What Is Bulimia? How Does This Eating Disorder Develop, and How Is It Treated?

Bulimia nervosa is a serious and potentially life-threatening eating disorder that can significantly impact all aspects of someone’s life. It causes people to have abnormal eating patterns and a distorted body image. 

Bulimia can result in serious health complications, like heart problems and digestive issues, so getting treatment is very important. If you have bulimia nervosa, it’s important to know that you are not alone. Even if you’ve struggled with it for many years, recovery is possible.

In this guide to bulimia, we’ll cover its symptoms, how it develops, and how you can get treatment.

Quiz: Do I have an eating disorder?

What is bulimia nervosa?

Bulimia nervosa (often just called bulimia) is a serious eating disorder that causes cycles of binging and purging. 

During a binge, people feel a loss of control and eat more food than most people would in a similar situation. Afterward, they may try to “get rid” of the extra calories through purging (like by using laxatives or making themselves vomit), even though this doesn’t really work. Many people with bulimia have these behaviors in secret.

Bulimia affects 2% to 3% of women in the U.S. and is much more common in females, but it can affect men and non-binary people as well. It’s more likely to affect gay and bisexual men than heterosexual men. College athletes may be also at increased risk for bulimia.

Bulimia can affect people from all races and ethnicities, but Hispanic people may be more likely to suffer from it than non-Hispanics. Bulimia is more common in young girls and women, and on average starts around age 19. However, it can happen at any age.

People with bulimia are also at higher risk of having other mental and physical health conditions, which can be potentially life-threatening. Having bulimia can also affect your job or schoolwork, your relationships, and even your ability to function in daily life. 

Do you have bulimia nervosa?

If you’re worried about bulimia, the first step is to talk to a healthcare provider. If you’re not sure whether you’re ready to talk to a provider, the National Eating Disorders Association has a free online screening tool that can help you understand whether you might have bulimia. 

When you meet with a provider, they will want to know more about your eating habits and body image. They may also measure your height and weight, and do a physical exam. In some cases, they might also suggest blood tests and a special test to check your heart (called an electrocardiogram). 

How is bulimia diagnosed?

Your healthcare provider will use the information from your interview, physical exam, and tests to decide whether or not you have bulimia. 

People who are diagnosed with bulimia often share the following characteristics:

• Recurring episodes of binge eating: This means eating more than most people would in the same amount of time, under similar circumstances. During the episodes, you feel like you can’t stop eating or can’t control what you’re eating.

• Recurring episodes of purging: This means trying to prevent weight gain by:

  • Self-induced vomiting

  • Misusing laxatives, water pills (diuretics), or other medications

  • Fasting, or avoiding food

  • Exercising a lot

• Body shape and weight: Body image has an especially strong effect on how you feel about yourself.

For most people with bulimia, binging and purging happens at least once a week, for at least 3 months. If you have a very low body weight, you may be more likely to have a different eating disorder called anorexia nervosa.

Does bulimia also cause physical symptoms?

Yes. People with bulimia can also have physical signs and symptoms:

• Belly pain or bloating

• Dry mouth

• Dizziness or fainting

• Scars or calluses on fingers

• Sore throat

• Cough

• Swollen neck

• Fatigue

Do I have bulimia if I don’t binge?

If you purge without binging, you don’t have bulimia — but may have another eating disorder called purging disorder (PD). 

Like bulimia, people with PD use purging to try and change their weight or body size. Purging disorder can also cause serious health issues, like teeth problems, changes in your blood electrolyte levels, and gut problems. If you purge at all, it’s important to get help.

Can you have overweight with bulimia?

Yes. People with bulimia can have overweight, although they are more likely to be in the weight range considered “normal” by the medical community.

What causes bulimia nervosa?

We don’t know exactly what causes eating disorders, including bulimia. It’s likely that bulimia is caused by a combination of factors: your genes (family history), your environment, and your life experiences. 

