Bulimia Nervosa

Was there a time when you craved so much food that you couldn’t stop eating? And before you knew it, you started feeling guilty because of all the calories you’ve just taken. You might wonder if this was because of your hormones or just plain emotional eating. Or maybe this happens regularly, and it crossed your mind that perhaps you have an eating disorder. 

Bulimia Nervosa Bulimia Nervosa

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Table of contents
    • What is bulimia nervosa?
    • What are symptoms of bulimia nervosa? Of binging and purging?
    • What are consequences of bulimia nervosa?
    • What are causes of bulimia nervosa?
    • What are treatment and prevention options for someone with bulimia nervosa?

    Bulimia Nervosa, A woman binge eating, StudySmarterWoman drinking soda at the table with junk food, pexels.com

    Bulimia Nervosa Definition in Psychology

    Research by Ricca et al. (2012) says that emotional eating is a possible trigger for binge eating, particularly in bulimia nervosa. People with eating disorders have higher scores on emotional eating scales than those without eating disorders. Bulimia nervosa is one of the many types of eating disorders. But before we talk about bulimia, let’s define eating disorders.

    APA Dictionary of Psychology (n.d.) defines bulimia nervosa as an eating disorder marked by recurrent uncontrolled eating of large quantities of food followed by behaviors that compensate for uncontrolled eating, such as laxative abuse or self-induced vomiting.

    Bulimia Nervosa, A woman eating a chocolate cake, StudySmarterWoman eating a whole box of chocolate cake, pexels.com

    This illness is different from a binge-eating disorder where the inappropriate behaviors to make up for the binge eating episodes are absent. But, what about anorexia nervosa?

    Difference Between Anorexia and Bulimia Nervosa

    Anorexia nervosa and bulimia nervosa are eating disorders described as overvaluing thinness with dysfunctional eating patterns. The fundamental distinction between the two diagnoses is that anorexia nervosa involves self-starvation, with weight loss reaching 15 percent or more of the ideal body weight. In contrast, bulimia nervosa patients usually have average weights or may even be slightly overweight.

    While bulimia nervosa involves extreme dieting, binging, and purging (e.g., vomiting, laxatives, diuretics), patients with anorexia nervosa who binge and purge are likely diagnosed with anorexia nervosa over the binge/purge type eating disorders. Constant and strenuous exercising to lose weight and avoiding weight gain are typical of anorexia and bulimia nervosa.

    Criteria for Diagnosis of Bulimia Nervosa

    In the DSM-5, the diagnostic criteria are as follows:

    • Persistent episodes of binge eating that include:
      • Eating unusually larger quantities of food than normally other people would eat under the same period (e.g., within an hour or two) and conditions.

      • Feeling lack of control during the episode, such as over how much one eats or restraining oneself from eating.

    • Behaviors that compensate for the binge eating episodes, such as excessive exercise, self-induced vomiting, fasting, and abuse of laxatives, diuretics, and other medications.

    • Episodes of binge eating and negative behaviors occur at least once a week for three months.

    • One's body and weight heavily influence self-opinion.

    • The distress and other negative behaviors accompanied by this condition aren't only present in episodes of anorexia nervosa.

    Bulimia Nervosa Symptoms

    The binge-purge cycle, an eating pattern characterized by bulimia nervosa, involves various signs and symptoms that indicate whether the individual is exhibiting binging or purging.

    Binge Symptoms

    Some of the most common binge symptoms include:

    • Eating large amounts of food is seen as numerous empty food wrappers, containers in the trash bin, and the disappearance of food in a short time.

    • Concealment of binge episodes such as eating alone, keeping food stashes in strange places, and having a set schedule for binge eating.

    • No sense of control over eating, such as reaching the point of physical discomfort.

    • Regularly switching between overeating and fasting, sometimes skipping meals or limiting food intake to small portions during regular meals—rare instances of eating normally.

    Purge Symptoms

    Purge symptoms are:

    • Frequent bathroom trips after meals to throw up and hiding the sound of vomiting by running the water

    • Drinking laxatives, diuretics, or diet pills after meals to compensate for binging and prevent weight gain

    • Using mouthwash, gums, and mint excessively to hide the smell of vomiting

    • Engaging in strenuous exercises, including high-intensity activities such as running, especially after eating

    Bulimia Nervosa, A man who is experiencing tooth issues due to purging, StudySmarterA man experiencing tooth pain and sensitivity, pixabay.com

    Physical Signs of Bulimia Nervosa

    Some of the common signs of bulimia nervosa are:

    • Noticeable weight changes; weight may range from average to overweight due to cycles of binging and purging.

