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Bulimia Nervosa

Signs, Symptoms, Treatment, and Help

Bulimia Nervosa In This Article

We've all been there: turning to food when feeling lonely, bored, or stressed. But with bulimia, overeating is more like a compulsion. And instead of eating sensibly to make up for it, you punish yourself by purging, fasting, or exercising to get rid of the calories. This vicious cycle of bingeing and purging takes a toll on your body and emotional well-being. But the cycle can be broken. You can develop a healthier relationship with food and overcome your feelings of anxiety, guilt, and shame.

What is bulimia?

Bulimia nervosa is an eating disorder characterized by frequent episodes of binge eating, followed by frantic efforts to avoid gaining weight. It affects men and women of all ages.

When you’re struggling with bulimia, life is a constant battle between the desire to lose weight or stay thin and the overwhelming compulsion to binge eat.

You don't want to binge—you know you'll feel guilty and ashamed afterwards—but time and again you give in. After the binge ends, panic sets in and you turn to drastic measures to "undo" your overeating, such as taking ex-lax, vomiting, or going for an intense run. Meanwhile, you feel increasingly out of control.

Not all bulimics purge

It’s important to note that bulimia doesn’t necessarily involve purging: physically eliminating the food from your body by throwing up or using laxatives, enemas, or diuretics.

If you make up for your binges by fasting, exercising to excess, or going on crash diets, this also qualifies as bulimia.

Are you bulimic?

  • Are you obsessed with your body and your weight?
  • Does food and dieting dominate your life?
  • Are you afraid that when you start eating, you won’t be able to stop?
  • Do you ever eat until you feel sick?
  • Do you feel guilty, ashamed, or depressed after you eat?
  • Do you vomit or take laxatives to control your weight?

Signs and symptoms of bulimia

If you’ve been living with bulimia for a while, you’ve probably "done it all" to conceal your bingeing and purging habits. It’s only human to feel ashamed about having a hard time controlling yourself with food, so you most likely binge alone. If you eat a box of doughnuts, then you’ll replace them so your friends or family won’t notice. When buying food for a binge, you might shop at four separate markets so the checker won’t guess. But despite your secret life, those closest to you probably have a sense that something is not right.

Binge eating signs and symptoms

  • Lack of control over eating – Inability to stop eating. Eating until the point of physical discomfort and pain.
  • Secrecy surrounding eating – Going to the kitchen after everyone else has gone to bed. Going out alone on unexpected food runs. Wanting to eat in privacy.
  • Eating unusually large amounts of food with no obvious change in weight.
  • Disappearance of food, numerous empty wrappers or food containers in the garbage, or hidden stashes of junk food.
  • Alternating between overeating and fasting – Rarely eats normal meals. It’s all-or-nothing when it comes to food.

Purging signs and symptoms

  • Going to the bathroom after meals – Frequently disappears after meals or takes a trip to the bathroom to throw up. May run the water to disguise sounds of vomiting.
  • Using laxatives, diuretics, or enemas after eating. May also take diet pills to curb appetite or use the sauna to “sweat out” water weight.
  • Smell of vomit – The bathroom or the person may smell like vomit. They may try to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.
  • Excessive exercising – Works out strenuously, especially after eating. Typical activities include high-intensity calorie burners such as running or aerobics.

Physical signs and symptoms of bulimia

  • Calluses or scars on the knuckles or hands from sticking fingers down the throat to induce vomiting.
  • Puffy “chipmunk” cheeks caused by repeated vomiting.
  • Discolored teeth from exposure to stomach acid when throwing up. May look yellow, ragged, or clear.
  • Not underweight – Men and women with bulimia are usually normal weight or slightly overweight. Being underweight while purging might indicate a purging type of anorexia.
  • Frequent fluctuations in weight – Weight may fluctuate by 10 pounds or more due to alternating episodes of bingeing and purging.

