Bulimia nervosa, also known as bulimia, is a type of eating disorder
characterized by repeatedly eating large amounts of food in a short period of time and then eliminating the calories in an unhealthy way to prevent weight gain.
People suffering from bulimia often engage in purging. This involves forcing food from the body, usually by vomiting or taking laxatives. Others with the disease may avoid eating, exercise excessively or enforce a strict diet after binge eating
In addition to affecting a person’s eating habits, bulimia also affects self-image. Many people with the disorder closely monitor their physical appearance. Battling low self-esteem, they often criticize their perceived flaws and harbor fears of gaining weight.
People with bulimia commonly have other mental health conditions, including anxiety, depression and substance use disorders. Luckily, numerous evidence-based treatment approaches for bulimia and its co-occurring disorders
Co-Occurring Disorders: Substance Abuse and Bulimia
Many bulimic individuals turn to drugs or alcohol to achieve an ideal weight. Between 3 and 50 percent of people with bulimia also experience addiction. The rate of addiction among people with bulimia is higher than the rate of the general population or that of people with other eating disorders.
People with bulimia may use drugs or alcohol to numb physical or psychological pain or to interrupt binging and purging cycles. But using drugs as an escape can cause serious problems, such as cardiovascular diseases or substance use disorders
“A lot of times with substance abuse and bulimia, the behaviors are used to numb and avoid, or shove down, uncomfortable feelings, past experiences [or] traumatic events,”Christina Purkiss, program director at Blue Horizon Eating Disorder Services, told DrugRehab.com. “It’s a big distraction from reality, whether it’s the binge and purge or getting high by using drugs.”
A 2010 study published in the journal Psychological Medicine looked at the association between substance use and various eating disorders, including anorexia, bulimia and binge-eating disorder. In the report, researchers evaluated 13,297 women drawn from a Swedish registry.
Researchers found that bulimic women were more likely than a group without the disorder to use opioids, sedatives or stimulants in their lifetime. Bulimic women were also more likely than women without the disorder to use cannabis
at least 10 times in a month or in their lifetime.
Genetics may play a role in the development of alcohol addiction
in people with bulimia. A 2012 study published in the journal Behavior Genetics found significant genetic correlations between bulimia symptoms and alcohol use.
Teen Girls and Young Women Face Highest Risk for Bulimia
Researchers have not identified the causes of bulimia, but they believe a combination of life events and genetics can trigger the disorder.
- Traumatic events such as abuse or neglect
- Low self-esteem
- Media messages
- Social experiences
- Mental illness
Bulimia affects people of all ages and backgrounds, but the majority of individuals affected by the disorder are girls and women.
Typically a female teen or young adult, the average person with bulimia is hard-working, introverted, self-critical and impulsive. She may also resist change and exhibit low self-esteem.
Older women also develop the disease. A study published in the International Journal of Eating Disorders found that 13 percent of nearly 1,850 American women aged 50 or older exhibited signs of an eating disorder.
- According to the University of Rochester Medical Center, 1 to 4 percent of female teens and young adult women report having the disease.
- On average, women develop the disorder at age 18 or 19.
- Bulimia is most commonly diagnosed in Caucasians.
Purkiss said that bulimia also affects men, but she is unsure of specific demographics. The disease is more closely associated with women, but she said that many eating disorder statistics may be skewed.
“Statistics show that more women than men experience eating disorders. However, it is important to question this data,” said Purkiss. “It is likely that the prevalence of eating disorders in men is inaccurate due to men either not recognizing that they have an eating disorder or not seeking appropriate treatment.”
A 2012 article published in the journal Eating Disorders listed the results of several studies examining the prevalence of eating disorders in men. In one 2005 study, 10 percent of patients with anorexia and bulimia were men, and more men experienced bulimia than anorexia.
A 2007 study reported that men account for 25 percent of anorexia and bulimia cases. According to the National Institute of Mental Health, about 1 million men have eating disorders. Authors of the 2012 article stated that the number is likely an underestimate.
Signs and Symptoms of Bulimia
Symptoms of bulimia may be difficult to recognize. People with the disorder may be overweight, underweight or at a healthy weight. Over time, however, signs of bulimia may be noticeable.
