Bulimia nervosa: Causes, Risk Factors, Symptoms, Treatment

Bulimia nervosa

Bulimia Nervosa, also known as bulimia is derived from a Greek word ‘boulimia’ defining ‘ravenous hunger’. It is an eating disorder characterized by uncontrolled bingeing/episodes of overeating/overfeeding followed by intentional purging, either though vomiting or laxative use. Besides, non-purging methods include excessive exercise or fasting. The purging cycles can occur from several times a day to several times a week. A Person with this eating disorder usually falls under normal BMI or above normal BMI. Diagnosing patients with this disorder is usually challenging as they won’t exhibit any classical symptoms in the initial stages. Also, many people with bulimia don’t seek a medical help until they reach the ages of 30 or 50. According to National Comorbidity Survey Replication (2001- 2003), Occurrence of Bulimia was 2-fold high among females (1.6%) than males (0.8%). The exact cause of Bulimia nervosa is unknown. People with this disorder usually come from families with the same history, or a known history of physical or mental illness and people undergoing body shaming/any sort of judgments about physical appearance. Early treatment can prevent serious complications like Malnutrition. Severity of this disorder might lead to morbidity and mortality and the malnutrition affects every organ in the body. Therapy/Treatment for bulimia nervosa looks at the link between the behavior, thoughts and feelings of the patient. Usually anti-depressants or anti-anxiety medications can help in case of depression/anxiety. Moral support from family, friends and health care professionals can delay the progression of this health condition.

Risk Factors of Bulimia Nervosa

If you suspect you or someone else is experiencing Bulimia Nervosa, it is crucial to seek immediate medical attention by calling emergency services or consult with a Nutritionist.


Bulimia nervosa, a serious eating disorder, is influenced by a combination of factors that contribute to its development. Understanding the causes behind this disorder is crucial in order to effectively address and treat it. One of the main causes of bulimia nervosa is believed to be psychological factors. Individuals with low self-esteem, body dissatisfaction, and perfectionistic tendencies are more susceptible to developing this disorder. The pressure to meet societal beauty standards and the desire for control can also play a significant role in triggering bulimic behaviors. Additionally, environmental factors can contribute to the development of bulimia nervosa. Cultural influences that emphasize thinness as an ideal body type, as well as exposure to media promoting unrealistic beauty standards, can contribute to body image dissatisfaction and disordered eating patterns. Biological factors may also play a role in the development of bulimia nervosa. Research suggests that individuals with a family history of eating disorders or other mental health conditions may be at higher risk for developing this disorder. Furthermore, imbalances in brain chemicals such as serotonin may contribute to the onset and maintenance of bulimic behaviors. It is important to note that these causes are multifaceted and interact with each other in complex ways. A comprehensive understanding of these causes is essential for effective prevention strategies and treatment approaches for individuals struggling with bulimia nervosa.

Risk Factors

There are several risk factors associated with the development of bulimia nervosa, including:

Genetics and Family History: There is evidence suggesting a genetic predisposition to eating disorders. Individuals with a family history of eating disorders or other mental health conditions may be at a higher risk.

Psychological Factors: Certain psychological and emotional factors can contribute, such as low self-esteem, perfectionism, body dissatisfaction, anxiety, depression, and difficulty coping with stress or emotions.

Sociocultural Influences: Pressures from societal or cultural expectations regarding body image, beauty standards, and the idealization of thinness can significantly impact the development of bulimia nervosa, especially in cultures where these ideals are prominent.

Traumatic Experiences: Trauma, abuse (physical, emotional, or sexual), neglect, or other adverse experiences during childhood or adolescence can increase the risk of developing eating disorders, including bulimia.

Dieting and Weight-Centric Behaviors: Engaging in strict dieting, weight loss attempts, or participating in activities that emphasize weight and appearance can contribute to the development of bulimia nervosa.

Biological Factors: Certain biological factors, such as hormonal imbalances or irregularities in brain chemicals (neurotransmitters), may play a role in the development of eating disorders, including bulimia nervosa.

Personality Traits: Certain personality traits, like impulsivity or a tendency towards obsessive thinking, may contribute to the development or maintenance of bulimia nervosa.


Symptoms of bulimia can be categorized into several areas:

Binge eating: Individuals with bulimia often consume large amounts of food in a discrete period, feeling a lack of control over their eating during these episodes. Binges are typically accompanied by feelings of guilt, shame, and distress.

Compensatory behaviors: Following a binge, individuals may engage in various activities to compensate for the caloric intake and prevent weight gain. These can include self-induced vomiting, misuse of laxatives, diuretics, fasting, or excessive exercise.

Concern with body weight and shape: People with bulimia often place an excessive emphasis on their body weight and shape, leading to a distorted self-image. Their self-esteem is often closely tied to their perceptions of weight and shape.

Physical signs and symptoms: These can include frequent fluctuations in weight, swollen cheeks or glands (from repeated vomiting), dental erosion or cavities, esophageal inflammation, gastrointestinal problems, dehydration, electrolyte imbalances, and irregular menstrual periods in females.

Emotional and behavioral signs: Individuals with bulimia may exhibit mood swings, anxiety, depression, feelings of guilt or shame related to eating behaviors, social withdrawal, secrecy about eating habits, and a preoccupation with food, calories, and dieting.

Physical complications: Bulimia can lead to severe health complications over time, such as electrolyte imbalances (which can affect the heart), digestive problems, dehydration, chronic sore throat, dental issues, and in severe cases, it can be life-threatening.

Need an Appointment?


Diagnosis involves several key criteria:

Recurrent episodes of binge eating: Binge eating involves eating a larger amount of food than most individuals would eat during a similar period, accompanied by a feeling of lack of control over eating.