We do know some of the risk factors for bulimia. Having these risk factors may make you more likely to get bulimia. No two people are the same, and these factors may affect each person differently.

​​Social risk factors

• Being teased or bullied in the past, especially about weight

• Being socially isolated

• Being exposed to weight stigma (discrimination or stereotyping based on weight)

• Having a traumatic life event or stress

• Believing society’s idea of an “ideal body”

Psychological risk factors

• Identifying as a perfectionist

• Being unhappy with your body image

• Having a hard time changing your behaviors  

Physical and genetic risk factors

• Having a first-degree relative (like a parent) with an eating disorder

• Having a family member with mental illness

• Having a personal history of anxiety disorder

• Having certain genes that may be associated with bulimia

What are the health complications of bulimia?

Bulimia can cause serious mental and physical health problems. Many of these are associated with recurrent purging, especially vomiting and laxative misuse.

Medical complications of bulimia

• Digestive problems (like heartburn, constipation, or diarrhea)

• Gum disease (gingivitis)

• Dental cavities and decay

• Dehydration

• Changes in blood electrolyte levels (like potassium or sodium)

• Irregular heart rhythm 

• Low blood pressure

• Osteoporosis or osteopenia

• Irregular or absent periods

• Death

Psychological problems associated with bulimia

• Distorted body image and dissatisfaction with your body  

• Obsessive thoughts about eating, food, and body size and weight

• Withdrawal from social activities

• Feeling shame, guilt, or self-loathing

• Mental health disorders like anxiety, depression, personality disorder, or bipolar disorder

• Substance use

• Impulsivity (like engaging in risky sexual behavior)

• Self-injury (like cutting or other forms of self-harm)

• Diabulimia (misusing insulin to lose weight if you have Type 1 diabetes)

• Suicidal thoughts and behavior

How do you treat bulimia?

The main goal of treatment is to reduce bulimia symptoms (like binging and purging), but also to improve the quality of life and the relationship with food. It’s also important to treat any other associated health problems.

Bulimia treatment is individualized for each person, and it may involve a team of providers, like a therapist, a nutritionist, and a psychiatrist. 

Studies show that most women who get treatment for bulimia will recover. It can be harder to treat bulimia in people who have:

• Features of borderline personality disorder

• Substance use problems

• Low motivation to change

• A history of obesity

Here’s a look at different treatment options for bulimia.

Psychotherapy

Different forms of psychotherapy (sometimes called talk therapy) can be helpful in treating bulimia. Cognitive behavioral therapy is usually the first choice for treatment.

• Cognitive behavioral therapy (CBT) helps identify and change negative or inaccurate thoughts in order to change behavior. A specific type of CBT is used for bulimia, and it can be an effective treatment for some people.  

• Interpersonal psychotherapy helps improve relationships and resolve interpersonal issues in order to tackle bulimia symptoms. It may be recommended if CBT doesn’t work.

• Family therapy helps family members understand and support each other. It may be especially helpful for people under 18 years of age. 

• Support groups help individuals and families share their stories and get support, and can be helpful when added to other treatments.

Medications

Medications can also be used to treat bulimia. They often work best when used together with psychotherapy.  

The first-choice medication for bulimia is fluoxetine (Prozac). Fluoxetine is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). It is the only medication FDA-approved for treating bulimia in adults. 

If fluoxetine doesn’t help your symptoms get better, your provider might suggest trying a different medication. Other medications used for bulimia include: 

• Other SSRIs: Sertraline (Zoloft), escitalopram (Lexapro), and fluvoxamine (Luvox) are other types of SSRIs used to treat bulimia. They are usually a second choice, after fluoxetine.

• Tricyclic antidepressants: Desipramine (Norpramin) and imipramine (Tofranil) are types of tricyclic antidepressants. They may help lower binge-eating episodes and other bulimia symptoms. They are usually only used when SSRIs haven’t worked.

