Understanding Bulimia Nervosa

What is Bulimia Nervosa

Bulimia nervosa (often referred to as “bulimia”) is an eating disorder characterized by a cycle of binge eating and  purging. Depression, body image concerns, and intense fear of weight gain often accompany these behaviors.

Bingeing can be a confusing term because people use it casually in other contexts, such as watching back-to-back episodes of a TV series. When it comes to eating disorders, bingeing means eating an unusually large amount of food in a short period of time,  with a feeling of being out of control. Bingeing often happens in secret and can bring on intense feelings of guilt and shame. 

Purging behaviors include not only vomiting but also fasting, exercising, and misusing laxatives or other medications.

Who gets bulimia?

Like other eating disorders, bulimia can affect anyone. There is evidence that women may be more vulnerable, but people of all genders can develop this disorder. Research shows that girls and women of color have a 50% higher rate of bulimia than their white peers, but they are far less likely to get diagnosed and treated.

What are the signs or symptoms of bulimia?

There are several warning signs and symptoms of bulimia, including:

  • Having obsessive attitudes or behaviors surrounding body image concerns weight loss, and dieting.
  • Evidence of binge eating, such an unusual number of food wrappers/containers or large amounts food missing from its usual place.
  • Evidence of purging behavior, such as going to the bathroom after meals, sounds and smells of vomiting, having specific food rituals, or showing discomfort around eating.
  • Taking a long shower after eating.
  • Exercising in a rigid or compulsive way (for instance doing exercise they don’t enjoy or exercising when injured).
  • Withdrawing from friends and activities.
  • Overall irritability or other mood changes.
  • Puffy lips and cheeks, scrapes on knuckles and hands, and dental problems, which could indicate repeated self-induced vomiting.
  • Fluctuations in weight.
  • Misusing medications, such as laxatives or insulin.

Because someone with bulimia is likely to do everything they can to hide any bingeing and purging, it can be difficult for friends and family to notice. If you see any of the signs listed above, or you notice changes in temperament and behavior, like irritability, low self-esteem, preoccupation with body size, or symptoms of depression and/or anxiety, consider starting a conversation with the person you’re worried about–or seeking out additional support.

What are the health impacts of bulimia?

In addition to the emotional toll, bulimia nervosa can have serious, dangerous effects on the body. It can lead to electrolyte and chemical imbalances that affect the heart and other major organs. Electrolyte imbalance and cardiac arrest can kill without warning. Other health consequences include:

  • Long-lasting digestive issues, especially in the upper digestive tract, from damage associated with vomiting/stomach acid (acid reflux, inflammation/irritation of the esophagus, which may increase risk of esophageal cancer)
  • Irregular menstrual cycles or difficulty conceiving.
  • 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.

Bulimia often comes with increased risk of self-harm and suicidal thoughts. If you are feeling the urge to hurt yourself or end your life, seek help immediately — tell a friend, counselor, doctor, or call a help-line.

When to seek help

It’s important to get help as soon as possible.. Treatment for eating disorders tends to be most effective when the intervention comes early on in the illness. However, it’s never too late to seek treatment; recovery is possible even if you’ve been suffering for a while.

Any signs of disordered eating–like dieting, bingeing, feeling guilty or “bad” about the food you eat, restricting certain foods, excessive exercising, or just simply feeling negative about your body–are all risk factors for developing bulimia and are reason enough to get support, even if you don’t think you’re “sick enough” to have an eating disorder. Seeking helping from a school counselor or other mental health professional on your campus can be an important step.

Seek immediate medical attention if you experience any of these symptoms:

  • You feel dizzy or 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 experience symptoms of hormonal disruption, such as loss of libido or sexual functioning or, for those who menstruate, a loss of your period or other change in your menstural cycle
  • You’re losing hair or noticing 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

If you think your friend may be struggling with bulimia, it can be hard to know what to do. The first step is to express your worry from a place of compassion, not criticism. Because eating disorders can become more difficult to treat the longer they persist, it’s important to support your friend to seek help as soon as possible.

Start the conversation

Rather than making an accusation, try to convey empathy and concern. Remember that someone with bulimia may already be suffering from shame and low self-worth. Simple “I” statements can be helpful in conveying a caring, nonjudgmental tone:

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

If you’re noticing that things are not improving after your conversation, talk to someone who can help. Caring friends often decide to share their concerns with a school counselor, administrator, or someone at a campus mental health center. Reaching out for support from a professional on your campus–even if your friend is currently refusing treatment–can be tough, but it can also be literally life-saving. 

Stay involved

Friends can offer tremendous support during the recovery process. You can help your friend by:

  • Avoiding diet talk or labeling foods and eating behaviors as “guilty” or “bad” 
  • Encouraging a neutral “all foods fit” approach to eating
  • Avoiding comments–positive or negative–on appearance (theirs, your own, or other people’s) 
  • Assisting their efforts to stay in treatment and follow any meal plan they have been given by an eating disorder professional
  • Offering meal support (eating with them) 
  • Being with them after meals or at other times when the urge to purge may be high
  • Being understanding and accepting during any lapses that may occur during the recovery process

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

For more support, contact the National Eating Disorders Association hotline by phone or chat at 800-931-2237 for more information and resources.

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If you or someone you know needs to talk to someone right now, text HOME to 741-741 or call 1-800-273-TALK (8255) for a free confidential conversation with a trained counselor 24/7. 

If you are experiencing a mental health crisis, text or call 988.

If this is a medical emergency or if there is immediate danger of harm, call 911 and explain that you need support for a mental health crisis.

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