Compensatory behaviors: Recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, fasting, or excessive exercise.

Frequency: Binge eating and compensatory behaviors occur, on average, at least once a week for three months.

Self-image: Excessive emphasis on body shape or weight in self-evaluation.

Not exclusively during episodes of anorexia nervosa: The behaviors do not exclusively occur during episodes of anorexia nervosa.

Severity: The disturbance does not occur exclusively during episodes of bulimia nervosa and is not better explained by another mental health disorder.


Treatment for bulimia nervosa typically involves a combination of therapies, including psychotherapy, nutritional counseling, and sometimes medications. Here are some common approaches to treating bulimia nervosa:

  1. Psychotherapy/Counseling:

    • Cognitive-Behavioral Therapy (CBT): This is often considered the most effective treatment for bulimia nervosa. CBT helps individuals recognize and change their unhealthy patterns of thinking and behavior.
    • Interpersonal Psychotherapy (IPT): Focuses on addressing interpersonal issues and relationship problems that may contribute to bulimia.
    • Dialectical Behavior Therapy (DBT): Helps individuals regulate their emotions, improve interpersonal skills, and manage distress.
  2. Nutritional Counseling:

    • Working with a registered dietitian or nutritionist to establish healthy eating patterns and habits is crucial. This involves learning about proper nutrition and establishing regular, balanced meal plans.
  3. Medications:

    • Sometimes, medications such as antidepressants (e.g., selective serotonin reuptake inhibitors - SSRIs) may be prescribed to help manage symptoms like depression or anxiety that often coexist with bulimia nervosa. However, medication alone is not usually sufficient for treating bulimia.
  4. Hospitalization or Residential Treatment: In severe cases or when there's a risk of serious health complications, hospitalization or residential treatment programs might be necessary to stabilize the individual and provide intensive therapy and monitoring.

  5. Support Groups: Joining support groups or attending group therapy sessions can provide valuable peer support and encouragement from others who understand what it's like to deal with bulimia.

  6. Family-Based Treatment: Especially for adolescents, involving family members in treatment can be beneficial. Family therapy can help address family dynamics that may contribute to the disorder.

Preventive Measures

Preventing bulimia nervosa involves fostering a supportive environment that promotes healthy body image, self-esteem, and balanced attitudes towards food and weight. Early education about body diversity, nutrition, and the dangers of extreme dieting can help individuals develop a positive relationship with food. Encouraging open communication within families, schools, and communities about the importance of mental health, self-care, and seeking professional help for emotional distress or disordered eating behaviors can play a pivotal role in prevention. Additionally, creating awareness about societal pressures, unrealistic beauty standards, and the harmful effects of media portrayal of 'ideal' bodies can aid in building resilience against triggers that may contribute to the development of bulimia nervosa. Ultimately, a multifaceted approach that involves education, supportive environments, and promoting mental health awareness is crucial in preventing the onset of this eating disorder.

Do's & Don’t's

Do's Don't
Seek professional help and support. Avoid discussing weight or appearance.
Encourage open and non-judgmental communication. Don't shame or blame the individual for their struggles.
Educate yourself about Bulimia Nervosa and its effects. Avoid making comments on food choices or eating habits.
Offer emotional support and empathy. Don't force the individual to eat or follow a specific diet.
Encourage a healthy and balanced lifestyle. Avoid focusing solely on the symptoms or behaviors.
Support them in seeking therapy or counseling. Don't ignore or dismiss warning signs or behaviors.
Help create a supportive environment. Avoid making jokes or derogatory remarks about eating disorders.
Encourage self-care and positive coping mechanisms. Don't pressure them to "just stop" their behaviors.
Practice patience and understanding. Avoid enabling harmful behaviors.
Foster a sense of trust and confidentiality. Don't try to control or micromanage their eating.

If you suspect you or someone else is experiencing Bulimia Nervosa, it is crucial to seek immediate medical attention by calling emergency services or consult with a Nutritionist.

Frequently Asked Questions
Bulimia nervosa is an eating disorder characterized by recurrent episodes of overeating followed by compensatory behaviors, such as self-induced vomiting, excessive exercise, or the use of laxatives.
Symptoms may include binge eating, self-induced vomiting, misuse of laxatives or diuretics, excessive exercise, preoccupation with body weight and shape, and feelings of guilt or shame about eating.
While anyone can develop bulimia, it often begins in adolescence or early adulthood. Risk factors include a history of dieting, low self-esteem, perfectionism, and societal pressure to meet certain body standards.
Diagnosis typically involves a comprehensive assessment by a healthcare professional, including a physical examination, discussion of symptoms, and possibly psychological assessments. Criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are often used.
Bulimia can lead to various health issues, including electrolyte imbalances, gastrointestinal problems, dental issues, cardiovascular complications, and mental health issues such as depression and anxiety.
Treatment often involves a combination of psychotherapy, nutritional counseling, and medical management. Cognitive-behavioral therapy (CBT) has shown effectiveness in treating bulimia. In severe cases, hospitalization may be necessary.
While prevention strategies may not guarantee that someone will not develop bulimia, promoting a healthy body image, fostering self-esteem, and addressing societal pressures can contribute to reducing the risk.
Yes, recovery is possible with appropriate treatment and support. It may involve a combination of therapy, nutritional counseling, and medical management. The earlier the intervention, the better the prognosis.
Offering non-judgmental support, encouraging the individual to seek professional help, and learning about the disorder can be helpful. Avoiding comments about appearance and food can contribute to a positive environment.
Seeking help from a healthcare professional, such as a doctor, therapist, or nutritionist, is crucial. Local mental health hotlines and organizations specializing in eating disorders can provide resources and support.
Share With:

Related Diseases