Understanding Bulimia Nervosa

What is Bulimia Nervosa

Bulimia nervosa (often referred to as bulimia) is a dangerous and potentially fatal eating disorder characterized by a cycle of binge eating and subsequent purging behavior, like self-induced vomiting. Binging behaviors are characterized by eating excessive amounts in a short period of time, along with a feeling of being out of control. Purging behaviors include vomiting, fasting, excessive exercise, and misuse of laxatives or other medications that cause weight loss. Because bulimia is cyclical — meaning people may engage in this behavior for periods of time and then stop for a while before starting again — it’s different from other eating disorders such as anorexia nervosa and binge eating disorder.

What are the signs or symptoms of bulimia?

There are several warning signs and symptoms of bulimia including:

  • Exhibiting obsessive attitudes or behaviors surrounding body image, weight loss and dieting
  • Evidence of binge eating such as hoarding food or food missing from its usual place
  • Evidence of purging behavior, such as going to the bathroom frequently after meals, sounds and smells of vomiting, having specific food rituals, or showing discomfort around eating
  • Withdrawing from friends and activities and overall irritability
  • Puffy lips and cheeks, scrapes on knuckles and hands, and teeth issues which could indicate repeated self-induced vomiting

Because bulimia is associated with fluctuating weight, and not abnormally low weight like anorexia or binge eating disorder, it can be difficult for family and friends to pick up on signs of bulimia if the person struggling appears to be a healthy body weight. If you see any of the signs listed above, or you notice changes in temperament and behavior, like sudden irritability, low self-esteem, preoccupation with body image, depression, anxiety, etc., consider starting a conversation with the person you’re worried about.

What are the consequences of not acknowledging and dealing with bulimia?

Bulimia nervosa can have serious, dangerous effects on the entire digestive system. It can lead to electrolyte and chemical imbalances in the body that impact the heart and other major organ functions. Even in someone with seemingly perfect laboratory tests, electrolyte imbalance and cardiac arrest can kill without warning. Other lasting health consequences include:

  • Resultant long-lasting digestive issues, especially in the upper digestive tract, from damage associated with vomiting/stomach acid (acid reflux, inflammation/irritation of the esophagus, may increase risk of esophageal cancer)
  • Irregular menstrual cycles or difficulty conceiving due to the stress on the body caused by binge/purge cycles
  • Tooth decay and gum disease from repeated exposure to stomach acid
  • Dehydration and subsequent kidney problems
  • Nutrient deficiencies which lead to dry skin, brittle nails, and hair loss

When to seek help for bulimia

It’s always important to seek help as soon as you notice any warning signs or symptoms. Treatment for eating disorders is most effective before the condition becomes chronic.

Because of diet culture, and communities on social media disguising the encouragement of eating disorders as “detoxing,” and “thinspiration,” disordered eating behaviors can quickly become reinforced and romanticized/rewarded, making them harder to unlearn the longer the condition lasts.

Any signs of disordered eating, like binging, feeling guilty or “bad” about the food you eat, restricting certain foods, excessive exercising, or just simply feeling negative about your body regardless of its shape or health, should be discussed with a doctor, nutritionist, or therapist. Eating disorders often develop from the ideas pushed by diet culture and thin-idealizing beauty standards.

If you’re struggling with any eating disorder, it’s crucial to disengage with any online community that may trigger or encourage disordered eating behavior. These could be as apparent as “pro-ana” (pro-anorexia) pages and posts, to “how to lose weight in X days” posts and workouts.

If you don’t know if/when to get help, consider getting help when:

  • You notice any changes in your heartbeat or blood pressure
  • You experience chronic pain in your mouth (gums, cheeks, or teeth), throat, chest, or stomach
  • You’re struggling to stay hydrated (yellow urine)
  • You feel the need to binge or restrict — one will lead to the other, so interrupting that cycle with a change in behavior or professional intervention may help
  • You experience fluctuations in weight
  • You experience a change in libido or a change in your hormonal cycles (ovulation, menstruation)
  • You’re losing hair or experience changes in your skin
  • You develop thoughts or urges to harm or kill yourself. If this happens, seek help immediately — tell a friend, counselor, doctor, or call a help-line

How to help a friend

Recognizing signs in ourselves is one thing, but how can you help a friend you think may be struggling with bulimia? Because eating disorders become more difficult to treat the longer they persist, it’s important to encourage your friend to seek help early on.

Start the conversation

Try and convey a tone of empathy and concern. “I” statements can help prevent shame and guilt on the behalf of the person with the eating disorder:

  • “I noticed lately…”
  • “I’m concerned about [this behavior] because…”
  • “I want to support you…”

Don’t give in to their avoidance

Don’t enable or implicitly encourage unhealthy eating patterns, or negative body image, by catering to your friend’s desire to avoid food-related situations, talking about weight loss, or evaluating bodies.

  • Avoid comments on appearance, even if it sounds positive to someone without an eating disorder.
  • Avoid comments on your own appearance or comments comparing appearances of others.
  • Avoid labeling foods and eating behaviors as “guilty,” or “bad.” Foods have no morality.

Want more tips on what not to say? This helpful guide, Things You Don’t Say to Someone With an Eating Disorder, can help.

Stay involved

Much of the time, people use eating disorders as coping mechanisms in the face of difficult emotional problems; controlling food is seen as a way to exercise control. A crucial part of recovery is learning to rely on friends and family for emotional support instead of the eating disorder. You can support your friend by:

  • Encouraging neutrality surrounding foods and health body image
  • Assisting their efforts to go to or start therapy
  • Being understanding and accepting during relapses or slips

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