What it is
Bulimia nervosa involves repeated episodes of binge eating (eating an unusually large amount of food with a sense of loss of control), followed by behaviors to prevent weight gain (purging by vomiting or laxatives, excessive exercise, or fasting). Body shape and weight strongly influence self-worth. People of any size can have bulimia.
Bulimia is treatable. Early support reduces medical risks and speeds recovery.
Common signs and symptoms
- Binge episodes: eating much more than usual in a short time, feeling out of control
- Compensatory behaviors: self-induced vomiting, laxatives/diuretics, fasting, or compulsive exercise
- Body image: overvaluation of weight/shape; frequent body checking; guilt/shame after eating
- Physical signs: sore throat, dental enamel erosion, swollen salivary glands, bloating, constipation, irregular periods, electrolyte imbalances
- Emotional patterns: secrecy, rigid food rules, perfectionism, mood swings
Medical risks include low potassium (which can affect the heart), dehydration, and GI issues. Risk exists regardless of weight.
Why it happens
- Biological: genetic vulnerability; reward and impulse-control circuitry differences
- Psychological: perfectionism, all-or-nothing thinking, emotion regulation difficulties
- Environmental: diet culture, weight stigma, social pressures; stress and trauma can contribute
- Restriction–binge cycle: restricting increases biological and psychological drive to binge; purging temporarily relieves guilt, reinforcing the cycle
What helps
- Medical and dental care
- Screen vitals, electrolytes (especially potassium), and ECG; address dental erosion
- Evidence-based therapies
- CBT-E (enhanced CBT): gold-standard; normalizes eating, challenges rules, reduces binges/purges
- DBT skills: emotion regulation, distress tolerance, reduce impulsive cycles
- Family-Based Treatment (FBT) for adolescents
- Nutrition
- Regular eating pattern (3 meals + 2–3 snacks/day) to prevent extreme hunger
- Include previously avoided foods in a structured way to reduce deprivation
- Medications
- SSRIs (fluoxetine has best evidence for bulimia) can reduce binge/purge frequency
- Reduce triggers
- Limit extreme dieting, weigh-ins, and body-checking; address alcohol/substances that lower inhibition
Recovery focuses on medical stabilization, regular eating, coping skills, and flexible thinking about food and body.
When to seek help now
- Purging multiple times per day, chest pain, fainting, or muscle cramps
- Signs of low potassium or dehydration
- Blood in vomit or severe abdominal pain
- Thoughts of self-harm or not wanting to live (seek urgent help)
How to talk to a clinician
- “I have episodes of binge eating followed by purging/restriction. I’d like an urgent medical check and referral to CBT-E/FBT and a dietitian experienced in eating disorders.”
Outlook
Most people improve significantly with CBT-E and support; lapses are common but manageable. Early, consistent care shortens recovery time.
Resources for readers in the USA
- Immediate help: 988 Suicide & Crisis Lifeline (call/text 988); Crisis Text Line (text HOME to 741741)
- Eating disorder care: National Alliance for Eating Disorders (allianceforeatingdisorders.com); NEDA (nationaleatingdisorders.org); F.E.A.S.T. (feast-ed.org)
- Find care: Psychology Today (filter for eating disorders/CBT-E/FBT); FindTreatment.gov; NAMI HelpLine (nami.org/help)
- Low-cost/community: Community Health Centers (findahealthcenter.hrsa.gov); 211
- Insurance tips: Verify in-network programs and levels of care (IOP/PHP/residential), nutrition visits, prior authorization, parity law appeals; copay/coinsurance, deductible, out-of-pocket max
- Work/school supports: FMLA, ADA accommodations (meal breaks, reduced load), EAP; campus counseling and disability services
- Urgent options besides ER: If medically unstable, ER is appropriate; otherwise Mobile Crisis via 988 (where available), behavioral urgent care
Disclaimer: Educational information, not a diagnosis. If in crisis, use the resources above.