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Bulimia nervosa (BN) is an eating disorder that affects between 0.5% and 1.5% of people throughout their lifetime.
However, the actual lifetime prevalence is not known due to the secrecy and shame that can lead a person to avoid seeking help for their condition.
While eating disorders can be life-threatening, they are treatable, and a full recovery is possible when effective treatment is provided.1
A person with bulimia nervosa engages in frequent episodes of binge eating, recurrent inappropriate compensatory behaviors as a means to prevent weight gain, and self-assessment that is unjustifiably based on body shape and weight.8
People who struggle with an eating disorder like bulimia nervosa express intense dissatisfaction with their bodies, believing they are overweight when they are clinically underweight.
Classic symptoms include a restrictive attitude about food and inadequate nourishment of the body. Patients with bulimia nervosa engage in purging and non-purging compensatory behaviors, such as self-induced vomiting, prolonged bouts of exercise, or other behaviors meant to “undo” episodes of overeating.
Distinguishing bulimia nervosa from other eating disorder subtypes requires an exam by a healthcare professional. A physical exam by a medical professional is also crucial due to the potentially devastating medical consequences of bulimia nervosa.
The physician will assess behavioral, psychological, and physical factors during the exam, such as eating behaviors, compensatory mechanisms used, and frequency of episodes.
In addition to the primary criteria, the severity of bulimia nervosa is determined by the frequency of behaviors.
When purging occurs at any level (from mild to extreme), it's important to seek treatment before it's too late.
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Due to complex emotions and shame, patients experiencing eating disorders may find it difficult to share their behaviors with others. This can lead to people hiding their symptoms, making bulimia nervosa particularly difficult to recognize.
Many effects of bulimia nervosa overlap with other types of eating disorders, but there are some distinct side effects of bulimia nervosa.
Bulimia nervosa rarely occurs in isolation and is associated with other mental health disorders as well.
Conditions that frequently coexist with bulimia nervosa include the following:
Treatment options for bulimia nervosa depend on the severity and type of compensatory mechanisms involved.
Multidisciplinary care teams have become the gold standard for the treatment of eating disorders. This comprehensive treatment utilizes evidence-based standards to ensure nutritional imbalances, related medical conditions, and psychosocial elements are adequately addressed to produce the best possible outcomes.
The main levels of care for eating disorders are:
While hospitalization and outpatient therapy are necessary in some cases, the two most common treatments for bulimia nervosa include the following therapies:
Some patients with bulimia nervosa respond well to medication. These BN medications repair neurobiological pathways that impact mood, executive functioning, anxiety, and other variables contributing to their suffering. The following medications are prescribed in some cases:
Patients with bulimia nervosa have a struggle around the pursuit of thinness, and a preoccupation with body size. They are often very restrictive in their eating patterns, which eventually leads to thoughts and feelings of deprivation resulting in compensatory behaviors like self-induced vomiting, the use of laxatives, or extreme levels of exercise after consuming food or beverages.
While the cause of bulimia nervosa is not clear, strong evidence suggests that a genetic component plays a significant role. For example, individuals with parents with an eating disorder are more likely to exhibit disordered eating behaviors.8
For those living with bulimia, weight and body image are the primary criteria used to measure self-worth. Any deviation from their self-imposed ideal, no matter how unrealistic, warrants a correction of behavior to induce weight loss.
Patients with eating disorders benefit from understanding the origin of their disordered eating behaviors, the role of restriction in binge eating, and the relationship between mind and body.
Self-care, a multidisciplinary team with specialized training in treating eating disorders, and supportive friends and family are vital for successful outcomes.
Within Health offers comprehensive treatment programs that focus on each patient’s unique needs to ensure that a full recovery is possible.
In 1979, a British physician named Gerald Russell recorded the first notes about bulimia nervosa, describing it as a phase of anorexia nervosa.4 Today, experts recognize BN as a separate disorder in the DSM-5 that requires different forms of treatment.
Cultural influences contribute to the development of eating disorders like bulimia as well.
Unrealistic body size standards within the fashion and beauty industry, the idealization of thinness on social media platforms, and the unrelenting marketing and advertising of diet-related products and services on television celebrate small bodies.5
In the movie Black Swan, which portrays a dancer who struggles with bulimia, the Hollywood actors lost an extreme amount of weight for the film. This weight loss highlighted the reality that performers and entertainers are encouraged to hold unrealistic expectations of their body size and shape. Natalie Portman was even celebrated for her rapid weight loss and rewarded an Oscar for the role, despite the health risks she put her body through.
The glamorization of thinness and the romanticizing of dieting have left many people with eating disorders feeling even more out of alignment with their bodies.
If you or someone you love is struggling with bulimia nervosa, don’t delay treatment. The earlier a patient with an eating disorder enters treatment, the better their chances of a positive outcome.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
Purging, described by patients as a desire to “undo” the undesirable feelings of fullness from overeating, may include behaviors such as excess exercising, self-induced vomiting, or using substances, such as diuretics or laxatives.
Prominent signs of bulimia nervosa are bruised or blistered knuckles, eating in private, eroded tooth enamel, and visiting the restroom immediately after eating.
Bulimia nervosa is considered a mental illness or disorder. It is considered a disease when looking at the definition of a disease as "a disorder of structure or function in a human, animal, or plant, especially one that has a known cause and a distinctive group of symptoms, signs, or anatomical changes."
