Text Link

Learn more about the results we get at Within

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Suspendisse varius enim in eros elementum tristique. Duis cursus, mi quis viverra ornare, eros dolor interdum nulla, ut commodo diam libero vitae erat. Aenean faucibus nibh et justo cursus id rutrum lorem imperdiet. Nunc ut sem vitae risus tristique posuere.

Learn more about the results we get at Within

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Suspendisse varius enim in eros elementum tristique. Duis cursus, mi quis viverra ornare, eros dolor interdum nulla, ut commodo diam libero vitae erat. Aenean faucibus nibh et justo cursus id rutrum lorem imperdiet. Nunc ut sem vitae risus tristique posuere.

What is bulimia nervosa (BN)?

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

In fact, nearly 74% of patients who seek treatment for bulimia nervosa fully recover from the condition.1

 minutes read
Last updated on 
February 1, 2024
February 1, 2024
woman by window
In this article

What is bulimia nervosa?

Bulimia nervosa is a pattern of disordered eating behaviors characterized by a cycle of:

  1. Restricting calories due to concerns about weight
  2. Bingeing due to prior food restrictions
  3. Purging episodes
woman thinking

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.

what is bulimia definition graphic
Bulimia treatment that comes to you
Learn about our virtual program

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.

Compensatory behaviors


Diagnosing bulimia nervosa

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.

man in therapy session

According to the DSM-5, bulimia nervosa is diagnosed using the following criteria:8

  1. Recurrent binge eating episodes with both of the following features:
    • Eating larger amounts of food than what most individuals would normally eat within a two hour period
    • Feeling out of control when eating
  2. Use of compensatory behaviors to prevent weight gain, at least once a week for three months
  3. Inaccurate self-assessment of weight and body image

In addition to the primary criteria, the severity of bulimia nervosa is determined by the frequency of behaviors.

Frequency of Behaviors

When purging occurs at any level (from mild to extreme), it's important to seek treatment before it's too late.


Signs & symptoms of bulimia nervosa

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. 

woman upset with mirror

Effects of bulimia nervosa

Many effects of bulimia nervosa overlap with other types of eating disorders, but there are some distinct side effects of bulimia nervosa.

Short-term effects

Although the early effects of BN are often subtle, they are not trivial. Left untreated, they can lead to much more serious health consequences. Short-term effects of bulimia nervosa:

  • Dental enamel erosion & cavities
  • Gum disease
  • Electrolyte imbalances
  • Facial swelling and puffy face
  • Heartburn/Reflux (GERD) 
  • Fatigue 
  • Throat soreness 

Long-term effects

When food restriction and compensatory behaviors persist, the risks of more serious – and sometimes permanent – damage occurs.Long-term effects of bulimia nervosa:

  • Esophageal tearing 
  • Esophageal scarring and strictures
  • Difficulty swallowing (dysphagia)
  • Bone density loss (osteoporosis)
  • Enlarged glands in the neck
  • Loss of muscle mass (cachexia)
  • Thin or brittle hair 
  • Fine hair growth (lanugo)
  • Severe constipation
  • Irregular or absent menstrual cycles in women (amenorrhea)
  • Low blood pressure
  • Irregular heart rhythms and permanent heart damage
  • High sensitivity to cold temperatures
  • Fatigue 
  • Reduced immune function
  • Infertility
  • Cognitive impairment
  • Death, if untreated

Related disorders

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: 

  • Body dysmorphic disorder
  • Anxiety disorder
  • Depression
  • Borderline Personality Disorder
  • Self-harm (cutting, etc.)
  • Addiction disorders
  • Food insecurity 
  • Post-traumatic stress disorder (PTSD)
  • Mood disorders
  • Obsessive compulsive disorder (OCD) 
woman sitting on window sill

Treatment of bulimia nervosa

Treatment options for bulimia nervosa depend on the severity and type of compensatory mechanisms involved. 

