Bulimia nervosa is an eating disorder. Much like other eating disorders it tends to develop during adolescence and into early adulthood.  Bulimia tends to be more common in women (90%) than in men (10%). Those with bulimia will binge eat unusually large amounts of food in a specific period of time. During a binge eating episode a person continues until they are well past full, often painfully so. During a binge, the person often feels that they cannot control how much they are eating. Nor are they able to stop eating.

Binges can happen with any type of food. However they most frequently occur with foods the individual generally avoids. Those with bulimia then purge to compensate for the calories consumed and to relieve gut discomfort. Common purging behaviors include induced vomiting, fasting, laxatives, diuretics, enemas, and excessive exercise.

What are the symptoms?

Symptoms often present as similar to those of binge eating or purging sub types of anorexia nervosa. Those individuals with bulimia usually maintain a relatively normal weight, rather than becoming underweight.

Common symptoms of bulimia nervosa include:

  • recurrent episodes of binge eating with a feeling of lack of control
  • recurrent episodes of inappropriate purging behaviors to prevent weight gain
  • a self-esteem overly influenced by body shape and weight
  • a fear of gaining weight, despite having a normal weight

What are the side effects?

  • an inflamed / sore throat
  • swollen salivary glands
  • worn tooth enamel
  • tooth decay
  • acid reflux
  • irritation of the gut
  • severe dehydration
  • hormonal disturbances

In the most severe cases, bulimia can also create an imbalance in levels of electrolytes (sodium, potassium, and calcium).This can trigger a stroke or heart attack.

What Causes Bulimia?

The cause of bulimia is not fully known at this time.  A common theory is that it may be caused by both genetic and environmental factors. Bulimia tends to run in families. Research has shown that neurotransmitters appear to function abnormally in acutely ill people with bulimia nervosa. There also appears to a link between bulimia and other psychiatric problems, most frequently depression and OCD. Environmental influences may also play a role in developing bulimia. These can include participation in endeavors that emphasize thinness (dancing, gymnastics or modeling). Family pressures can also  play a role. A study found that mothers who are extremely concerned about their daughters’ physical attractiveness and weight can, in part, cause bulimia in them. In addition, girls with eating disorders tend to have males in their lives that are hypercritical regarding their weight. Bulimia tends to run in families.


Bulimia is most successfully treated when diagnosed early. The person suffering from bulimia is frequently in denial. They will go to great lengths to avoid getting medical help. According to the American Psychiatric Association, a diagnosis of bulimia requires that a person have all of the following symptoms:

  • recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months)
  • a feeling of lack of control over eating during the binges
  • regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
  • persistent over-concern with body shape and weight

Early intervention and treatment is paramount.  If not treated early bulimia can become chronic, bringing serious health consequences. A comprehensive treatment plan is required to address the complicated interaction of physical and psychological problems in bulimia. A combination of drug and behavioral therapies is commonly used.

Behavioral approaches include individual psychotherapy, group therapy, and family therapy . There is an adapted form of Dialectical behavioral therapy (DBT) that is designed specifically to treat those with eating disorders. Education via nutritional counseling and self-help groups can also have appositive impact.

Antidepressants commonly used to treat bulimia include desipramine (Norpramin), imipramine (Tofranil), and fluoxetine (Prozac). These medications also may treat any co-existing depression.