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Learn more about the results we get at Within

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What causes bulimia nervosa?

Bulimia nervosa (BN) is a serious eating disorder that revolves around cycles of binge eating and purging, which can be dangerous to someone's mental, physical, and emotional health.

What causes bulimia is often not just one factor but a combination of biological, psychological, and environmental considerations. Still, learning more about the causes of bulimia and ways to look out for them may be able to help you or your loved one recognize the issue and find appropriate treatment.

 minutes read
Last updated on 
February 24, 2024
February 24, 2024
What causes bulimia?
In this article

Biological causes of bulimia nervosa

Eating disorders of all kinds were once considered primarily social disorders, impacted by factors like peer pressure and cultural norms around thinness. But thanks to developments in technology, doctors, scientists, and researchers are increasingly finding biological factors as potential bulimia causes.

Inherited traits
Hormonal triggers
Brain activity

Psychological causes of bulimia

From a psychological standpoint, there are many potential causes of bulimia.

BN has been connected to several comorbid conditions, which are disorders that occur at the same time and often play off each other. Some of the most closely linked conditions include obsessive-compulsive disorder (OCD), perfectionism, and a behavior called trait urgency, which is the tendency to react recklessly in response to stress.1,5

Bulimia is also highly comorbid with various mood disorders, especially anxiety disorders and depression.12 Many people with BN struggle with concurrent drug and alcohol abuse.12

What causes bulimia in people with these risk factors depends on various things. However, individuals often use eating as a coping mechanism to deal with the stress of these additional mental health conditions.5

Environmental bulimia causes

Most studies on causes of bulimia and other eating disorders have focused on sociocultural influences. Many scientists have long attributed the development of these disorders almost exclusively to environmental factors.

While the examination of biological causes of bulimia continues to expand and round out scientific knowledge on the issue, many outside factors play a significant role in developing BN.

Environmental stress and history of trauma
Role modeling
Peer pressure and cultural expectations

Treatment of bulimia nervosa

While there are many causes of bulimia, there are many treatments for the condition, as well. And no matter what causes bulimia in a person, it's possible to overcome the disorder. In fact, nearly 74% of people struggling with BN fully recover after seeking treatment.11

Several types of therapy have been found to be especially effective against BN, including:

  • Cognitive behavioral therapy (CBT): This type of therapy operates on the idea that unhelpful behaviors are caused by unhelpful thoughts. CBT helps patients learn to recognize these patterns and teaches them strategies for changing them, with the eventual goal of eliminating disordered thoughts and the behaviors they cause, all together.
  • Self-help: This type of care has also been found to be a useful treatment for bulimia nervosa. Mostly mirroring the concepts of CBT, self-help allows a patient to practice these techniques at their own pace, by working through a notebook or an online course, with little or no interaction with a therapist.
  • Interpersonal psychotherapy (IPT): This modality focuses on helping people understand and better navigate the social dynamics in their life. IPT has been found especially helpful for reducing binge eating behaviors, partly by teaching patients how to manage boundaries and helping them improve self-esteem.13

Finding help for bulimia nervosa

If you or a loved one are struggling with BN or another eating disorder, it's crucial to seek help from a mental health professional. These conditions can be dangerous or even deadly if left untreated.

Thankfully, there are many ways to treat bulimia nervosa. Several types of therapies have shown promise for reducing binge eating behaviors and improving body image and self-esteem. Your primary care physician or therapist can help you determine the best care.

Remote care for bulimia nervosa

At Within, we understand the many causes of bulimia and factors that must be considered, so we have a team of multi-disciplinary experts to create individualized treatment plans for each patient. We ensure all of our patients get the kind of care they need for their specific history and needs.

Contact us today to see how you can get started on the road to recovery.

Get help

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. Berrettini, W. (2004). The genetics of eating disorders. Psychiatry, 1(3), 18–25.
  2. MSU research uncovers genetic risk factors for eating disorders. (2007, May 9). Michigan State University. Retrieved May 10, 2022.
  3. MSU researchers discover potential genetic factor in eating disorders. (2010, June 4). Michigan State University. Retrieved April 10, 2022.
  4. Avena, N. M., & Bocarsly, M. E. (2012). Dysregulation of brain reward systems in eating disorders: Neurochemical information from animal models of binge eating, bulimia nervosa, and anorexia nervosa. Neuropharmacology, 63(1), 87–96.
  5. Fischer, S., Smith, G. T., & Cyders, M. A. (2006). Integrating personality and environmental risk factors for bulimia nervosa. In P. I. Swain, Anorexia nervosa and bulimia: New research (pp. 159–184). Nova Science Publishers.
  6. Mazzeo, S. E., & Bulik, C. M. (2009). Environmental and genetic risk factors for eating disorders: What the clinician needs to know. Child and Adolescent Psychiatric Clinics of North America, 18(1), 67–82.
  7. Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2013). Eating disorders, trauma, PTSD, and psychosocial resources. Eating Disorders, 22(1), 33–49.    
  8. Quiles Marcos, Y., Quiles Sebastián, M. J., Pamies Aubalat, L., Botella Ausina, J., & Treasure, J. (2012). Peer and family influence in eating disorders: A meta-analysis. European Psychiatry, 28(4), 199–206.
  9. Al-sheyab, N. A., Gharaibeh, T., & Kheirallah, K. (2018). Relationship between peer pressure and risk of eating disorders among adolescents in Jordan. Journal of Obesity, 2018, 1–8.
  10. 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.
  11. Herzog, D. B., Dorer, D. J., Keel, P. K., Selwyn, S. E., 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 American Child Adolescent Psychiatry, 38(7), 829-837.
  12. Bushnell, J. A., Wells, J. E., McKenzie, M., et al. (2009). Bulimia comorbidity in the general population and in the clinic. Psychological Medicine, 24(3), 605-611.
  13. McElroy, S., Guerdjikova, A., Mori, N., et al. (2015). Overview of the treatment of binge eating disorder. CNS Spectrums, 20(6), 546-556.


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Further reading

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