Bulimia nervosa; Binge-purge behavior; Eating disorder - bulimia
Bulimia is an eating disorder in which a person has regular episodes of eating a very large amount of food (bingeing) during which the person feels a loss of control over eating. The person then uses different ways, such as vomiting or laxatives (purging), to prevent weight gain.
Many people with bulimia also have anorexia.
Many more women than men have bulimia. The disorder is most common in teenage girls and young women. The person usually knows that her eating pattern is abnormal. She may feel fear or guilt with the binge-purge episodes.
The exact cause of bulimia is unknown. Genetic, psychological, family, society, or cultural factors may play a role. Bulimia is likely due to more than one factor.
With bulimia, eating binges may occur as often as several times a day for many months. The person often eats large amounts of high-calorie foods, usually in secret. During these episodes, the person feels a lack of control over the eating.
Binges lead to self-disgust, which causes purging to prevent weight gain. Purging may include:
- Forcing oneself to vomit
- Excessive exercise
- Using laxatives, enemas, or diuretics (water pills)
Purging often brings a sense of relief.
People with bulimia are often at a normal weight, but they may see themselves as being overweight. Because the person's weight is often normal, other people may not notice this eating disorder.
Symptoms that other people can see include:
- Spending a lot of time exercising
- Suddenly eating large amounts of food or buying large amounts of food that disappear right away
- Regularly going to the bathroom right after meals
- Throwing away packages of laxatives, diet pills, emetics (drugs that cause vomiting), or diuretics
Exams and Tests
A physical exam may also show:
- Broken blood vessels in the eyes (from the strain of vomiting)
- Dry mouth
- Pouch-like look to the cheeks
- Rashes and pimples
- Small cuts and calluses across the tops of the finger joints from forcing oneself to vomit
People with bulimia rarely have to go to the hospital, unless they:
- Have anorexia
- Have major depression
- Need medicines to help them stop purging
Most often, a stepped approach is used to treat bulimia. Treatment depends on how severe the bulimia is, and the person's response to treatments:
- Support groups may be helpful for mild bulimia without other health problems.
- Counseling, such as talk therapy and nutritional therapy are the first treatments for bulimia that does not respond to support groups.
- Medicines that also treat depression, known as selective serotonin-reuptake inhibitors (SSRIs) are often used for bulimia. Combining talk therapy with SSRIs may help, if talk therapy alone does not work.
People may drop out of programs if they have unrealistic hopes of being "cured" by therapy alone. Before a program begins, people should know that:
- Different therapies will likely be needed to manage this disorder.
- It is common for bulimia to return (relapse), and this is no cause for despair.
- The process is painful, and the person and their family will need to work hard.
The stress of illness can be eased by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone.
Bulimia is a long-term illness. Many people will still have some symptoms, even with treatment.
People with fewer medical complications of bulimia and those willing and able to take part in therapy have a better chance of recovery.
Bulimia can be dangerous. It may lead to serious health problems over time. For example, vomiting over and over can cause:
- Stomach acid in the esophagus (the tube that moves food from the mouth to the stomach). This can lead to permanent damage of this area.
- Tears in the esophagus.
- Dental cavities.
- Swelling of the throat.
Vomiting and overuse of enemas or laxatives can lead to:
When to Contact a Medical Professional
Call for an appointment with your health care provider if you or your child has symptoms of an eating disorder.
American Psychiatric Association. Feeding and eating disorders. In: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013:329-354.
Kreipe RE, Starr TB. Eating disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 41.
Lock J, La Via MC; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. J Am Acad Child Adolesc Psychiatry. 2015;54(5):412-425. PMID: 25901778
Tanofsky-Kraff M. Eating disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 206.
Thomas JJ, Mickley DW, Derenne JL, Klibanski A, Murray HB, Eddy KT. Eating disorders: evaluation and management. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 37.
Last reviewed on: 5/10/2020
Reviewed by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.