What is bulimia?
Bulimia nervosa, usually referred to as just bulimia, is an eating disorder where someone repeatedly eats large amounts of food (known as a bingeing), and then tries to “get rid of” the food through different harmful behaviors (known as purging). Purging can take a number of different forms, including vomiting, compulsive exercise, or misuse of laxatives or diuretics.
Bulimia is not a choice or a vanity issue. Like all eating disorders, bulimia has complex neurological and biological underpinnings, which is why we refer to it as a brain disorder. While environmental and social factors play a role in eating disorder development, they are never the singular cause (nor is anything else). Rather, eating disorders emerge out of a “perfect storm” of factors.
Bulimia has serious short- and long-term health consequences, and can be fatal if left untreated. But with the right support, lasting recovery is possible for everyone struggling.
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Signs and symptoms of bulimia
When people think about bulimia, they generally think of the two most commonly known behaviors: binge eating (uncontrollably consuming a large amount of food in a short amount of time), and purging through self-induced vomiting. However, bulimia doesn’t always show up that way, and there are other symptoms and behaviors a person might experience. Additionally, bingeing and purging almost always happen in secret, so it’s important to be aware of other red flags.
Signs and symptoms of bulimia can be physical, psychological, or behavioral, and touch many different aspects of a person’s life.
- Noticeable changes in weight, both up and down
- Stained or discolored teeth
- Calluses on the hands from self-induced vomiting
Bingeing and Purging
People with bulimia engage in repeated cycles of binge eating and purging. The binge-purge cycle can also show up in other eating disorders, but it is primarily associated with bulimia. Diagnoses that involve bingeing and/or purging:
Bulimia
A person with bulimia experiences recurrent episodes of binge eating, or eating a large amount of food in a short period of time, followed by episodes of purging, or attempting to “get rid of” the food through various compensatory behaviors.
Binge eating disorder (BED)
A person with BED experiences recurrent binges without purging afterward
Purging disorder
A person with purging disorder (a type of OSFED) experiences recurrent episodes of purging, without binges
Anorexia binge-purge subtype (AN-BP)
A person with AN-BP experiences bingeing and purging alongside restricted eating.
What is bingeing?
Bingeing, or binge eating, is when a person eats an objectively large amount of food in a short amount of time. Eating an extra slice of cake or going back for a third serving of pasta isn’t a binge—binges are distinct psychological events with specific characteristics.
Someone who’s engaging in a binge may feel like they’re unable to control how much they’re eating, and even have the sense that they’re outside their body while the binge is occurring. During a binge, a person typically continues to eat after they feel full, often to the point of extreme physical discomfort. Episodes of binge eating are almost always followed by intense feelings of shame or guilt and significant emotional distress.According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), binge eating episodes are defined by two things:
Within a 2-hour period, eating an amount of food that is definitely larger than most people would eat under similar circumstances
Feeling a lack of control over eating during the episode
Episodes of binge eating are also associated with other characteristics, including:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of being embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed, or very guilty after overeating
How does binge eating affect the body?
For people struggling with bulimia or binge eating disorder, binges can provide a temporary sense of relief, helping people to numb tough feelings. However, that relief is quickly and inevitably replaced by emotional and psychological distress, often in the form of shame, guilt, embarrassment, disgust, or other distressing emotions.
In addition to these mental health consequences, bingeing can also take a toll on your body.
Short- and long-term physical effects of binge eating include
- Abdominal bloating
- Abdominal cramping
- Nausea
- Vomiting
- Acid reflux
- Diarrhea
- Constipation
- Lethargy
- Insulin resistance
- Sleep apnea
- Metabolic syndrome
- Heart disease
- Type 2 diabetes
- High blood pressure
- Musculoskeletal problems
What is purging?
Purging is a term used to describe any behavior meant to “get rid of” or “make up for” food a person has eaten. People with bulimia or anorexia binge-purge subtype will purge after a binge, while people with purging disorder will purge without having binged beforehand.
When people think of the purging associated with bulimia, they tend to think of vomiting. And while this is a common purging behavior, purging can also take several other forms, including excessively exercising, abusing laxatives or diuretics, or fasting.
