Bulimia nervosa: Symptoms, treatment, and risks

Bulimia, or bulimia nervosa, is a serious and potentially life-threatening psychiatric illness.

It is an eating disorder in which a person binge eats and then tries to compensate by over-exercising and purging, either through vomiting or the use of laxatives.

In the United States (U.S.), 1 percent of young women and 0.1 percent of young men may have bulimia at any one time.

However, numbers are difficult to determine as bulimia, like other eating disorders, is often steeped in secrecy.

Researchers have suggested that bulimia will affect between 1.1 and 4.6 percent of females and between 0.1 and 0.5 percent of males at some time in their life.

It is the
most common
eating disorder in the U.S.

What is bulimia?

[woman and fridge]
Bulimia involves episodes of bingeing on food followed by purging.

The two major symptoms of bulimia nervosa are recurrent bingeing on food, followed by purging, to compensate for the overeating.

Bingeing involves eating large amounts of high-calorie foods in a short time, usually defined as a 2-hour period. The individual may consume up to 3,000 calories or more.

When bingeing starts, it is hard to stop. The person may consume the food so fast that they hardly taste it. They cannot control their behavior.

Bingeing episodes may be spontaneous, or they may be planned, where the individual goes out shopping for specific foods for the binge.

After bingeing, the person feels bloated, unattractive, guilty, ashamed, and regretful. There is a powerful and overwhelming fear of gaining weight.

To compensate, they try to reduce the risk of gaining weight through actions such as self-induced vomiting, over-exercising, fasting or dieting, and overusing diuretics, enemas, or laxatives. They may take amphetamines or other illegal substances.

can lead to serious complications. Moreover, it does not reduce weight and may even contribute to weight gain in the long term.

A vicious cycle of guilt results, due to low self-esteem and feeling overweight, even if the person’s weight is normal. The individual may then set themselves strict and unrealistic rules about eating, exercise, or both. When they are unable to maintain these goals, another binge occurs.


A person with bulimia nervosa is most likely of normal weight or slightly overweight. It can be difficult to notice the signs and symptoms because the person will try hard to hide them.

Behavioral indications of bulimia include:

an obsession with eating and food

eating alone

the sudden disappearance of food, or the appearance of many wrappers in the trash

a lot of money spent on food

leaving the room after eating, normally to visit the bathroom

hiding or hoarding food

compulsive exercising

constantly complaining about being overweight

going through phases of fasting or saying they are not hungry, and then eating too much

Pills may be hidden away, including laxatives, diuretics, diet pills, and emetics, a drug to induce vomiting. Drug packaging may appear in the trash.

Physical signs include:

[bulimia involves purging ]
Purging can lead to serious complications, including damage to the esophagus.

severe dehydration

nutritional deficiencies, leading to poor health

changing body weight

scars on the knuckles, known as “Russell’s Sign,” where fingers are forced down the throat to induce vomiting

acid reflux disorder

chronic sore or inflamed throat and damaged teeth, due to the acidity in the vomit

swollen cheeks, due to damage to the parotid glands

irregular menstruation

broken blood vessels in the eyes

Friends or family may notice that the person withdraws from their usual activities and that they show signs of mood swings, and possibly anxiety and depression. Interpersonal conflicts may occur. The person may lie to cover up their behavior.

The patient is usually aware that they have a problem, but they may be too ashamed or unable to tell anyone about it.

[telling doctor about bulimia]
Many people who seek treatment recover from bulimia.

It is essential for the patient to accept their need for treatment, and agree to co-operate and participate. Some patients resist treatment, while others may fluctuate in their adherence.

Stressful life events may trigger relapses.

Behavioral and cognitive therapy can help patients:

understand why they have the disorder, and which feelings, behaviors, and thoughts are contributing to it

change their perception of appearance, body weight, food, and eating

Support from family and friends is key to effective and long-term positive outcomes.

The patient’s family needs to understand what bulimia nervosa is and to identify its signs and symptoms rapidly. Family therapy can help in the healing process.

Interpersonal therapy focuses on social roles and relationships. Patients learn new ways to manage conflicts with friends or family and to improve these relationships.

Medications can help with depression. Fluoxetine, also known as Prozac, is approved by the U.S. Food and Drug Administration (FDA) for use in bulimia nervosa.

Nutritional counseling can help break the cycle of bingeing and compensation. Patients learn to structure and pace their meals, and to set calorie goals that match their needs.

Hospitalization is rarely needed unless there is a risk of suicide or self-harm.

The University of Maryland Medical Center (UMM) suggest that the following complementary treatments may help:

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