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Bulimia Nervosa - Symptoms, Risk Factors, Diagnosis, and Treatment

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Bulimia nervosa is a severe eating disorder that is majorly caused by psychological reasons. To know more, read the following article.

Written by

Dr. Akanksha

Medically reviewed by

Dr. Vishal Anilkumar Gandhi

Published At January 4, 2023
Reviewed AtOctober 6, 2023

What Is Bulimia Nervosa?

Bulimia nervosa is a serious psychological condition in which a person experiences several episodes of binging and purging. It is characterized by eating food in large quantities with a loss of control over eating and then purging to get rid of the food.

To get rid of the calories and avoid gaining weight, people often use inappropriate and unhealthy ways like fasting, self-induced vomiting, enemas (injecting liquid or gas into the rectum through the anus to cleanse or expel the bowel), excessive use of laxatives (medications that speed up the movement of food through the body) and Diuretics (medication that leads to increased production of urine), using dietary supplements and herbal products to lose weight and, compulsive exercising. These episodes of binging and purging can happen many times a day.

A person with bulimia nervosa is never satisfied with their body even though they weigh in the normal range according to their age and height. This disorder is related to self-image. People judge themselves harshly for their self-perceived flaws. That is why they always binge in private, as they feel disgusted and ashamed of themselves. Such people are obsessed with food and their weight, and this can cause harm to their emotional and physical well-being. Bulimia nervosa usually tends to start in late childhood or early adolescence, and it can be hard to overcome. Though effective treatment can help in adopting healthy eating patterns making the person feel good himself or herself, and avoiding and reversing serious complications.

What Is the Difference Between Bulimia Nervosa and Anorexia Nervosa?

Both bulimia nervosa and anorexia nervosa are eating disorders. Bulimia nervosa, as already explained, is binge eating followed by purging. Anorexia nervosa is a condition where the patient skips meals and adopts unhealthy diets to avoid gaining weight. Patients with anorexia nervosa do not follow the habit of purging.

What Are the Signs and Symptoms of Bulimia Nervosa?

The symptoms of bulimia nervosa are hard to notice as people with this disorder binge and purge secretly. Empty laxative packaging and food wrappers can be warning signs of bulimia nervosa.

Behavioral and emotional signs and symptoms are:

  • Repeated episodes of binging and purging and fear of not being able to control it.

  • Visits the bathroom very often.

  • Obsessed with body image.

  • Extreme fear of gaining weight.

  • Feeling guilty and disgusted about eating.

  • Getting socially isolated and withdrawing from friends and family.

  • Excessive exercising.

  • Feeling out of control emotionally.

  • Feeling anxious.

Physical symptoms of bulimia nervosa are:

  • Dental issues like erosion of tooth enamel from stomach acid because of self-induced vomiting, teeth become more sensitive and appear clear instead of white.

  • Gastrointestinal problems like acid reflux and constipation.

  • Swollen glands in the face and neck region.

  • Swollen jawline or cheeks.

  • Pain and discomfort in the throat.

  • Loss of consciousness or fainting.

  • Irregular menstruation.

  • Redness of eyes from inflamed blood vessels (bloodshot eyes).

  • Bloating, indigestion, and heartburn.

  • Dehydration.

  • Feeling cold.

  • Sleeping issues.

  • Dry and brittle nails and dry skin.

  • Calluses and scars on knuckles from forced throwing up.

  • Muscle fatigue.

What Are the Risk Factors of Bulimia Nervosa?

People who are likely to get bulimia nervosa are:

  • Women and girls are more prone to have bulimia nervosa than men and boys.

  • People with first-degree relatives having eating disorders are more prone to bulimia nervosa.

  • People who were overweight during childhood or adolescence are more likely to have bulimia nervosa.

  • People going through depression, anxiety disorders, or substance use are at higher risk.

  • People with a negative mindset about themselves are more likely to have bulimia nervosa.

  • Any kind of traumatic incident and environmental stress are contributing factors.

  • People who are dieting tend to develop bulimia nervosa.

How to Diagnose Bulimia Nervosa?

For the diagnosis of bulimia nervosa, the doctor will ask for medical history and would question eating habits. The patient has to be honest while answering this in order to get the right help. The doctor may ask the family and friends of the patient about the behavioral history. Psychological testing will also be done, which will include questions related to body image. The doctor will also suggest a physical examination to be sure about the diagnosis.

To check for the effects of bulimia nervosa on health and nutritional status, the doctor may recommend the following tests:

  • Blood tests.