Bulimia causes and effects

There is no single cause of bulimia. While low self-esteem and concerns about weight and body image play major roles, there are many other contributing causes. In most cases, people suffering with bulimia—and eating disorders in general—have trouble managing emotions in a healthy way. Eating can be an emotional release so it’s not surprising that people binge and purge when feeling angry, depressed, stressed, or anxious.

Risk factors for bulimia include:

  • Poor body image, particularly when paired with strict dieting.
  • Low self-esteem: Things that can contribute to low self-esteem include depression, perfectionism, and a critical home environment.
  • Stressful life changes, such as a breakup, going away to college, starting a new job, or going through puberty.
  • History of trauma or abuse: This includes things such as sexual assault, childhood neglect or abuse, troubled family relationships, and the death of a loved one.

Effects of bulimia

When you are living with bulimia, you are putting your body—and even your life—at risk. The most dangerous side effect of bulimia is dehydration due to purging.

Vomiting, laxatives, and diuretics can cause electrolyte imbalances in the body, most commonly in the form of low potassium levels. Low potassium levels trigger a wide range of symptoms ranging from lethargy and cloudy thinking to irregular heartbeat and death. Chronically low levels of potassium can also result in kidney failure. Using ipecac syrup is also very dangerous, and can cause sudden death.

How bulimia affects your body

Source: National Women's Health Information Center

Getting help for bulimia

If you are living with bulimia, you know how scary it feels to be so out of control. Knowing that you are harming your body just adds to the fear. But recovery is possible. Regardless of how long you’ve struggled with bulimia, you can learn to break the binge and purge cycle and develop a healthier attitude toward food and your body.

Steps to bulimia recovery

  • Admit you have a problem. Up until now, you’ve been invested in the idea that life will be better—that you’ll finally feel good—if you lose more weight and control what you eat. The first step in bulimia recovery is admitting that your relationship to food is distorted and out of control.
  • Talk to someone. It can be hard to talk about what you’re going through, especially if you’ve kept your bulimia a secret for a long time. You may be ashamed, ambivalent, or afraid of what others will think. But it’s important to understand that you’re not alone. Find a good listener—someone who will support you as you try to get better.
  • Stay away from people, places, and activities that trigger the temptation to binge or purge. You may need to avoid looking at fashion or fitness magazines, spend less time with friends who constantly diet and talk about losing weight, and stay away from weight loss web sites and "pro-mia" sites that promote bulimia. You may also need to be careful when it comes to meal planning and cooking magazines and shows.
  • Seek professional help. The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.

If you or a loved one has bulimia…

Call the National Eating Disorders Association’s toll-free hotline at 1-800-931-2237 for free referrals, information, and advice.

Bulimia recovery tip 1: Break the binge and purge cycle

Binge and Purge Cycle

The first step in bulimia recovery is stopping the vicious cycle of bingeing and purging. In order to do this, it’s essential that you quit trying to diet.

Dieting triggers bulimia’s destructive cycle of bingeing and purging. The irony is that the stricter the diet, the more likely it is that you’ll become preoccupied, even obsessed, with food. When you starve yourself, your body responds with powerful cravings—its way of asking for needed nutrition.

As the tension, hunger, and feelings of deprivation build, the compulsion to eat becomes too powerful to resist: a "forbidden" food is eaten; a dietary rule is broken. With an all-or-nothing mindset, you feel any diet slip-up is a total failure. After having a bite of ice cream, you might think, "I’ve already blown It, so I might as well go all out."

Unfortunately, the relief that bingeing brings is extremely short-lived. Soon after, guilt and self-loathing set in. And so you purge to make up for bingeing and regain control.

But purging only reinforces binge eating. Though you may tell yourself this is the last time, in the back of your mind there’s a voice saying you can always throw up or use laxatives if you lose control again. However, purging doesn’t come close to wiping the slate clean after a binge.

