Bulimia: Causes, Symptoms, Characteristics, Warning Signs, Diagnosis, Treatment, and Related Risks

It is characterized by binge-eating episodes (with a frequency of at least once a week for three months).

Bulimia nervosa is an eating disorder and a mental health condition.

The amount of food consumed is greater than what most people would eat under the same circumstances and in the same period of time and is characterized by a lack of control over food consumption.

Eating disorders are often associated with an abnormal attitude towards food or body image: body shape and weight.

Everyone has their own eating habits, for example, people with a food intolerance must avoid eating certain foods to stay healthy.

However, people who suffer from eating disorders tend to use their eating habits and behaviors to cope with emotional distress and often have an abnormal or unrealistic fear of food, calories, and fat.

People with bulimia try to control their weight by severely restricting the amount of food they eat, then binge eating and purging food from their bodies.

The cycle of binge eating and purging may initially be experienced as calming, but are generally followed by feelings of shame and self-loathing.

Some people describe binges and purges as addictive, this is likely because these behaviors have been reinforced over time by the reduction in anxiety that occurs after them.

People with bulimia engage in compensatory behaviors in an attempt to “undo the damage” from the binge.

Common behaviors include: self-induced vomiting, laxatives, diuretics, and / or other drug abuse, periods of fasting, and excessive exercise.

Due to fear, people with bulimia nervosa tend to restrict their food intake.

They purge themselves because they fear that bingeing will make them gain weight, and they generally feel guilty and ashamed of their behavior.

That is why these behaviors are generally done in secret.

Cycles of overeating can be triggered by hunger or stress, or they are a way of coping with emotional distress.

Bulimia is twice as likely to occur in women than in men.

Studies show that 1 to 3% of adolescents, especially young women, have bulimia nervosa.

The disorder is most likely to occur in adolescents and at the age of twenty to thirty years.

Among those with bulimia, a third of people have had a previous history of anorexia nervosa.

Also, bulimia is common in people who are obese or in people who have obese parents.


The cause of the condition is related to the fear of gaining weight, more complex emotions generally contribute to the problem.

These acts of binge eating and purging are often a way of dealing with intense emotions.

Some common factors that can lead to bulimia are detailed below.

Low selfsteem

Most people with bulimia also struggle a lot with perfectionism and low self-esteem.

Often they have had a history of feeling bad about themselves.

This can include negative views on your abilities and your overall self-esteem.

They may engage in self-talk and negative self-criticism.

The patient may have low self-esteem and perceive weight loss as a way to improve his opinion of himself and to please others.

the depression

People with bulimia often feel depressed, so they binge eat.

However, the purge does not alleviate this depression and the cycle continues.


Bulimia can sometimes occur after stressful situations or life events such as death, a separation from a loved one.

In the course of life-changing events such as moving away from family, an inheritance of unwanted obesity.

It can also arise after experiencing physical illnesses, sexual abuse and any psychological triggers such as a difficult childhood, family problems.

Mental health problems

Research shows that bulimia is more common in people with psychological problems such as anxiety disorders, obsessive compulsive disorder, post-traumatic stress disorder, and personality disorders.

Cultural and social environment.

The pressures of social media, fashion with stereotypes of very thin and elegant people provoke in some people the aspiration to lose weight to achieve those standards.

Receive constant criticism at home, in college, or at work about physical appearance.

Sometimes they grew up in homes where parents made negative comments about their appearance or how much they were eating, or parents made most of the food-related decisions.

Or maybe they never learned to regulate their food intake or grew up in households where food intake was the only thing they could control or with limited access to food and were driven to eat, due to fear of scarcity.


At puberty, when hormonal changes make young people more aware of their bodies, many young people are affected by eating disorders.

In teens, bulimia may seem like the only way they can take control of their lives.


It is possible that there is a genetic factor related to the development of bulimia.

Much research suggests that those who have a close relative who has or has suffered from bulimia are more likely to develop bulimia than those who do not have a relative with the disease.

Symptoms of bulimia

The essential symptom of bulimia is overeating.

According to the criteria of the Diagnostic and Statistical Manual of Disorders, a binge is defined as eating a large and excessive amount of food in a short period (two hours or less).

Binge eating is often accompanied by a loss of control over the amount of food eaten.

People with bulimia often feel unable to stop eating more and more, even if they feel quite full.