Let us help guide you

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:

Intensive Outpatient Programs (IOP)

IOP treatment for BN is best for patients who have a supportive home environment but still value a bit of clinic care and structure. Patients will typically attend a clinical setting a few days per week for treatment, while maintaining treatment protocols at home for the rest of the week.

Partial Hospitalization Program (PHP)

Patients with BN who need more structure than IOP should seek out PHP which involves speaking four or more days per week at a hospital or clinical treatment program.

Residential Treatment

For patients looking for more hands on care, or for those who don’t have an adequate home environment for healing should try residential treatment for bulimia nervosa. Here they will receive 24-hour oversight, as well as a place to live while receiving treatment.

Inpatient Hospitalization

Patients with bulimia nervosa who are at risk of suicide or struggling with major psychological disorders, such as depression, may require an inpatient hospitalization program. Inpatient hospitalization provides 24/7 medical oversight and care.


of those who complete our treatment program report reduced eating disorder symptoms

The Within results

Therapies for bulimia nervosa

While hospitalization and outpatient therapy are necessary in some cases, the two most common treatments for bulimia nervosa include the following therapies: 

Cognitive Behavioral Therapy (CBT)
Group Therapy

Medications for bulimia nervosa

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:

  • Approved in 1994, Fluoxetine hydrochloride (Prozac, Sarafem, Rapiflux, Selfemra) is a selective serotonin reuptake inhibitor that effectively reduces binge-eating and vomiting episodes.7
  • Tricyclic antidepressants, such as desipramine (Norpramin®, Aventis), imipramine (Tofranil®, Ciba Geigy), and amitriptyline (Elavil®, Merck & Co.).11
  • Anticonvulsant topiramate (Topomax®, Ortho-McNeil Pharmaceutical) may help reduce binge frequency.11
student studying and drinking from a mug

Understanding bulimia nervosa

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

Risk factors for bulimia nervosa:
  • Genetics: Researchers now believe genes may be an independent risk factor for developing eating disorders.
  • Abuse: Traumatic life experiences, such as sexual assault and physical or emotional abuse, are also linked to eating disorders. 
  • Psychological Influence: Things like low self-esteem, depression, anxiety, lack of healthy coping strategies, obsessive thinking, perfectionism, sensitivity to reward and punishment, and difficulty expressing emotions and feelings may lead to disordered eating behaviors.
  • Environment: Disordered eating behaviors are also tied to environmental factors, such as living or working in spaces that focus on weight or dieting. For example, athletes face immense pressure in their environments to change their body size. 
  • Cultural Norms: Family and mainstream media messaging that idealizes thinness is thought to promote unhealthy eating behaviors and body image standards.

Living with bulimia nervosa 

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.

Coping with bulimia nervosa

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. 

History of bulimia nervosa 

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. 

Bulimia nervosa in pop culture

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.

dancer stretching

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.

Inclusive treatment

Within Health offers inclusive eating disorder treatment for people of all shapes, sizes, colors, and orientations. Call our admissions team to learn how our treatment milieu can help you heal from bulimia nervosa.


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.