- Scrapes or calluses on knuckles
- Swollen face
- Gastrointestinal problems such as constipation
- Severe dehydration
- Sensitive or decaying teeth
Behavioral changes may also occur. For example, people with bulimia may avoid engaging in hobbies or social activities, exhibit sadness, have difficulty expressing anger, exercise obsessively or visit the bathroom after meals to vomit.
Those with bulimia have trouble controlling their behavior. They may constantly worry or complain about their weight, avoid eating in public or display a distorted perception of a healthy body weight.
Bulimia vs. Anorexia: What’s the Difference?
Bulimia and anorexia are common eating disorders that can severely damage the body and mind. Affecting millions of people each year, both mental diseases involve unhealthy behaviors related to food intake, self-image and feelings of guilt or shame. Like bulimia, anorexia
can also include binging and purging.
However, these eating disorders have several key differences. Significantly low body weight is closely associated with anorexia, while individuals with bulimia often maintain a healthy body weight. People with anorexia also have an intense desire for thinness, which isn’t always the case with bulimic individuals.
“[With] bulimia, that doesn’t happen as much,” said Purkiss. “It can happen, but it’s not as common.”
Anorexic people don’t maintain a healthy body weight, and they lose weight more rapidly than those with bulimia. Bulimia can occur after observing thin people in the media and wanting a similar body, while anorexia can result from an inability to connect with others.
Intestinal Damage, Throat Swelling and Other Consequences of Bulimia
Bulimia can lead to a number of physical and psychological health problems, including dehydration, anxiety and stomach damage from overeating.
- Irregular menstrual cycles
- Tooth decay
- Electrolyte imbalance
- Intestinal damage
Bulimia can also result in throat swelling, irregular heartbeat, dry skin, low sex drive, bloody vomit and red eyes. Binging and purging can put tremendous strain on the body and cause mental and emotional health problems.
Depression and Bulimia
is a psychological disorder common in individuals with bulimia. This mental illness can negatively affect feelings, thoughts and actions. It can cause feelings of sadness and lead to a number of physical and emotional issues.
Bulimia nervosa frequently co-occurs with mood disorders such as major depressive disorder, according to Purkiss. She said that research has shown depression and bulimia can precede one another.
A 2017 study published in the Journal of Abnormal Psychology identified symptoms that may bridge the relationship between bulimia, anxiety
and depression. Researchers found that symptoms such as dizziness and changes in appetite were associated with all three disorders. This suggests that cognitive behavioral treatment for bulimia and a co-occurring depressive disorder should address symptoms of depression as well as a patient’s fear of gaining weight.
Bulimia Affects Pregnancy
Bulimia can also influence a woman’s reproductive health. Constant binging and purging can disturb the menstrual cycle, disrupting the ability to conceive.
For those who are pregnant
, bulimia can increase the risk for miscarriage, premature birth and cesarean section delivery. The disease can cause low birth weight or birth defects in newborns. Women with bulimia also have a greater chance of developing postpartum depression.
Bulimia can severely affect someone’s health, but effective treatment options
are available. The type of treatment is determined by age, overall health, the extent of symptoms, medical history and tolerance to meal plans, medications and therapies.
To treat bulimia, medical professionals use a combination of psychotherapy, individual and family therapy, medications and nutrient rehabilitation.
Therapists commonly use cognitive behavioral therapy to treat bulimia. This psychotherapy teaches people to replace dysfunctional thoughts with healthy ones. CBT is
a popular treatment approach for multiple mental health disorders, including depression, addiction and other eating disorders.
A 2014 study published in The American Journal of Psychiatry compared CBT with psychoanalytic psychotherapy in 70 people receiving treatment for bulimia. The results showed that 42 percent of people in CBT stopped binge eating and purging five months after treatment, while just 6 percent of people in psychoanalytic psychotherapy had stopped in that time.
Blue Horizon Eating Disorder Services uses dialectical behavior therapy to treat people with bulimia. DBT uses mindfulness techniques to decrease intrusive thoughts and behaviors. The approach has also been used to help people overcome depression, borderline personality disorder
“We work with them to be able to sit with their thoughts and emotions and be able to tolerate the present moment without having to turn to binging and purging,” said Purkiss.