• Topiramate (Topamax): Topiramate is a medication used to treat seizures and prevent migraines. It may also improve binge and purge symptoms in bulimia. Topiramate is usually only used when other medications haven’t worked.  

Keep in mind: There are no FDA-approved medications specifically for treating bulimia in children and teens. Medications for bulimia are usually only recommended for people under age 18 if other treatments haven’t worked (like therapy or nutritional counseling).  

Nutrition

Getting adequate nutrition and practicing healthy eating habits is an important part of treating bulimia. Nutritional counseling can help you improve your relationship with food, and can reduce the urge to binge and purge.

Hospitalization

People with serious medical complications or who don’t respond to treatment may need to be hospitalized. This provides 24-hour care under medical supervision to improve their mental and physical health. Hospitalization may be required with symptoms like:

• Fainting

• Abnormal levels of potassium or chloride in your blood

• Tears in your esophagus (the tube that leads to your stomach)

• Vomiting that has blood in it, or if you can’t stop vomiting

• Concern that you may harm yourself or attempt suicide

You can read more about the different levels of care (outpatient, inpatient, and residential) in our GoodRx guide to eating disorder treatment options. 

Self-care

When you’re getting treatment for bulimia, it’s important to take care of yourself. Here are some self-care tips:

• ​​It can be hard, but it’s important to stick to your treatment plan.  

• Talk to your provider to make sure you’re getting the right nutrition.

• Avoid weighing yourself.

• Keep in touch with your support system.

• Talk to your provider about what — if any — physical activity is good for you during treatment.

• Be kind to yourself.

Can you prevent a bulimia relapse?

Once you have recovered — or are recovering — from bulimia, here are some steps you can take to help prevent a relapse.

• Create -— and use — a support system including friends, family, and healthcare providers.

• Identify triggers that may cause you to return to disordered eating (like being stressed or feeling lonely) and develop a plan to deal with them (like calling a friend).  

• Plan your meals and stick to a consistent eating schedule.

• Minimize negative influences in your life, like time with people who may make comments about your weight or eating.

• Take time for yourself and find activities that you enjoy and that minimize stress.

How to help someone you think may have bulimia 

It may not be obvious that a person has bulimia. Here are some warning signs that could mean someone has it:

• Being preoccupied with weight loss, dieting, and food

• Signs of binge eating, like many empty food containers and wrappers

• Signs of purging, like frequent bathroom trips after meals, presence of laxatives, and excessive exercising

• Fear or discomfort about eating with others or in public

• Noticeable changes in weight (up or down)

If someone you care about may have bulimia, you may feel helpless and not sure what to do. It can be hard to talk to people about their eating habits or body image, but there are things you can do to help. 

Having an open discussion with them and offering your support in a non-judgmental way is a good start. Sometimes just listening is the best thing you can do. You can’t force someone to get help, but you can offer to help find a qualified provider and even offer to go with them to the appointment. 

There are also many online resources that can help with finding treatments, and learning more about bulimia:

• ​​Project HEAL

• National Eating Disorders Association (NEDA) and their eating disorder screening tool

• The Eating Disorder Foundation

• Eating Disorders Coalition

• Pride Counseling

• National Suicide Prevention Lifeline (1-800-273-8255 any time of day)

• National Alliance on Mental Illness (NAMI)

What can parents do?

Talking to your child about bulimia can be hard. But it’s an important conversation to have if you think they may be struggling with it. 

Here are some suggestions to make it easier:

• Set a time to talk and discuss your concerns in a loving and open way.

• Avoid accusations and judgments in expressing your concerns.

• Be prepared to listen.

• Try starting your sentences with “I” rather than “you” (like “I’m concerned about you”).

• Remind them that you’re there to help and support them.

• Don’t be upset if they don’t open up right away.

Your pediatrician or family medicine doctor is also a great resource. You can talk to them about your concerns, and get advice on taking the next step. 

Family-centered resources like F.E.A.S.T. and Maudsley Parents can also help you get support, find care, and connect with other parents.

Why trust our experts?

Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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