It should be noted that compulsive behavior typically distinguishes bulimia nervosa from anorexia nervosa.

The distinguishing symptom of bulimia from binge eating disorder is that those with bulimia also engage in purging behaviors.

The goal of a purge behavior is to eliminate the food or calories that are consumed.

Most of the time people purge themselves through vomit.

However, some people will use laxatives and diuretics to remove food from their system.

Other people will fast (not consume food) before the binge or after the binge.

Some will use excessive amounts of exercise to cut calories.

People with bulimia often appear as average weight, which can give them a false sense of their health.

Often times, people with bulimia are not aware of the toll it can take on their body.

The binge-eating and purging behaviors characteristic of bulimia can have significant health consequences.

For example, dentists can often say that a person is engaging in purging behaviors through vomiting because it wears down the enamel on their teeth and causes other dental problems. Other health symptoms include:

  • Pain and irritation in the throat (from vomiting and dehydration).
  • Swollen parotid glands (these are the salivary glands, irritated by vomiting).
  • Esophagitis (inflammation of the esophagus, associated with acid reflux and chest pain).
  • Hypertension (low blood pressure, usually due to vomiting and use of laxatives and dehydration).
  • Electrolyte imbalance (due to poor nutrition, as well as vomiting and the use of laxatives).
  • Edema and swelling (often the result of dehydration and the resulting water retention).
  • Muscle cramps and weakness (usually due to an electrolyte imbalance).

Having one or more of these symptoms can be worrisome.

Muscle cramps and bloating may be noticeable, but the patient may not be aware of problems that may be occurring internally.

However, if a person is found to be having problems and exhibiting the symptoms of bulimia, it is important that they seek help before developing these symptoms and other even more serious physical complications.

Characteristics associated with bulimia

In addition to the key symptoms such as bingeing and purging, bulimia is characterized by other situations.

Many people with bulimia have had a history of trauma or problems in their family.

Often in the face of such challenges, people struggle to cope.

Bulimia behaviors can be developed and used as a way to deal with and cope with feelings.

However, this tends to be maladaptive, as although it makes people feel better in the short term, people often feel much worse in the long term.

In addition to turning to food for comfort, people with bulimia often have a complex relationship with food.

Another sign of Bulimia is difficulty concentrating because those in thoughts are preoccupied with food.

Sometimes people with Bulimia will spend hours thinking about the foods they want to eat. They can plan a binge and look forward to it.

After the binge, they may be overwhelmed with feelings of guilt and regret. They can fill your mind with thoughts of the purge and come back to it to feel better.

In many cases, people with bulimia also have a sense of shame about how they look. They may be very afraid of gaining weight.

This shame leads to guilt when they binge and often contributes to their urge to purge. People with bulimia can also show other mental health concerns. They may have symptoms of anxiety and depression.

They may have a hard time managing their emotions. They may also be working hard to hide their symptoms and struggles from the people around them.

As such, they may display unusual behaviors, such as appearing reserved or getting angry when asked about their eating.

Warning signs of bulimia nervosa

People struggling with bulimia symptoms often engage in behaviors that may seem strange but are generally part of the disorder and their attempts to hide it.

Watching for these warning signs can help you know if someone may have bulimia:

  • Reserved eating habits, such as hiding food and even eating at night.
  • Withdrawing from friends and family after meals.
  • Spending excessive amounts of time, many hours a day, exercising.
  • Knuckle or hand injuries and scars (a sign of using fingers to induce vomiting).

If someone shows these warning signs, it doesn’t mean they have bulimia.

In fact, people can engage in some of these behaviors for a number of reasons.

However, if you suspect that they are engaging in purging and compulsive behaviors, it can be valuable to reach out to them and learn about their concerns and help them connect with a professional for help.

If left untreated, bulimia can lead to physical and health consequences.

Diagnoses for bulimia

You may be more familiar with the term Bulimia, but the name of this condition is Bulimia nervosa.

When psychologists diagnose eating disorders (and other conditions), they do so with the Diagnostic and Statistical Manual: Fifth Edition.

With that guide, psychologists use the following criteria to define the symptoms of Bulimia Nervosa:

  • Recurring bouts of bingeing.
  • Recurrent inappropriate compensatory behavior to prevent weight gain.
  • Binge eating and compensatory behaviors occur, on average, at least once a week for at least three months.
  • Body shape and weight unduly influence self-assessment.

