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Commonly Asked Questions: Bulimia Nervosa1

Garret D. Evans, Samuel F. Sears, and Heidi L. Radunovich2

What is it?

Bulimia nervosa is an eating disorder. People with this disorder often eat in "binges" and then try to eliminate the food from their system by making themselves vomit, using laxatives, dieting or exercising excessively, and using other techniques.

Sometimes people confuse bulimia nervosa with anorexia nervosa. Unlike people with anorexia, people with bulimia stay at an average or above-average weight for their height. While people with anorexia may binge-eat from time to time, they tend to exercise, diet, or eliminate food from their system so frequently that their body weight is dangerously low.

Approximately nine out of ten people diagnosed with bulimia are female. Most are diagnosed in their late teens or early- to mid-20s; that said, their symptoms often begin several years earlier. Like anorexia, bulimia is seen mostly in the cultures of North America, Europe, and parts of the South Pacific.

What are the symptoms?

If you are wondering whether someone you know has bulimia, here are a few critical characteristics to look for:

Frequent Binge Eating

Binge eating means eating a significantly larger amount of food than normal (usually two to three times the amount the average person would eat, which may amount to thousands of calories) over a short period of time (usually less than two hours). Eating a large meal during a holiday or celebration or snacking all day are not considered eating binges.

People with bulimia often binge on sweet, high-calorie foods, such as chocolate, cookies, cake, or ice cream. However, they can also binge on other types of foods, such as fried chicken, hamburgers, or pizza, as well as high-carbohydrate foods, such as crackers or breads.

People diagnosed with bulimia often say that they feel "out of control" when they binge-eat. They feel as though they cannot stop eating, even when they experience physical pain or emotional distress from it.

Drastic Attempts to Prevent Gaining Weight

People with bulimia often try to prevent weight gain through two basic patterns.

  • Purging—These individuals regularly attempt to eliminate food from their system by making themselves vomit or misusing laxatives or enemas. Approximately 80 to 90% of people who are treated for bulimia regularly attempt to make themselves vomit. It appears that vomiting helps calm their worries about gaining weight and relieves the physical discomfort of overeating. However, research indicates that purging does not remove most of the calories from the body.

  • Non-purging—These individuals try to limit weight gain by going on "crash" or starvation diets and/or exercising excessively. Like people who attempt to purge their food, these individuals are trying to overcompensate for their binge eating.

Many people with bulimia do not fit neatly into one category. They may combine vomiting with crash diets or the use of laxatives with exercising three times a day.

People who have eaten or exercised a lot more than usual over the past few weeks do not necessarily have bulimia. Bulimia is a lasting condition. It is generally accepted that people must be binging and compensating at least once a week for three months before the diagnosis of bulimia nervosa can be considered.

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Self-Esteem and Body Image

For most of us, our self-esteem is partly related to our thoughts about how we look. It is natural to feel better about yourself when you think that you look pretty good. However, the self-esteem of people with bulimia hinges almost completely on their thoughts and fears of being overweight.

Do people have bulimia forever?

In most cases, the answer is "no." Some people are successfully treated, while others seem to "grow out" of the problem. However, researchers are not yet sure of the long-term course of bulimia.

Part of the problem is that bulimia has only been frequently diagnosed in the past 20 to 30 years. In many cases, it can take several years before the bulimic behaviors are reduced or eliminated.

Sometimes the binging and compensating activities may disappear for months or even years only to come back during times of stress. Other times they may morph into overeating without purging. They may disappear and never return, or they may continue, especially if left untreated, without ever stopping.

Are there any medical complications?

Unfortunately, yes. As with anorexia nervosa, women with bulimia may menstruate (have their periods) irregularly. These problems may be due to malnutrition, emotional stress, or rapid changes in weight.

In addition, the electrolyte imbalances caused by vomiting or laxative use and the extreme changes in diet often seen with bulimia may cause cardiac (heart) or gastrointestinal (stomach and intestines) problems. Frequent vomiting may cause tooth decay or chipping of teeth.

What are the psychological factors?

There is no one "personality" that describes people with bulimia. However, we know that people with bulimia often feel ashamed about their eating problems. They may attempt to hide their binge eating while others are around. Food may be hidden away in closets or at work for times when no one can see them.

Most people with bulimia are afraid of gaining weight. They may become very nervous about any perceived or actual changes in their body shape.

People with bulimia are more likely to be depressed or have problems with anxiety than others. These emotional difficulties may have been part of the reason they developed bulimia, or they may be in response to their eating problems.

Also, people with bulimia tend to be more impulsive in general and are more likely to abuse alcohol and drugs (especially stimulants) to cope with depression and anxiety or to lose weight.

Can bulimia be treated?

Fortunately, health care professionals are having more success in treating bulimia. Typically, treatment is coordinated by a physician, psychologist or other mental health professional, and a registered dietitian.

The first step in getting help for people with bulimia nervosa is to have them see a doctor. A physician can assess their general health and provide more information about their current and expected weights.

Mental health professionals, such as psychologists or licensed clinical social workers, who specialize in eating disorders often provide psychotherapy designed to help these individuals understand and modify their thoughts and behaviors to help decrease binge eating and purging and improve mood and self-image. The mental health professional can help them learn new strategies to cope with their negative feelings and understand and modify their expectations for themselves, family members, significant others, or the world in general. Especially with younger patients, family therapy is often used to address body image and expectations as well as family issues that may be contributing to the eating disorder.

Long-term nutritional counseling may also be required. This counseling can best be accomplished by a registered dietitian who can assess the patients’ current dietary practices and establish eating plans that meet their individual needs.

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Publishing.

Sanders, P. (1998). Handbook of medical nutrition therapy. Lake Dallas: Helm Publishing.

Footnotes

1.

This document is FCS2121, one of a series of the Family, Youth and Community Sciences Department, UF/IFAS Extension. Original publication date June 1997. Revised August 2015. Visit the EDIS website at http://edis.ifas.ufl.edu.

2.

Garret D. Evans, former associate professor, Department of Family, Youth and Community Sciences; Samuel F. Sears, former associate professor, Department of Clinical and Health Psychology; and Heidi L. Radunovich, associate professor, Department of Family, Youth and Community Sciences; UF/IFAS Extension, Gainesville, FL 32611.


The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information and other services only to individuals and institutions that function with non-discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, marital status, national origin, political opinions or affiliations. For more information on obtaining other UF/IFAS Extension publications, contact your county's UF/IFAS Extension office.

U.S. Department of Agriculture, UF/IFAS Extension Service, University of Florida, IFAS, Florida A & M University Cooperative Extension Program, and Boards of County Commissioners Cooperating. Nick T. Place, dean for UF/IFAS Extension.