About Eating Disorders

What Is Bulimia Nervosa?

Bulimia nervosa is characterized by recurrent binge eating episodes and persistent, inappropriate compensatory behaviors with the hope of avoiding weight gain. Binge eating episodes involve eating, in a discrete period of time, an amount of food that is objectively larger than most individuals would eat in a similar period of time under similar circumstances. Such episodes of bulimia are accompanied by feelings of self-loathing, disgust, or guilt and a sense of lack of control. Individuals engage in often dangerous compensatory behaviors that may include purging, fasting, compulsive exercise, and/or the use of laxatives or diuretics. Individuals with bulimia nervosa may appear healthy, even though they are very ill. Additionally, their self-concept is unduly influenced by body weight and shape.

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What causes bulimia nervosa?

Like all eating disorders, bulimia nervosa develops over a period of time as a result of a complicated blend of genetic, biological, and environmental factors. There is no single cause to point to and, despite common misconceptions, families and communities of support are not to blame. In fact, they are often recovery’s strongest ally. Many individuals have genetic predispositions to bulimia nervosa that, depending on environmental influences, may or may not be awakened over the course of their lifetime. Communities of color are disproportionately affected by bulimia nervosa.

Malnutrition-induced changes in physiological processes and altered hunger and fullness signals
Experiencing a traumatic event may tip someone into bulimia
Genetic predisposition and societal pressures (e.g., drive for thinness)
Lack of environmental control and persistent, extreme stress, or minority stress can lead to bulimia

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What should you look for if you worry that someone has bulimia nervosa?

Being familiar with the signs and symptoms of bulimia nervosa can help you champion early intervention and recovery through bulimia nervosa treatment. Watch for elusive behaviors around mealtimes, inflammation around the mouth and knuckles, exercise-routine rigidity, hiding food, and/or immediately going to the bathroom after a meal. Associated disorders, or “comorbidities,” include major depressive disorder, post-traumatic stress disorder, bipolar I and II disorder, attention-deficit/hyperactivity disorder, and substance use disorder.

Inappropriate conflation of body weight and shape with identity can be a sign of someone struggling with bulimia
Distorted body image and fear of weight gain
Eating alone or in secret and consistent retreats after meals is often characteristic of bulimia
Extreme exercise-routine rigidity, refusal to hydrate, and overuse injuries
Abrasions or scars on knuckles, inflammation around mouth, and burst blood vessels in eyes often accompany bulimia

What are the risk of bulimia nervosa?

Bulimia nervosa can have extreme medical and physiological consequences that may or may not resolve completely during recovery.

Dangerous, potentially lethal electrolyte imbalances
Bulimia can result in impaired decision-making and impulse control
Delayed wound healing
Tooth decay, muscle fatigue, and irregular bowel activity
Heart palpitations, low pulse, and low blood pressure may be consequences of bulimia
In males: decreased frequency of erections and nocturnal emissions
In females: polycystic ovarian syndrome, endometrial cancer, amenorrhea, difficulty conceiving, and if pregnant, increased risk for miscarriage and postpartum depression

How does purging (a prominent behavior of bulimia nervosa) affect the mouth?

Vomiting brings acids that are normally confined to the stomach into contact with the soft tissues in the mouth. This can irritate saliva glands and cause swelling around the jaw and cheeks.

Additionally, painful sores on the roof of the mouth, inner cheeks, inner lips, throat, and tongue are also common. Such sores can swell up and become infected.

Dry mouth may also develop, which, when combined with mouth sores, can be incredibly painful. Plus, dry mouth can make it harder for someone with bulimia to enjoy food because it can change food’s texture and taste.

Continual vomiting can also seriously damage teeth. Stomach acid corrodes the enamel that protects teeth. It also discolors teeth, leaving them with a yellow tint. When enamel wears away, a cavity could appear. Subsequent vomiting will then be even more detrimental to teeth that are already vulnerable due to cavities. It’s a vicious cycle. Ultimately, if a cavity isn’t filled, the tooth may loosen and fall out.

The purging associated with bulimia nervosa puts the gums at risk, too. Gingivitis often develops from frequent vomiting. This is when the gums become sensitive, red, inflamed, and likely to bleed during brushing or even from contact with tough foods. If gingivitis persists long enough, the gums may become so unhealthy that they can no longer anchor teeth effectively.

How does bulimia nervosa affect the heart and kidneys?

The frequent purging associated with bulimia nervosa often causes dehydration; furthermore, purging disrupts the balance of electrolytes in the body and puts undue strain on the heart. These factors increase the risk of heart attack or seizure.

People with an eating disorder (such as bulimia nervosa), are five times more likely to have a heart attack and six times more likely to have coronary artery disease than those without an eating disorder. The strain of repeated purging can even lead to an irregular heartbeat. Prolonged dehydration, too, has long term effects: urinary tract infections, kidney stones, and even kidney failure, which could be fatal.

How does the repeated vomiting of bulimia nervosa affect the endocrine system?

Purging can interfere with the proper flow of hormones throughout the body. This can mean comparatively minor problems such as fatigue; however, hormone imbalances can also impede libido and disrupt menstrual cycles. Females may stop regularly releasing eggs. Males may experience a reduction or outright cessation of sperm production. Drastic hormonal changes brought about by continual vomiting can lead to infertility.

The purging characteristic of bulimia nervosa is especially dangerous during pregnancy. Dire complications can occur: miscarriage, premature birth, breech birth, birth defects, higher risk of cesarean delivery, and stillbirth. After birth, the mother may struggle with breastfeeding and weight gain, which in turn can cause stress that only exacerbates the cycle of bingeing and purging.

How can you recover from bulimia nervosa?

If you or a loved one are struggling with binge eating and purging, don’t wait to reach out for help. The earlier bulimia is treated, the better the outcomes tend to be.

At Veritas Collaborative, we work with you to create an individualized care plan so you or your child with bulimia get the right treatment at the right time. We offer a full continuum of care, which includes inpatient, residential, partial hospitalization (PHP), intensive outpatient (IOP), outpatient, and virtual programs for children, adolescents, and adults. This allows us to provide best-in-class care and support throughout your recovery journey, even as your needs change. Our treatment programs focus on real-life skills, including hands-on nutrition and culinary experiences that you can take with you for lasting recovery. We encourage family involvement and offer family-based therapy and educational support for children and adolescents.

Key Takeaways

Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors, such as self-induced vomiting or excessive exercise.
The exact causes of bulimia nervosa are unknown, but it is believed to be caused by a combination of genetic, environmental, and psychological factors.
Bulimia nervosa can have serious physical and psychological consequences, including electrolyte imbalances, gastrointestinal problems, depression, and anxiety.
Treatment for bulimia nervosa typically involves a combination of therapy, medication, and nutrition counseling.
Recovery from bulimia nervosa is possible with appropriate help at an eating disorder treatment center, and it is important to seek help as soon as possible if you or someone you know is struggling with this disorder.

Updated March 2023

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