These are very specific criteria that psychologists and doctors use to define and assign the official diagnosis of Bulimia Nerviosa.

If you or someone you know shows any of these symptoms, they are worrisome, and help should be sought before symptoms get worse.

In fact, it is best to get help earlier while the symptoms are still manageable.


The first step to improving is recognizing the problem and having a genuine desire to improve. This can involve a big change in lifestyle and circumstances.

Treatment usually begins with psychological treatments, with the goal of helping you reestablish healthy attitudes toward eating.

People with bulimia need to explore and understand the underlying problems and feelings that are contributing to their eating disorder, and change their attitudes towards eating and weight.

Psychological treatment generally includes:

  • Cognitive behavior therapy which is the most common of the psychological treatments for bulimia nervosa. It is about discovering new ways of thinking and acting on situations, feelings, and foods.
  • Interpersonal therapy, where the focus is more on personal relationships than on the problems the patient has with food. The goal of therapeutic treatments is to help the patient establish supportive relationships.
  • Sometimes your doctor may suggest that you try a medication, usually in addition to psychological treatment. Medication with known antidepressants such as the use of selective serotonin reuptake inhibitors such as fluoxetine (Prozac) is generally recommended to treat bulimia.

Selective serotonin reuptake inhibitors are used primarily to treat depression, but they are also used to treat eating disorders, obsessive compulsive disorder, anxiety, and social phobia.

Selective serotonin reuptake inhibitors, as with any antidepressant, will generally take one to several weeks before their effects are seen. Usually a low dose will be started, then gradually increased as the body adjusts to the medicine.

When selective serotonin reuptake inhibitors are started, a doctor should be seen after two, four, six, and twelve weeks to check progress and see if the patient is responding to the medication.

Not all patients respond well to the use of antidepressant medications, so it is important that their progress be carefully monitored.

Very few medications are recommended for children and youth under 18 years of age.

It is also best not to take selective serotonin reuptake inhibitors, if the patient has a history of epilepsy or a family history of heart, liver, or kidney disease.

Bulimia is generally not treated in the hospital.

However, if you have serious health complications and your life is at risk, you may be admitted for hospital treatment.

Treatment in the hospital is also considered when the patient is at risk of death, suicide, or self-harm.

The recovery process is very slow, once diagnosed, people with bulimia can recover, but it can take a long time.

It can be very difficult, both for the affected person and for their family and friends.

To recover, someone with bulimia needs:

  • Change your eating habits.
  • Change the way they think about food.
  • Gain weight safely, if necessary.

The longer someone has had bulimia, the more difficult it will be to relearn healthy eating habits and gain weight.

It is important to start treatment as soon as possible so that the person has the best chance of recovery.

For most people, recovery goes through several stages, where progress can include steps forward and steps backward.

Risks related to bulimia

Some of the risks and complications that can be induced by constant purging or unhealthy vigorous exercise are:

Loss of essential nutrients

Forced vomiting or purging can lead to the loss of essential nutrients from the body.

The body loses a large amount of fluids, minerals and nutritional elements necessary for good health.

This can lead to dehydration, weakening of the immune system, and fatigue.

Digestive tract disorders

Frequent vomiting and vomiting food can have serious effects on the digestive system.

It can cause abdominal irritation, pain, bleeding in the esophagus and stomach.

Complications from the use of laxatives

Using different laxative medications to induce vomiting can lead to critical health problems.

Using certain over-the-counter laxatives can cause severe muscle spasms (sudden, involuntary contraction of a muscle or group of muscles).

Palpitations (irregular, fast or pulsating heartbeat), constipation, rectal prolapse (a falling or slipping place of an organ or part, such as the uterus) and even serious heart conditions.

Dental problems and cavities

Repetitive and forceful vomiting and purging can have a severe effect on a person’s teeth.

Acids produced by the stomach during vomiting and purging can irritate the gums and deteriorate tooth enamel.

Eventually, you develop tooth decay.


Bulimia can also cause depression in people.

This disorder is a consequence of the distorted image of the body and the irrational desire to eat.

This condition becomes a cycle; the person cannot stop eating, feels guilty for having eaten so much, and purges immediately.

In the long run, the person can be deeply depressed about it, which can lead to other mental health problems.