both behavioral and physical signs that are consistent with malnutrition, anxiety, depression, and addiction. If you see any behaviors exhibited that prevent your loved one from functioning well during the day, it is important to seek advice from a professional about how to move forward and get them help.  

Treatment for Bulimia

Both inpatient and outpatient treatment programs have proven to be effective, but in either case, treatment programs should include an emphasis on behavioral therapy in addition to physical recovery. Cognitive behavioral therapy (CBT), for example, helps clients develop healthy coping mechanisms in response to binge triggers and identify new ways to handle stress. Through behavioral therapy, clients can also explore the subconscious beliefs they harbor that contribute to self-destructive behaviors.  

Because psychological conditions, such as anxiety disorders, often coexist with eating disorders like bulimia, which can exacerbate and reinforce the behaviors of someone suffering from the disorder, an assessment to determine any such co-occurring disorders is also important. At Sprout Health Group, the individualization of each treatment plan to a client’s unique medical history, co-occurring conditions, family support and personal goals is a cornerstone of our treatment approach.


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