    • Callused knuckles and hands due to sticking fingers often down the throat to induce vomiting

    • Dental issues (e.g., cavities, sensitivity, and discoloration of teeth because of purging)

    • Bulimia face (puffy cheeks and face swelling)

    • Hair thinning and strands that are dry and brittle

    • Dry skin and nails

    Health Consequences of Bulimia

    Bulimia nervosa is a severe and life-threatening illness. Long-term purging and prolonged use of laxatives and diuretics can cause dehydration and low potassium levels. Potassium is essential for normal heart function, and chronic low potassium can cause a wide range of symptoms such as irregular heartbeat, kidney failure, and even death.

    Other health consequences of bulimia nervosa include:

    • Digestive problems (e.g., bloating, acid reflux, ulcers, cramps, and constipation)

    • Swelling in the vicinity of the salivary glands

    • Weakened immune system and wound healing

    • Irregular menstrual period

    • Injured stomach and esophagus

    Harmful Mental Effects of Bulimia Nervosa

    Bulimia nervosa, like most eating disorders, does not appear suddenly; instead, it develops gradually over time. Before purging, people with bulimia usually show signs of low self-esteem and negative body image. The last psychological effects to appear are usually the binging and purging behaviors. The psychological effects of bulimia nervosa are short-term and long-term.

    Short-Term Harmful Mental Effects of Bulimia Nervosa

    • Negative body-image

    • Feeling insignificant and having poor self-esteem

    • Frequently compares oneself with others

    • Extreme attempts to lose weight (e.g., fad diets and cutting out certain foods in one's diet)

    • Mealtime discomfort or unpleasantness

    Before making an official diagnosis of bulimia nervosa, specific behaviors characterized in this condition must continually appear for at least six months. The problem, however, is that bulimics tend to switch from one eating pattern to another, making short-term diagnosis impossible.

    For example, a person binging and purging for several months but eventually abandons binge eating due to newfound restriction patterns typical of anorexia nervosa. Careful monitoring of all disordered behaviors and planning accordingly is vital.

    Bulimia Nervosa, Woman feeling lonely and depressed while sitting on the floor, StudySmarterA woman experiencing depression, pexels.com

    Long-Term Harmful Mental Effects of Bulimia Nervosa

    • Depression: Feeling a lack of control over eating and purging behaviors might lead to a new or worsening bout of depression. Spiraling into depression leads to more negative outcomes such as losing hope or confidence, insomnia, demotivation, chronic fatigue, and even weight gain or weight loss.

    • Anxiety: An excessive worry or fear of the future and preoccupation with the past. Experiencing a tragic event can leave a person traumatized, becoming a source of fear, feeding his anxiety. As he struggles with it, he may find temporary relief from binge eating and purging, even at the cost of his health.

    • Suicide: Suicide rates among bulimia nervosa patients and other eating disorders are higher than those without eating disorders. Because bulimia is not just an eating disorder but also a severe mental health concern, suicide prevention is necessary, especially in severe cases of bulimia nervosa.

    There are also co-existing conditions among people with bulimia nervosa, including self-harm, drug abuse (which can also trigger depression), impulsiveness or being uncontrollable, and insulin misuse (diabulimia).

    Causes of Bulimia Nervosa

    There is no single cause attributed to bulimia nervosa. Many factors contribute to its development, such as biological, psychological, and socio-cultural factors.

    Biological Factors

    Genetics contributes more than half of the risk of developing this eating disorder. Having a mother or a sister with bulimia increases your likelihood of developing it too up to four times if you're a woman. But even without a family history of bulimia, an individual can still have this illness. Certain inherited personality traits also increase the overall risk of developing bulimia.

    The following traits usually characterize someone with bulimia nervosa:

    • Excessive impulsivity

    • Sudden and frequent mood changes

    • Having intense emotions

    • Inability to see the bigger picture

    • Difficulty accepting and adjusting to new perspectives or information (rigid thinking)

    Psychological Factors

    A person's mental and emotional state also contributes to the development of bulimia nervosa. Poor psychological conditions can lead to distorted views and self-criticism, evident in individuals with this illness. Having low self-esteem causes negative thinking patterns that can lead to bulimia. Perfectionists are also at a greater risk of having this illness because of the way they see their mistakes and having extreme concern for approval.

    Sociocultural Factors

    Concepts of beauty accepted by the norm, beliefs, and customs relating to eating and media influences are some of the socio-cultural factors that increase the risk of developing bulimia nervosa. Unrealistic beauty standards portrayed by the media, specific cultural values about appearance, and even situations that emphasize weight and appearance put pressure on people adding burden to the risk of having this condition.

    Traumatic events are also triggering factors in eating disorders. Tagay et al.'s (2014) research shows that those with eating disorders endured a traumatic event, especially those within the bulimia eating disorder circle.

    Bulimia Nervosa: Treatment and Prevention

    Successfully addressing eating orders requires early detection and treatment as more serious medical consequences are common in people with eating disorders. Generally, treatment for eating disorders includes talk therapy, medical treatment and monitoring, dietary counseling, pharmaceuticals, or a mix of these approaches.