  • Electrocardiogram.

  • Urine test.

  • Kidney function tests.

What Are the Complications of the Bulimia Nervosa?

Bulimia nervosa is a life-threatening disorder that can cause multiple complications, and it also prevents the body from getting the required nutrients. Complications caused by bulimia nervosa are:

  • Ulcers in the throat and stomach.

  • Esophagitis (inflammation of the esophagus).

  • Stomach rupture and damage to intestines.

  • Electrolyte imbalance due to loss of large amounts of body fluids.

  • Arrhythmia (abnormal heart rhythm).

  • Heart failure.

  • Dental problems.

  • Decreased sexual drive.

  • Digestive problems like indigestion.

  • Suicidal tendencies.

What Is the Treatment of Bulimia Nervosa?

The main aim of the treatment of patients with bulimia nervosa is to change their behavior and correct their nutritional problems. The treatment plan is decided on the basis of the physical and psychological needs of the patient. In the treatment of bulimia nervosa patients, medical, nutritional, and mental health professionals are involved as a team.

1. Medical Help: Medicines help in the case of patients dealing with depression or anxiety. An FDA-approved drug for the treatment of bulimia is Fluoxetine (Prozac) which is an antidepressant. It also helps in reducing the desire to eat food abnormally. Hospitalization is required in patients with electrolyte imbalance and not in every patient with bulimia nervosa.

2. Psychotherapy: Psychotherapy treatment involves-

  • CBT (Cognitive Behavioral Therapy) - It is a type of individual counseling that involves teaching the patient proper eating habits, learning the things that are leading to binging and purging, and avoiding them. It also includes how the patient challenges unhealthy behavior and difficult situations. The patient is also made to learn the importance of self-love and avoid the fear of gaining weight.

  • Family-based Therapy - It is helpful when the patient is a child or teenager. The family is made to understand the condition and the complications it can cause and help them deal with it.

  • Interpersonal Psychotherapy - This therapy helps the patients understand social relationships and build them in a healthier way. This would help them to stabilize their emotional state and mental health.

3. Nutritional Therapy: With the guidance of a professional dietician, the patient is taught healthy eating habits and proper eating patterns according to his or her body’s signals toward food and hunger. This will help the patient to gain confidence as the body weight will get stabilized, and the patient will gain a healthy attitude toward food.

4. Self-care: Along with professional help, the patient has to concentrate on self-care too. This includes actively connecting with people socially, avoiding any triggers that cause the urge to binge eat and then purge, and looking after their bodies in healthier ways.

5. Support Groups: A support group is a congress of people who share their experiences, feelings, and issues while dealing with bulimia nervosa. Patients can benefit a lot from these conversations by getting motivated, loving themselves the way they are, and adopting a healthy lifestyle.


Bulimia nervosa is considered hard to cure as its cause of it is unknown. However, it can be prevented if a proper and healthy lifestyle is maintained and people take care of their emotional and mental health. After bulimia nervosa is diagnosed, the main focus remains on how to prevent it from getting worse and the patient from harming himself or herself. Even after proper treatment, the rate of recurrence of bulimia nervosa is really high. It is the responsibility of people to look out for their friends or family members who might suffer from it and seek professional help immediately.

Frequently Asked Questions


What Is Bulimia Nervosa?

Bulimia nervosa is a disorder marked by repeated binge eating sessions followed by purging methods such as induced vomiting, abuse of laxatives or diuretics, extreme dieting or excessive exercise. People with bulimia often excessively worry about their body weight and shape and fear gaining weight. This disorder can result in severe physical and mental health problems and affect individuals regardless of age, gender, or background.


What Is the Effect of Bulimia Nervosa?

Bulimia nervosa affects individuals of all ages, genders, and backgrounds, with a higher incidence in females and usually appearing during the late teenage years or early adulthood. It is not limited to any particular race or ethnicity and can occur in individuals of any body weight or size. This disorder can severely affect a person's physical and mental health, relationships, and overall daily functioning.


What Is the Difference Between Binge Eating and Bulimia Nervosa?

Binge Eating Disorder is characterized by consuming a large quantity of food within a short span without trying to make up for it by purging, fasting, or excessive exercise, which often results in feelings of embarrassment and remorse. In contrast, Bulimia Nervosa involves binge eating followed by acts of purging, such as self-induced vomiting or improper use of laxatives to avoid weight gain and is often accompanied by a fixation on body weight and shape.


