What is bulimia nervosa?

Bulimia nervosa is a type of psychological eating disorder characterized by episodes of binging and purging. Typically, people with bulimia nervosa will eat large amounts of food in secret (binge), and then somehow get rid of the food they just consumed (purging). Purging is done in an unhealthy manner and may include forcing oneself to vomit or exercising excessively. 
In some cases, people will purge after they’ve binged on large amounts of food, but in other cases people may purge even after eating a normal sized meal or snack. People with bulimia nervosa engage in this behavior because they want to prevent themselves from gaining weight, and are completely consumed by thoughts of their body shape and size/weight. They typically perceive themselves to have many flaws and judge themselves harshly. 
There are two categories of bulimia nervosa:
  • Purging bulimia is characterized by self-induced vomiting and/or misusing laxatives, diuretics, or enemas after episodes of purging. 
  • Non-purging bulimia is characterized by using other ways to get rid of consumed calories in order to prevent weight gain. These people may fast, go on strict diets, or exercise excessively. The behaviors tend to overlap and these attempts to get rid of consumed calories may also be referred to as purging in some cases.  
Bulimia nervosa typically develops in late childhood or early adulthood and is more common in females than males. The binging and purging is usually done secretively because people feel ashamed when they binge and then relief once they purge. During an episode of binging, people with bulimia nervosa may feel a loss of control - as if they can’t stop eating. The binging usually lasts less than two hours. The binge and purge episodes may occur multiple times a week or even multiple times a day.
People with bulimia nervosa are usually of normal weight for their age and height or more, but fear of gaining weight, desire to lose weight, and/or are very unsatisfied with their bodies. The fact that they are of normal weight allows them to hide their problem for years. Bulimia nervosa is a dangerous illness that can potentially be life threatening. 
Risk factors
  • Gender: Bulimia is more common in females.
  • Age: Bulimia usually develops in late teens/early adulthood.
  • Pressure from the media and society: Seeing skinny models and actresses/actors may cause people to associate being skinny with being successful and happy. It may cause them to associate body image with self-worth.
  • Pressure from sports, work, or other activities: Athletes, actors/actresses, dancers, and models are at higher risk for developing an eating disorder. They may feel pressure to lose weight in order to better their performance. 
  • Family history: People who have a first degree relative with an eating disorder are at a higher risk.
  • Being overweight or obese as a child puts one at higher risk for developing an eating disorder. 
  • Having psychological or emotional problems: Having a history of anxiety or low self-esteem may put one at increased risk for developing bulimia nervosa. Increased stress, a history of restrictive dieting, poor self-image, boredom, and/or experiencing a traumatic event may also put one at increased risk.  
The criteria for a diagnosis of bulimia nervosa is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which is published by the American Psychiatric Association. 
The DSM-5’s diagnostic criteria for bulimia nervosa is as follows:


  • Recurrent episodes of binge eating: An episode of binge eating is characterized by both of the following:
  • Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
  • A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of bulimia.

If your doctor thinks you have bulimia nervosa he/she will likely perform a complete medical history and physical exam. They will also likely take a look at your family history as well. They will probably want you to describe your behaviors and may ask your family and friends about your behaviors. Psychological testing may be done with a lot of questions about your attitudes toward food. Blood and urine tests are sometimes done to check your overall health and nutritional status. 

Several different types of treatment may be required when dealing with bulimia nervosa. Treatment is typically done in a team approach that involves many different specialists. A combination of psychotherapy and antidepressants is usually the most effective treatment method. 
Types of treatment that may be used when dealing with bulimia nervosa include:
  • Cognitive behavioral therapy (CBT)
  • Family-based therapy
  • Interpersonal psychotherapy
  • Antidepressants
  • Nutrition and weight education
  • Hospitalization
  • 1.5% of American women suffer from bulimia nervosa in their lifetime
  • 1 in 10 bulimia patients also have a comorbid substance abuse disorder
  • Greater than 1/2 of bulimia patients have a comorbid anxiety disorder
  • Almost 1/2 of bulimia patients have a comorbid mood disorder
  • Approximately 30 million people suffer from an eating disorder in the U.S.
about bulimia nervosa

  • "Bulimia nervosa." Mayo Clinic. Mayo Foundation for Medical Education and Research, 23 Aug. 2017. Web. 24 Aug. 2017.
  • "Bulimia Nervosa.” | Johns Hopkins Medicine Health Library. Johns Hopkins Medicine Health Library, n.d. Web. 24 Aug. 2017.
  • “Overview and Statistics.” National Eating Disorders Association. NEDA, n.d. Web. 24 Aug. 2017. 
  • “Bulimia Nervosa.” The Cleveland Clinic Foundation. Cleveland Clinic, 04 Mar. 2014. Web. 24 Aug. 2017. 
  • “Bulimia Nerovsa: Causes, Symptoms, Signs, & Treatment Help.” Eating Disorder Hope, 01 May. 2017. Web. 24 Aug. 2017. 
  • “Eating Disorder Statistics.” National Association of Anorexia Nervosa and Associated Disorders. ANAD, n.d. Web. 24 Aug. 2017. 


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