    Bulimia Nervosa, A woman in a counseling session, StudySmarter

    Women having therapy sessions, pexels.com

    For people who have bulimia, therapy is an essential component of treatment. Counseling sessions help address poor view of body shape and weight, feelings of isolation, and embarrassment due to the binge-purge cycle—the choice of therapy for bulimia nervosa cognitive-behavioral therapy.

    Learn more about Cognitive Behavioral Therapy (CBT) here!

    In bulimia nervosa, this therapy focuses on the eating patterns and distorted thoughts that feed the unhealthy cycle.

    Here's what you may expect from bulimia treatment:

    Stopping the cycle of binging and purging: The first stage is to break the binge-purge cycle and develop normal eating habits. You learn to keep track of your eating habits, avoid situations that tempt you to binge, deal with stress other than food, eat regularly to curb hunger, and resist the need to purge.

    Modifying harmful thinking patterns and behavior: The second stage of this treatment is recognizing and correcting unhealthy ideas about body weight, eating, and body shape. You learn to discover healthy perceptions about eating and discourage the notion that weight determines one's self-worth.

    Taking care of emotional problems: The last part of this treatment entails addressing the underlying emotional issues that led to the eating disorder, such as relationship problems, self-esteem issues, anxiety, depression, and feelings of shame and isolation.


    No one knows how to prevent bulimia nervosa with certainty. Though many risk factors (e.g., genetics) are at play in developing bulimia nervosa, like any eating disorder, adapting a healthy view of body weight, shape, eating habits, and keeping mental health in check is essential. Following a healthy lifestyle like coping with stress in healthy ways may also help reduce the risk of having bulimia nervosa.

    Here are some helpful ways to help prevent bulimia nervosa:

    1. Become self-aware of the illness and educate oneself on symptoms and risk factors.

    2. Seek help from a medical doctor after identification of any warning signs.

    3. Learn about healthy eating practices and create positive lifestyle changes to help deal with stress and other problems.

    4. Be mindful of any self-criticisms about body, weight, or overall health and adopt a positive body image.

    5. Always keep in check your mental health.

    Bulimia Nervosa - Key takeaways

    • Bulimia involves harmful eating habits and psychological problems perpetuating the negative binge-purge cycle.
    • Physical signs of bulimia nervosa include callused knuckles, puffy cheeks, thinning hair, brittle nails, and maintaining a stable weight.
    • There are health consequences of bulimia brought about by long-term purging and use of laxatives, diuretics, and other pills, such as dehydration, abnormal laboratory results, heart and kidney problems, and dental issues.
    • There are also short- and long-term harmful mental effects of bulimia, such as self-isolation (short-term) and depression (long-term).
    • Cognitive-behavioral therapy is the therapy of choice for bulimia nervosa.
    Frequently Asked Questions about Bulimia Nervosa

    What is the difference between anorexia nervosa and bulimia nervosa? 

    Anorexia nervosa and bulimia nervosa are eating disorders described as overvaluing thinness with dysfunctional eating patterns. The fundamental distinction between the two diagnoses is that anorexia nervosa involves self-starvation, with weight loss reaching 15 percent or more of the ideal body weight. In contrast, bulimia nervosa patients usually have average weights or may even be slightly overweight. 

    Which is a symptom of bulimia nervosa? 

    Binge symptoms of bulimia nervosa include the disappearance of food in a short time (e.g., numerous wrappers in the garbage), eating alone, inability to stop eating, and switching between overeating and fasting. 

    Purge symptoms of bulimia nervosa include frequent bathroom trips after meals, laxative abuse, hiding the smell of vomit by using mouthwash, gums, or mint, and doing high-intensity exercises. 

    How to prevent bulimia nervosa?

    No one knows how to prevent bulimia nervosa with certainty. Though many risk factors (e.g., genetics) are at play in developing bulimia nervosa, like any eating disorder, adapting a healthy view of body weight, shape, eating habits, and keeping mental health in check is essential. Following a healthy lifestyle like coping with stress in healthy ways may also help reduce the risk of having bulimia nervosa. 

    What characterizes the eating pattern of people with bulimia nervosa? 

    Bulimia nervosa is an eating disorder involving switching from binge eating to purging behavior such as self-induced vomiting, fasting, or laxative abuse. An individual with bulimia nervosa may feel compelled to eat due to hunger and deprivation brought about by a fad diet that they have recently tried to do. The person then starts binging and feels unable to stop eating. But, somehow, this gives them relief until guilt sets in, so they compensate for it by purging. Purging gives them a sense of control, and they think that even if they overeat, they can make up for it again. 

    What causes bulimia nervosa?

    Bulimia nervosa is caused by biological factors (genetics, personality traits), psychological factors (mental health), and sociocultural factors (concepts of beauty, traumatic events). 

    Test your knowledge with multiple choice flashcards

    Which is not true of eating disorders?

    What characterizes the eating pattern of people with bulimia nervosa?

    What differs anorexia nervosa from bulimia nervosa?


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