Bulimia Nervosa

Last Updated: July 20, 2023

Bulimia nervosa is a type of eating disorder characterized by binge eating (eating a lot of food in a short amount of time while feeling out of control) followed by purging via methods such as vomiting, laxatives, excessive exercise, fasting, or diuretics to prevent weight gain.

What is bulimia nervosa?

Bulimia nervosa (BN), also called bulimia, is a type of eating disorder characterized by eating a lot of food in a short amount of time while feeling out of control (binge eating) followed by feelings of disgust that lead a person to purge with vomiting, laxatives, excessive exercise, fasting, or diuretics to prevent weight gain.

Binging and purging can lead to stomach damage, dehydration, electrolyte imbalances, tooth decay, throat ulcers, menstrual irregularities, and intestinal problems. Teen girls and young women are at greatest risk of developing BN, but it can occur in all genders, races, and ages.[1][2]

What are the main signs and symptoms of bulimia nervosa?

Unlike some other eating disorders, BN may not affect a person’s body weight, so physical symptoms may not be apparent in the early stages of the disorder.

People with bulimia may engage in frequent postmeal visits to the bathroom (to purge) or compulsive exercise. They may also have a negative body image and may withdraw from social activities and previously enjoyed hobbies. They may also attach undue importance to their weight and experience body dysmorphia (an extremely distorted perception of their appearance).

Over time, people with purging behavior may develop physical signs caused by frequent vomiting, including swollen cheeks, calloused or scraped knuckles (from using fingers to induce vomiting), tooth decay, broken blood vessels in the eyes, severe dehydration, and gastrointestinal issues like acid reflux and constipation.[1][2]

How is bulimia nervosa diagnosed?

Bulimia is diagnosed when a person discloses typical binging or purging behavior to a healthcare provider. The provider then assesses their symptoms and medical history and conducts a clinical interview to make the diagnosis. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) a person is considered to have bulimia nervosa if they binge at least once a week for 3 months. People with purging-type bulimia use vomiting, laxatives, diuretics, or enemas after binging, whereas those with nonpurging bulimia engage in other compensatory behaviors, like fasting or excessive exercise.[1][3]

What are some of the main medical treatments for bulimia nervosa?

People with bulimia are rarely hospitalized unless they have other conditions that add to the health risk of bulimia — such as anorexia or major depressive disorder — or they require medication to address purging behaviors. Treatment typically follows a stepped approach based on severity and the individual's response to interventions.

Mild cases may benefit from support groups, and talk therapy and nutritional therapy are used to treat cases that don’t respond to support groups. Selective serotonin-reuptake inhibitors (SSRIs) are often combined with talk therapy. Even with treatment, many people will continue to have symptoms, but those who engage in therapy have a better prognosis.[1][2]

Have any supplements been studied for bulimia nervosa?

Certain vitamin and mineral supplements might be included as part of the treatment plan if an individual’s diet is lacking in some area, but no supplements have been studied for bulimia specifically.[1][2]

Are there any other treatments for bulimia nervosa?

One study reported that a 16-week physical activity program (including resistance training and high-intensity interval training) along with dietary therapy (education and practical skills related to nutrition and eating) improved bulimia symptoms as effectively as cognitive behavioral therapy.[4] Intranasal oxytocin has been studied in bulimia, but it had no effect.[5][6]

What causes bulimia nervosa?

The exact cause of bulimia is unknown, and it’s likely the result of multiple sociocultural, psychological, and genetic factors. Other risk factors include perfectionism, impulsivity, a negative self-image, and being diagnosed with other mood disorders. A history of being bullied, sexually abused, or experiencing eating problems or obesity as a child could also increase the risk of eating disorders like bulimia.[7] Sociocultural beauty ideals and social media have also been identified as potential contributing factors.[8][1][2]

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Update History
  1. ^Bulimia: MedlinePlus; Bethesda, MD: National Library of Medicine US, cited June 15, 2023(April 30,2022)
  2. ^Bulimia Nervosa; Office of Women’s Health, cited June 15, 2023(February 20, 2022)
  3. ^Substance Abuse and Mental Health Services Administration(June 2016)
  4. ^Mathisen TF, Rosenvinge JH, Friborg O, Vrabel K, Bratland-Sanda S, Pettersen G, Sundgot-Borgen JIs physical exercise and dietary therapy a feasible alternative to cognitive behavior therapy in treatment of eating disorders? A randomized controlled trial of two group therapies.Int J Eat Disord.(2020-Apr)
  5. ^Chen CY, Chiang YC, Kuo TC, Tam KW, Loh EWEffects of intranasal oxytocin in food intake and craving: A meta-analysis of clinical trials.Clin Nutr.(2021-Oct)
  6. ^Leslie M, Leppanen J, Paloyelis Y, Treasure JThe influence of oxytocin on eating behaviours and stress in women with bulimia nervosa and binge eating disorder.Mol Cell Endocrinol.(2019-Nov-01)
  7. ^Lie SØ, Rø Ø, Bang LIs bullying and teasing associated with eating disorders? A systematic review and meta-analysis.Int J Eat Disord.(2019-May)
  8. ^Francisco-Javier Hinojo-Lucena, Inmaculada Aznar-Díaz, María-Pilar Cáceres-Reche, Juan-Manuel Trujillo-Torres, José-María Romero-RodríguezProblematic Internet Use as a Predictor of Eating Disorders in Students: A Systematic Review and Meta-Analysis StudyNutrients.(2019 Sep 9)