  1. Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348–358. https://doi.org/10.1016/j.biopsych.2006.03.040
  2. Herzog, D. B., Dorer, D. J., Keel, P. K., Selwyn, S. E., Ekeblad, E. R., Flores, A. T., Greenwood, D. N., Burwell, R. A., & Keller, M. B. (1999). Recovery and Relapse in Anorexia and Bulimia Nervosa: A 7.5-Year Follow-up Study. Journal of the American Academy of Child & Adolescent Psychiatry, 38(7), 829–837. https://doi.org/10.1097/00004583-199907000-00012
  3. Rushing, J. M., Jones, L. E., & Carney, C. P. (2003). Bulimia Nervosa. The Primary Care Companion to The Journal of Clinical Psychiatry, 05(05), 217–224. https://doi.org/10.4088/pcc.v05n050
  4. Castillo, M., & Weiselberg, E. (2017). Bulimia Nervosa/Purging Disorder. Current Problems in Pediatric and Adolescent Health Care, 47(4), 85–94. https://doi.org/10.1016/j.cppeds.2017.02.004
  5. Morris, A. M., & Katzman, D. K. (2003). The impact of the media on eating disorders in children and adolescents. Paediatrics & Child Health, 8(5), 287–289. https://doi.org/10.1093/pch/8.5.287
  6. Lydecker, J. A., & Grilo, C. M. (2019). Food insecurity and bulimia nervosa in the United States. International Journal of Eating Disorders. Published. https://doi.org/10.1002/eat.23074
  7. Bello, N. T., & Yeomans, B. L. (2017). Safety of pharmacotherapy options for bulimia nervosa and binge eating disorder. Expert Opinion on Drug Safety, 17(1), 17–23. https://doi.org/10.1080/14740338.2018.1395854
  8. National Eating Disorders Association. (2018, February 22). Bulimia Nervosa. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia
  9. Eating Disorders. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/eating-disorders
  10. IMDb.com. (n.d.). Black swan. IMDb.
  11. Gorla, K., & Mathews, M. (2005). Pharmacological Treatment of Eating Disorders. Psychiatry, 2(6), 43–48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000192/


What is purging?

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.

How can you tell if someone is experiencing bulimia?

Prominent signs of bulimia nervosa are bruised or blistered knuckles, eating in private, eroded tooth enamel, and visiting the restroom immediately after eating.

Is bulimia a disease?

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."

Further reading

Dangers of bulimia nervosa on your health and well-being

Bulimia nervosa is an eating disorder characterized by extremes. People struggling with this condition move...

What are the long-term effects of bulimia?

If you or a loved one has experienced bulimia nervosa (BN), it is important to be aware of the long-term...

Antidepressants and bulimia nervosa

Bulimia nervosa (BN) is a debilitating and dangerous eating disorder that can lead to numerous health...

The relationship between orthorexia and bulimia

Orthorexia nervosa (ON) is a more recently acknowledged disorder. While yet to be recognized by the DSM...

Bulimia nervosa in men

Bulimia nervosa (BN) may be one of the most widely-recognized eating disorders in the United States...

Psychological causes of bulimia nervosa

Bulimia nervosa (BN) is a psychiatric disorder that involves recurrent episodes...

Bulimia during pregnancy: What to expect

Pregnancy can be momentous and miraculous, but can bulimia affect...

What is non-purging bulimia?

Bulimia nervosa (BN) is a serious eating disorder defined by cycles. People who struggle with this...

What causes bulimia nervosa?

Bulimia nervosa (BN) is a serious eating disorder that revolves around cycles of binge eating and purging...

Understanding bulimia in men

Eating disorders like bulimia nervosa (BN) are almost exclusively attributed to girls and women, but a...

Signs and symptoms of bulimia nervosa

Bulimia nervosa (BN) is a serious mental health disorder, but the condition is often marked by a number of...

How to tell your loved ones you have bulimia

Telling your loved ones or family members that you struggle with bulimia nervosa (BN) can be a terrifying...

How to talk about bulimia nervosa

When you’re living with an eating disorder, like bulimia nervosa (BN), you can get...

How to stop bulimia

Bulimia nervosa is a complex eating disorder that often comes with feelings of...

How to help someone with bulimia

It can be incredibly difficult when someone you love is struggling with bulimia nervosa (BN). You may feel...

Examining the bulimia death rate

Eating disorders are among the most dangerous—and deadly—diagnoses in the Diagnostic and Statistical Manual...

Do I have bulimia?

If you’ve been struggling with your eating habits lately—especially if you’ve found yourself binging or...

Can bulimia kill you?

Bulimia nervosa (BN) is a serious eating disorder that affects up to 4.6% of women and...

What is bulimia nervosa (BN)?

Bulimia nervosa (BN) is an eating disorder that affects between 0.5% and 1.5% of...

Further reading

No items found.