Levels of severity
The DSM-5 characterizes the severity of a person’s bulimia based on how frequently they purge. The levels of severity are as follows:
Mild
Purges occur 1-3 times per week
Moderate
Purges occur 4-7 times per week
Severe
Purges occur 8-13 times per week
Extreme
Purges occur 14 or more times per week
These different levels of severity can be helpful for clinicians looking to understand and treat someone who purges—but they do not suggest who should and shouldn’t get treatment. Regardless of how frequently someone is purging, they’re at risk for serious mental and physical health complications. Plus, “mild” purging behaviors can easily and quickly escalate to “extreme” forms.
Getting help early is always the best approach, not only to prevent serious health issues, but also to set someone up for an easier recovery journey.
How does purging affect the body?
As with binge eating, purging is a coping behavior that can provide a sense of temporary relief for someone struggling with an eating disorder. But this relief, just like the relief associated with binge eating, is always overshadowed by distressing emotions.
Purging also carries physical health risks, some of which can be extremely serious and potentially deadly.Some of the most common physical effects of purging include:
- Discoloration and decay of the teeth
- Sore throat and temporary loss of voice
- Bleeding from the mouth
- Low blood pressure
- Heart arrhythmia
- Low heart rate
- Feeling cold often
- Chronic acid reflux
- Chronic diarrhea
- Chronic pain in the stomach
- Chronic cough
- Kidney failure
- Infertility
- Hormone disruptions
- Electrolyte imbalance
Bulimia's mortality rate is largely because it raises the risk of cardiac arrest (when the heart stops), or respiratory failure (when breathing stops).
Bulimia treatment
As with treatment for all eating disorders, bulimia treatment begins by normalizing eating habits, reducing disordered behaviors, and achieving weight restoration if necessary. Taking these steps first is essential, as it’s nearly impossible to make real progress or address any underlying issues while you’re still actively engaging in harmful behaviors and dealing with potential malnourishment.
Bulimia treatment requires a multidisciplinary approach, with support from different specialists including a therapist, dietitian, and medical provider. Treatment might also involve support groups, medication management, or therapeutic activities (like art or music therapy), depending on the specific treatment setting and program. Some approaches to treatment incorporate a patient’s loved ones, while others don’t.
There are many different potential treatment settings for bulimia:
Inpatient hospitalization
Usually a short-term treatment reserved for those experiencing medical instability Residential treatment
Patients stay at the treatment facility 24 hours a day, with round-the-clock supervisionPartial hospitalization program (PHP)
Patients attend treatment for most of the day, but return home to sleepIntensive outpatient program (IOP)
Patients attend treatment for several hours a day, several times a weekVirtual treatment
There are many different types of virtual treatment for bulimia. Depending on the program, patients will have different levels of support and involvement. Research has shown that virtual eating disorder treatment is as effective as in-person care. Bulimia is serious—but treatable
Bulimia is a deadly condition, but lasting recovery is possible. If you think you or a loved one might be struggling with bulimia, finding treatment promptly is vital.
What to expect from bulimia treatment at Equip
At Equip, we treat patients of all ages and acuity levels who are affected by bulimia. The specifics of treatment are tailored to each patient’s unique needs, challenges, and life circumstances, but all Equip treatment includes certain components, like nutritional support, therapy, and a dedicated multidisciplinary care team.
Throughout the recovery process, your team supports you with:
Your therapist will help you address the emotional and psychological factors that may be contributing to disordered behaviorals, as well as identify triggers and develop healthy coping strategies. They’ll also help you work through any co-occurring conditions, like anxiety or depression.
All Equip therapists are licensed practitioners who have specialized experience and training in eating disorders.
Proven results for
eating disorder patients
After completing treatment
improve to subclinical levels of eating disorder symptoms
improve to subclinical levels of anxiety
Our patients are getting better
After the first 8 weeks of treatment, Equip patients are well on their way to recovery
1lb
Average weekly weight gain for those who need it
8 in 10
Patients report a decrease in eating disorder behaviors
74%
Of patients report improvements with depression or anxiety
Common questions about bulimia
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