Many rehab centers in the United States
use CBT and DBT to treat clients with eating disorders such as bulimia.
Physicians often use selective serotonin reuptake inhibitors when treating bulimia.
Prozac (fluoxetine) is the only antidepressant approved by the Food and Drug Administration to treat bulimia. But some research shows that Luvox, a brand of fluvoxamine, may be more effective than Prozac in treating the disorder.
Because people with bulimia often fail to consume enough daily nutrients, a healthy diet
is important in recovering from the disorder. Generally, people with bulimia should drink six to eight glasses of filtered water each day and eat quality protein, such as lean meat, to gain muscle mass. These individuals also should avoid refined sugars, tobacco, alcohol and caffeine.
Although they do not specifically treat the disorder, certain herbs can also be beneficial to those battling bulimia. Holy basil can relieve stress, while catnip (nepeta spp.) can be taken two to three times per day to soothe the digestive system and alleviate nerves.
DrugRehab.com aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.
Matt Gonzales is a writer and researcher for DrugRehab.com. He graduated with a degree in journalism from East Carolina University and began his professional writing career in 2011. Matt covers the latest drug trends and shares inspirational stories of people who have overcome addiction. Certified by the Centers for Disease Control and Prevention in health literacy, Matt leverages his experience in addiction research to provide hope to those struggling with substance use disorders.
Certified Eating Disorders Specialist,
White Picket Fence Counseling Center
- Gagne, D.A. et al. (2012, June 21). Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: Results of the gender and body image (GABI) study. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1002/eat.22030/abstract
- Harvard University. (2013, March). Bulimia. Retrieved from https://www.health.harvard.edu/mind-and-mood/bulimia
- Levinson, C.A. et al. (2017, April). The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28277735
- Mayo Clinic. (2017, August 23). Bulimia nervosa: Overview. Retrieved from #
- Mayo Clinic. (2017, August 23). Bulimia nervosa: Symptoms and causes. Retrieved from #
- McAllister, M.S. (2013). Eating Disorders: Incidence and Treatment of Co-Occurring Substance Use Disorders in Women with Bulimia Nervosa. Retrieved from http://scholarworks.gsu.edu/cgi/viewcontent.cgi?article=1064&context=gsurc
- Miller, C. (n.d.). Anorexia vs. Bulimia. Retrieved from http://www.lonestar.edu/18157.htm
- Missouri Department of Mental Health. (n.d.). CPS Facts: Eating Disorders. Retrieved from https://dmh.mo.gov/docs/mentalillness/eatingdisorder.pdf
- National Institute on Mental Health. (2016, February). Eating Disorders. Retrieved from https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml
- Northwell Health. (n.d.). Bulimia nervosa. Retrieved from https://www.northwell.edu/find-care/services-we-offer/behavioral-health/conditions/bulimia-nervosa#14066
- Office on Women’s Health. (2017, July 11). Bulimia nervosa. Retrieved from https://www.womenshealth.gov/a-z-topics/bulimia-nervosa
- Office on Women’s Health. (2017, May 31). Bulimia Nervosa. Retrieved from https://www.womenshealth.gov/files/documents/fact-sheet-bulimia.pdf
- Pietrangelo, A. & Cherney, K. (2017, August 9). The Effects of Bulimia on Your Body. Retrieved from http://www.healthline.com/health/bulimia/effects-on-body
- Poulsen, S. et al. (2014, January). A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24275909
- Root, T.L. et al. (2010, January). Patterns of Comorbidity of Eating Disorders and Substance Use in Swedish Females. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788663/
- Slane, J.D., Burt, S.A. & Klump, K.L. (2012, July). Bulimic behaviors and alcohol use: shared genetic influences. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22302528
- Strother, E. et al. (2012, October). Eating Disorders in Men: Underdiagnosed, Undertreated, and Misunderstood. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479631/
- University of Rochester Medical Center. (n.d.). Bulimia Nervosa. Retrieved from https://www.urmc.rochester.edu/childrens-hospital/adolescent/eating-disorders/teens/bulimia-nervosa.aspx
- Washington University. (n.d.). Fast Facts. Retrieved from http://depts.washington.edu/thmedia/view.cgi?page=fastfacts§ion=bodyimage