Bulimia: Symptoms, Causes & Treatment

Bulimia is an eating disorder marked by episodes of binge eating followed by behaviors intended to prevent weight gain. These behaviors may include self-induced vomiting, laxative use, or very intense exercise.

Bulimia, also known as bulimia nervosa, is more common in young women, although it can affect people of any age or sex. In addition to an intense fear of gaining weight, a person may also have an anxiety disorder, borderline personality disorder, or major depressive disorder.

When signs of bulimia are noticed, support from family members can be important. Care from a psychologist and registered dietitian can help improve quality of life and reduce behaviors associated with bulimia.

Bulimia symptoms

The main symptoms of bulimia are:

• An uncontrollable urge to eat, known as binge eating

• Compensatory behaviors after meals, such as self-induced vomiting

• Regular use of laxatives, diuretics, or appetite suppressants

• Excessive physical activity after eating

• Eating large amounts of food in secret

• Feelings of distress and guilt after overeating

• Frequent throat inflammation

• Recurring cavities and worn teeth

• Frequent abdominal pain and inflammation in the digestive system

• Irregular periods

A person may also develop signs of dehydration and malnutrition because of behaviors related to bulimia nervosa. Depression, irritability, anxiety, low self-esteem, and an excessive need to control calorie intake may also occur.

Anorexia vs bulimia

With bulimia, a person may have an average weight or be overweight. Bulimia involves repeated episodes of binge eating followed by compensatory behaviors intended to prevent weight gain.

With anorexia nervosa, a person severely restricts food intake, leading to a significantly low body weight for their age, sex, and physical health.

Common causes

According to the National Institute of Mental Health, bulimia nervosa does not have one clearly defined cause. It is thought to develop through a combination of genetic, biological, behavioral, psychological, and social factors, including body-image pressure and influences from the media, family members, or peers.

A person with bulimia may feel deeply dissatisfied with their body and experience episodes of binge eating marked by a loss of control. These episodes may be followed by guilt and compensatory behaviors intended to prevent weight gain, such as self-induced vomiting, laxative misuse, fasting, or excessive exercise.

Potential complications

The complications of bulimia vary depending on the compensatory behavior used after eating, but they may include:

• Acid reflux and stomach ulcers

• Dehydration, dry skin, hair loss, and brittle nails

• Swollen salivary glands around the jaw and cheeks, along with tooth damage

• Missed periods or changes in the menstrual cycle

• Depression and mood changes

• Insomnia, tiredness, and weakness

• Intestinal inflammation and chronic constipation

• Muscle spasms

Bulimia may also affect bone health, increasing the risk of osteoporosis. It can also increase the risk of heart and kidney problems and, in some cases, lung complications.

To help prevent complications, bulimia should be diagnosed and treated by a multidisciplinary healthcare team that may include a psychologist, psychiatrist, and registered dietitian.

Treatment options

Treatment for bulimia should involve a coordinated care team that may include a psychologist or psychiatrist, a registered dietitian, and a medical provider.

Treatment focuses on improving eating patterns, developing a healthier relationship with food, reducing compensatory behaviors, and monitoring any physical complications.

1. Cognitive behavioral therapy

Cognitive behavioral therapy, or CBT, is an evidence-based treatment for bulimia nervosa. It helps a person identify and change unhelpful thoughts, emotions, and behaviors related to eating, body shape, and weight, while developing strategies to reduce binge eating and compensatory behaviors.

Therapy may also address personal relationships, stressful experiences, grief, or major life changes when these factors affect the person’s symptoms or recovery. Support from family members and friends may also be helpful, particularly for adolescents.

The frequency and length of therapy depend on the person’s needs and the treatment plan. Individual CBT is commonly used, although group therapy may also be recommended in some cases so participants can share experiences and support one another.

2. Nutritional counseling

Nutritional counseling is an important part of bulimia treatment. It helps answer questions about food and nutrition and teaches the person how to establish regular, balanced eating patterns without excessive restriction.

Nutritional counseling also supports a healthier relationship with food. A registered dietitian with experience treating eating disorders can create an individualized eating plan that considers the person’s nutritional needs, preferences, lifestyle, and treatment goals.

The eating plan may also address any nutritional deficiencies caused by restrictive eating or purging. In some cases, a healthcare professional or registered dietitian may recommend vitamin or mineral supplements, although most nutrients should come from food whenever possible.

3. Medication

Medication may be included in the treatment of bulimia, even when the person does not have another mental health condition. According to the American Psychiatric Association, adults with bulimia are usually treated with cognitive behavioral therapy focused on eating disorders, along with an antidepressant medication.

Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is FDA-approved for the treatment of bulimia nervosa. It may help reduce the frequency of binge-eating episodes and compensatory behaviors and may also improve co-occurring symptoms of depression or anxiety.

Medication should be prescribed and monitored by a psychiatrist or another qualified health care professional. Regular follow-up appointments allow the clinician to evaluate the response to treatment, monitor side effects, and adjust the treatment plan when necessary.