Table of Contents

What is Bulimia Nervosa?

Bulimia nervosa, commonly referred to as bulimia, is a serious eating disorder characterized by a cycle of binge eating followed by compensatory behaviors to prevent weight gain, such as vomiting, excessive exercise, fasting, or misuse of laxatives or diuretics (APA, 2022). People suffering with bulimia often have an unrealistic body image. They may be obsessed with their weight, are intensely self-critical, and often judge themselves harshly for what they perceive to be serious flaws. Because bulimia is related to self-image and is not just about food, it can be challenging to overcome, but treatment can often help people feel better about themselves, adopt healthier eating patterns, and even reverse serious health complications.

Key Features:

  • Binge Eating: Consuming an unusually large amount of food in a short time with a feeling of loss of control.
  • Compensatory Behaviors: Engaging in behaviors to “undo” the binge, such as self-induced vomiting (purging) or over-exercising.
  • Body Image Disturbance: Self-esteem is overly influenced by body shape and weight.
  • Frequency: These behaviors typically occur at least once a week for three months or more.

Signs and Symptoms of Bulimia Nervosa

Bulimia signs and symptoms may be behavioral, physical, or emotional and psychological:

Behavioral Signs:

  • Frequent episodes of binge eating (eating large amounts of food in a short time)
  • Purging behaviors (self-induced vomiting, or misuse of laxatives, diuretics, or enemas)
  • Excessive exercise or fasting after eating
  • Secrecy around eating or disappearing after meals (often to vomit)
  • Ritualistic eating habits (e.g., cutting food into tiny pieces, eating in private)
  • Frequently looking in the mirror for perceived flaws
  • Preoccupation with weight, food, and dieting

Physical Signs:

  • Fluctuating weight (can be normal, underweight, or overweight)
  • Swollen cheeks or jaw area (from salivary gland enlargement)
  • Sore throat or chronic sore throat
  • Dental erosion or cavities (due to stomach acid from vomiting)
  • Calluses or scars on knuckles (from inducing vomiting, known as Russell’s sign)
  • Acid reflux or gastrointestinal problems
  • Dehydration
  • Electrolyte imbalances (can lead to irregular heartbeat or even heart failure)
  • Fatigue or dizziness

Emotional and Psychological Signs:

  • Low self-esteem and distorted body image
  • Mood swings, irritability, or depression
  • Feelings of guilt or shame after eating
  • Anxiety, especially around meal times or weight gain
  • Loss of control during binge episodes

What Causes Bulimia Nervosa?

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

People with mental health conditions may be at a 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.

Lifestance Health specializes in Bulimia Nervosa treatment with multiple locations in 33 states. Services and available treatments vary by location.

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How is Bulimia Nervosa Treated?

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

Medication Treatment Options
While there is no medicine for bulimia, some individuals with bulimia experience depression. The most commonly prescribed medications for depression include:

  • Selective Serotonin Reuptake Inhibitors (SSRIs) such as Fluoxetine, Citalopram, Sertraline, Paroxetine, and Escitalopram
  • Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) such as venlafaxine and duloxetine
  • Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs) such as bupropion

Traditional Therapy Options
Discussing bulimia and related issues with a mental health professional during psychotherapy (also known as talk therapy or psychological counseling) can help improve symptoms of bulimia. A few kinds of therapy that may be effective include:

Cognitive Behavioral Therapy (CBT):

  • Cognitive Behavioral Therapy can help individuals with bulimia recognize the patterns between their thoughts, emotions, and eating behaviors. It focuses on identifying and challenging distorted beliefs about food, body image, and self-worth, and replacing them with more balanced, realistic thinking. CBT also teaches practical coping strategies to reduce binge-purge cycles and develop healthier eating habits.

Family-Based Treatment (FBT):

  • Family-Based Treatment is especially suitable for adolescents with bulimia. This approach empowers parents (of adolescents with bulimia) to take an active role in interrupting disordered eating behaviors, re-establishing regular meals, and supporting their child’s nutritional recovery. It also helps families build healthier communication patterns and restore the teen’s autonomy around food in a developmentally appropriate way.

Interpersonal Psychotherapy (IPT):

  • Interpersonal Psychotherapy addresses how relationship issues, social stressors, and unresolved emotional conflicts may contribute to bulimia. By improving communication skills, building healthy support networks, and resolving interpersonal challenges, IPT can help reduce emotional triggers that often lead to binge eating and purging.

Support From a Dietitian
People with bulimia nervosa are often caught in a cycle of bingeing, purging, and restricting, which can disrupt their ability to recognize natural hunger and fullness cues. A registered dietitian can help by guiding them toward balanced, structured eating habits, creating individualized meal plans to support physical and emotional healing, and helping them rebuild a positive relationship with food and their body.

Hospitalization in Severe Cases
Treatment for complications may include hospitalization for severe cases of bulimia. In these cases, treatment usually involves an antidepressant, psychotherapy, and a collaborative approach between your primary care doctor, mental healthcare provider, and family and friends.

Some eating disorder treatment facilities offer live-in or day treatment programs. Individuals participating in live-in programs at treatment facilities receive around-the-clock support and care. They take classes, attend therapy, and eat nutritious meals. They may also practice mindfulness through things like gentle yoga to increase body awareness.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Feb 1;61(3):348-58. doi: 10.1016/j.biopsych.2006.03.040. Epub 2006 Jul 3. Erratum in: Biol Psychiatry. 2012 Jul 15;72(2):164. PMID: 16815322; PMCID: PMC1892232.
Steiger H. Eating disorders and the serotonin connection: state, trait and developmental effects. J Psychiatry Neurosci. 2004 Jan;29(1):20-9. PMID: 14719047; PMCID: PMC305267.
Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 20, DSM-IV to DSM-5 Bulimia Nervosa Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t16/