Currently, there is no specific cause of bulimia nervosa that researchers have been able to pinpoint. Brain imaging research continues to provide insight about how eating disorders like bulimia nervosa work in the brain, which encourages further investigation into treatment methods. Psychologically, bulimia nervosa has roots in mental illness and trauma. Eating disorders like bulimia are often seen as manifestations of control. Trauma and mental illness can cause one to feel as though their lives are out of control. Themes of perfection which are common in eating disorders are an effort to compensate for the less-than-perfect areas of life. The fixation on body image, body purity, and often exercise is a personal self-defense mechanism and a way of taking one’s own life into their hands. Full of skewed perceptions and harmful beliefs, bulimia nervosa is a deeply mental but also physical disorder.

The Difference Between Bulimia and Anorexia

Bulimia consists of episodes of binging and purging. Binging is any episode of intentionally overeating for the sake of coping, or with the intention of purging later on. By way of excessive exercise, induced vomiting, laxative abuse, or restriction, the perceived consequences of a binge such as gaining weight, feeling too full, or distorting appearance are remedied. Anorexia, on the other hand, rarely includes binge eating episodes and focuses more on chronic restriction as well as starvation. With anorexia, there is typically evident changes in body weight. Bulimia doesn’t present the same obvious physical symptoms of anorexia, making it dangerously easy to hide.

Bulimia as a Co-Occurring Disorder

Bulimia and other eating disorders are commonly co-occurring with other mental health or substance use disorders. Bulimia is frequently co-occurring with depression, anxiety, alcoholism, bipolar, and borderline personality disorder. Eating disorders which are co-occurring can exacerbate other symptoms.

Symptoms of Bulimia Nervosa

Symptoms of bulimia are not always obvious because the eating disorder can be hidden. When bulimia becomes a chronic issue, some of the symptoms that may be present include:

Physical Symptoms of Bulimia Nervosa

• Decaying of the teeth or signs of gum damage, resulting from constant exposure to acids in the mouth produced by vomiting
• Complications with digestive and waste systems due to laxative abuse
• Heart palpitations and heart damage issues due to malnourishment and dehydration
• Noticeable weight fluctuations
• Stomach cramps or other gastrointestinal pain
• Feeling cold
• Dizziness or fainting
• Dry skin and brittle nails
• Fine hair on the body
• Muscle weakness
• Menstrual irregularities
• Impaired immune function

Behavioral Symptoms of Bulimia Nervosa

• Getting up to go to the bathroom before or after meals
• Taking “supplements” before or after meals
• Commentary about having to go to the gym, or face negative consequences due to eating choices
• Worsening mental health surrounding food, eating, and body image
• Disappearance of large amounts of food in short periods of time or lots of empty food wrappers
• The development of food rituals such as excessive chewing
• Stealing or hoarding food
• Drinking excessive amounts of water
• Hiding the body in baggy clothing
• Unusual swelling in the jaw area
• Withdrawal from friends and family

How to Help Someone That Has Bulimia Symptoms

When you suspect someone you love has an eating disorder, learn as much as you can about the issue so you can help. Learning about treatment options is also a good idea, because counseling and therapy will likely be necessary for recovery. Approaching your loved one to talk about the bulimia symptoms will be one of the first steps toward recovery. Stay calm and objective, don’t affix blame or guilt, and by firm about getting help.

Risk Factors and Complications (Especially if Bulimia isn’t Treated)

Allowing bulimia nervosa to go untreated has several risks. The mortality rate is just below four percent for people with bulimia nervosa, but there are other issues that can cause complications as well. People who suffer from bulimia may also have an increased risk of depression, anxiety, and self-harm behaviors. The low-self-esteem that often triggers bulimia nervosa can also cause other emotional or psychiatric symptoms. Left untreated, bulimia can cause long-term health problems such as esophageal bleeding, kidney problems, and abnormal heart rhythms.

What is the Next Step?

Recovering from bulimia nervosa is possible with treatment. Most people undergo medical treatment for physical issues, psychotherapy, and nutritional counseling. Some people may need inpatient treatment, while others may be able to recover with outpatient therapy and counseling. Learning how to cope with stress, anxiety, and other negative feelings without resorting to binge-purge cycles can take time, but it is possible to recover.

More Information About Bulimia Nervosa

• What Can Happen if Bulimia is Left Untreated?
• Bulimia: What is it?
• What is Bulimia?
• Bulimia Nervosa in Children
• What is Bulimia Nervosa?
• Bulimia Nervosa in Adolescents
• Bulimia Nervosa
• Eating Disorders: Bulimia Nervosa
• Overview of Bulimia Nervosa (PDF)
• Eating Disorder Files: Bulimia Nervosa (PDF)
• Eating Disorders Awareness: Bulimia Nervosa
• Assessing Patients for Eating Disorders (PDF)
• Eating Disorders: What Families Need to Know
• More Information About Eating Disorders
• What Are Eating Disorders?
• What Causes Bulimia?
• Understanding Anorexia and Bulimia for Students
• Eating Disorders During Adolescence
• The Affective Variant Hypothesis: How Is Bulimia Nervosa Related to Depression? (PDF)
• Emotion Regulation in Adolescent Females with Bulimia Nervosa: An Information Processing Perspective (PDF)
• Health Consequences of Eating Disorders (PDF)
• For Teens with Bulimia, Family-Based Therapy Works Best
• Bulimia Nervosa
• Eating Disorders: About More Than Food
• Eating Disorders: Bulimia Nervosa
• Overview of Bulimia
• Eating Disorders: Bulimia
• Eating Disorders (PDF)
• Understanding Eating Disorders
• Eating Disorders – ‘Not a Vanity Issue but a Mental Illness’
• Recovering From an Eating Disorder
• Body Wise Handbook (PDF)