Bulimia NervosaWhat is bulimia?
Bulimia nervosa—or just “bulimia”—is an eating disorder where someone uncontrollably eats large amounts of food (called binges) then tries to get rid of the food by purging. Purging may take the form of vomiting, misuse of laxatives, diuretics, or compulsive exercise. Bulimia has serious short- and long-term health consequences, and has a mortality rate near that of anorexia. Bulimia is not a choice or a vanity issue. Bulimia, like all eating disorders, 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 signs and symptoms

  • Evidence of binge eating, including large amounts of food disappearing in short periods of time, or empty food containers and wrappers
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of laxatives or diuretics
  • Frequently skipping meals and avoiding eating with others or in public
  • Keeping an overly strict exercise plan
  • Calluses on the back of the hands and knuckles from self-induced vomiting
  • Stained or discolored teeth
  • Making changes to a daily routine and lifestyle to be able to binge and purge
  • Social withdrawal
  • Fasting or dieting between binges
  • Being overly concerned with body image
  • Intense fear of gaining weight
  • Using excessive amounts of mouthwash, mints, and gum
  • Noticeable changes in weight, both up and down
Common questions about bulimia

As with all eating disorder treatment at Equip, the initial focus of bulimia treatment is normalizing eating habits, stopping eating disorder behaviors, and weight restoration if necessary.

We focus on these behavioral and nutritional aspects first and foremost, because it's difficult for patients to make progress in other areas when they're malnourished. This is true for all eating disorder patients, regardless of weight; disordered eating habits like restricting, binge eating, and purging—all hallmarks of bulimia—can lead to malnutrition. When the body is malnourished, the brain is, too. A malnourished brain doesn’t think clearly or take in new information well. People who are malnourished are more likely to be depressed, anxious, and have trouble paying attention.

Once patients have been able to normalize their eating habits and make progress toward restoring their weight (if necessary), the focus of treatment can shift to other areas. That might mean working on interpersonal relationships, setting goals outside of their eating disorder, learning to handle triggers in their daily life, or understanding potential root causes of the eating disorder.

To accomplish all this, our clinicians use a variety of different evidence-based treatment modalities, including CBT-E (a form of cognitive behavioral therapy designed specifically for eating disorders), DBT (dialectical behavioral therapy), and ERP (exposure and response prevention). For younger patients who live with their family, we generally use FBT (family-based treatment).

As frustrating as it is, there is rarely one identifiable cause of an eating disorder, and bulimia is no different. More often than not, it is a constellation of neurobiological and environmental factors: in other words, someone has a genetic predisposition to developing an eating disorder, and then the eating disorder is “turned on” by environmental factors. You can learn more about the causes of eating disorders on our blog.

Though the specifics of a binge or a purge will look different from person to person and circumstance to circumstance, there are some defining criteria. A binge is defined as an episode of eating in which a person eats a large quantity of food with a feeling of lack of control. This often means eating past the point of fullness until uncomfortable, eating extremely quickly, eating alone, and feeling shame after eating. A purge is defined as compensatory behavior meant explicitly to “make up for” or “get rid of” food eaten. In bulimia, this often takes the form of self-induced vomiting, or abuse of laxatives or diuretics.

Exercise bulimia is the term to describe purging through intense exercise. In exercise bulimia, someone will use exercise as a means to control their weight, exercising compulsively and excessively to compensate after binge or even non-binge eating. You can learn more about the role of exercise in eating disorders on our blog.

Bulimia statistics and facts to know

  • People with bulimia are often at—or above—a “normal” weight.
  • Up to 3% of females and 1% of males may experience bulimia during their lifetime.
  • Bulimia has a mortality rate of 3.9% largely because it raises the risk of cardiac arrest (when the heart stops), or respiratory failure (when breathing stops).
  • The recurrent binge-purge cycles of bulimia can lead to electrolyte imbalances that damage the heart and other major organs and can lead to death quite suddenly or without warning.
  • 2.0-5.4% of adolescent females fit some of the criteria for bulimia but not enough for an official diagnosis. Called “subthreshold bulimia,” this condition is still dangerous and should be treated.
  • 95% of people with bulimia have at least one other psychiatric disorder. 64% have three or more other psychiatric disorders.
Bulimia is a serious and deadly condition, but it is treatable, and lasting recovery is possible. If you think your loved one might be struggling with bulimia, finding treatment promptly is vital.
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My daughter's eating disorder seemed insurmountable, but Equip truly saved her. The coordinated support was incredible and it is so easy to schedule sessions. I wholeheartedly recommend Equip.
Dad of a 16-year-old with anorexia
I was pervasively hopeless about recovering prior to finding Equip and now I feel so optimistic about my journey for the first time ever.
45-year-old with bulimia
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Sister of a 19-year-old with anorexia
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33-year-old with BED
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Mother of a 13-year-old with ARFID
I love the team approach that touches every aspect. Their positive approach has inspired my son to want to improve and take a lot of the initiative to do so himself.
Mother of a 18-year-old with OSFED
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