How to Differentiate Between Binge-Eating Disorder Differing From Bulimia Nervosa?

Binge Eating Disorder is characterized by recurrent episodes of overeating, where an individual consumes an excessive amount of food within a brief period and experiences a lack of control over their food intake. Unlike Bulimia Nervosa, there is no purging after binge eating in Binge Eating Disorder. Bulimia Nervosa, on the other hand, involves binge eating followed by purging actions such as self-induced vomiting, improper use of laxatives or diuretics, fasting, or excessive exercise to avoid weight gain.


What Is Harder to Detect Bulimia Nervosa or Anorexia Nervosa?

Bulimia Nervosa can be more difficult to detect than Anorexia Nervosa as individuals with bulimia may maintain an average weight or only have a slight excess weight. Purging behaviors can be disguised, and people with bulimia may be good at hiding their symptoms. This disorder is often accompanied by feelings of shame and secrecy, causing those affected to keep their symptoms hidden. These factors can result in bulimia nervosa going undiagnosed for longer, making early detection and treatment challenging.


What Is Diffrebce Between Bulimia Nervosa and Anorexia Nervosa?

Anorexia Nervosa and Bulimia Nervosa are both eating disorders but exhibit different symptoms and behaviors. Anorexia is defined by an irrational fear of gaining weight and a distorted body image, causing a person to restrict their food intake and lose weight excessively. On the other hand, bulimia involves episodes of binge eating followed by purging through methods such as vomiting or excessive exercise to lose weight. People who have bulimia may have a standard or nearly average body weight. However, both disorders can significantly impact a person's physical and mental well-being.


How does bulimia nervosa affect a person and their life?

Bulimia Nervosa can severely affect a person's health and daily functioning. Purging can result in digestive issues, electrolyte imbalances, and dehydration, causing physical harm. Mentally, it can lead to anxiety, depression, and an altered body image. Socially, it can cause isolation and strained relationships. The disorder can also negatively impact academic and professional life, with malnutrition and exhaustion causing difficulty focusing and low energy levels. Therefore, seeking treatment is crucial to overcome bulimia and enhancing overall health and well-being.


What Is the Effect of Bulimia Nervosa on Teeth?

Bulimia nervosa can cause significant damage to a person's oral health, particularly their teeth. The constant exposure of the teeth to stomach acid during purging can erode tooth enamel, causing sensitivity, decay, and discoloration. This also raises the likelihood of gum disease and other oral health problems. Furthermore, malnutrition and dehydration can reduce saliva production, which is crucial in protecting the mouth from harmful bacteria. As a result, individuals with bulimia may experience dry mouth, bad breath, and an elevated risk of infection.


How to Treat Bulimia Nervosa?

To effectively manage bulimia nervosa, it's essential to adopt a comprehensive approach. This may include:
 - Seeking support from loved ones or a support group.
 - Educating oneself about the condition to better recognize triggers and behaviors.
 - Seeking professional help through talk therapy, medication, or nutrition counseling.
 - Practicing self-care and engaging in activities that promote physical and mental well-being.
 - Establishing a healthy lifestyle with balanced eating habits and regular physical activity.
 - Being patient and persistent in recovery can be a journey that takes time and effort.


What Are the Signs of Bulimia Nervosa signs?

The symptoms of Bulimia Nervosa can include binge eating and purging, excessive focus on weight and body image, mood swings, anxiety, and depression. Physical signs may include swelling in the cheeks, calluses on the knuckles from self-induced vomiting, and discoloration of teeth. In addition, these behaviors may be secretive and repetitive, which can significantly impact a person's overall well-being.


What Is the Similarirty Between Anorexia Nervosa and Bulimia Nervosa?

Anorexia Nervosa and Bulimia Nervosa share several similarities, including an obsession with food, weight, and body imIn addition, both disorders can result in severe physical and mental health problems, such as malnutrition, imbalanced electrolytes, and depression. These conditions can also significantly affect a person's daily life, including relationships, work, and school.


What Is Bulimia Nervosa?

Bulimia Nervosa is a mental health condition marked by recurrent binge eating episodes and compensatory behaviors to prevent weight gains, such as purging through vomiting, laxative abuse, or excessive exercise. People with bulimia have a distorted body image and unreasonable fear of weight gain, which causes them to feel out of control during binge eating. This disorder can have serious physical and mental health impacts, including malnutrition, imbalanced electrolytes, and depression.
Dr. Vishal Anilkumar Gandhi
Dr. Vishal Anilkumar Gandhi



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