Purging does NOT prevent weight gain

Purging isn’t effective at getting rid of calories, which is why most people suffering with bulimia end up gaining weight over time. Vomiting immediately after eating will only eliminate 50% of the calories consumed at best—and usually much less. This is because calorie absorption begins the moment you put food in the mouth. Laxatives and diuretics are even less effective. Laxatives get rid of only 10% of the calories eaten, and diuretics do nothing at all. You may weigh less after taking them, but that lower number on the scale is due to water loss, not true weight loss

Bulimia recovery tip 2: Develop a healthier relationship to food

As explained above, treatment for bulimia is much more likely to succeed when you stop dieting. Once you stop trying to restrict calories and follow strict dietary rules, you will no longer be overwhelmed with cravings and thoughts of food. By eating normally, you can break the binge-and-purge cycle and still reach a healthy, attractive weight.

  • Pay attention to your hunger. Don’t wait until you’re starving. This only leads to overeating! Eat as soon as you notice you’re feeling moderately hungry.
  • Eat regularly. Don’t skip meals. Try not to let over 4 hours pass without a meal or snack.
  • Don’t restrict foods. When something is off limits, it becomes more tempting. Instead of saying “I can never eat ice cream,” say “I will eat ice cream as an occasional treat.”
  • Focus on what you’re eating. How often have you binged in an almost trance-like state, not even enjoying what you’re consuming? Instead of eating mindlessly, be a mindful eater. Slow down and savor the textures and flavors. Not only will you eat less, you’ll enjoy it more.

Bulimia recovery tip 3: Learn to tolerate unpleasant feelings

While bingeing is often triggered by overly strict dieting that backfires, it can also be a way to control or numb unpleasant moods or feelings.

The next time you feel the urge to binge, ask yourself if there’s something else going on. Is there an intense feeling you’re trying to avoid? Are you eating to calm down, comfort yourself, or to relieve boredom? If so, instead of using food as a distraction, take a moment to stop whatever you’re doing and investigate what’s going on inside.

  • Identify the emotion you’re feeling. Do your best to name what you’re feeling. Is it anxiety? Shame? Hopelessness? Anger? Loneliness? Fear? Emptiness?
  • Accept the experience you’re having. Avoidance and resistance only make negative emotions stronger. Instead, try to accept what you’re feeling without judging it or yourself.
  • Dig deeper. Explore what’s going on. Where do you feel the emotion in your body? What kinds of thoughts are going through your head?
  • Distance yourself. Realize that you are NOT your feelings. Emotions are passing events, like clouds moving across the sky. They don’t define who you are.

Sitting with your feelings may feel extremely uncomfortable at first. Maybe even impossible. But as you resist the urge to binge, you’ll start to realize that you don’t have to give in. There are other ways to cope. Even emotions that feel intolerable are only temporary. They’ll quickly pass if you stop fighting them. You’re still in control. You can choose how to respond.

For a step-by-step guide to learning how to manage stress and uncomfortable emotions, check out Helpguide’s free Emotional Intelligence Toolkit.

Bulimia recovery tip 4: Challenge dysfunctional thoughts

The bingeing and purging of bulimia is often fueled by dysfunctional, self-sabotaging ways of thinking that undermine your confidence, color everything in an unrealistically negative light, and make you feel helpless, inadequate, and ashamed. The good news: you can learn to put a stop to these unhealthy mental habits.

Damaging mindsets that fuel bulimia

  • All-or-nothing thinking. You have a hard time seeing shades of gray, at least when it comes to yourself. If you’re not perfect, you’re a total failure and might as well binge.
  • Emotional reasoning. You believe if you feel a certain way, it must be true. “I feel fat” means “I am fat.” “I feel hopeless” means you’ll never get better.
  • Musts, must-nots, and have-tos. You hold yourself to a rigid set of rules (“I must not eat such and such a food,” “I have to get straight A’s,” “I must always be in control.” etc.) and beat yourself up if you break them.
  • Labeling. You label yourself and call yourself names based on mistakes and perceived shortcomings. “I’m unhappy with how I look” becomes “I’m disgusting.” Slipping up becomes “I’m a loser” or a “failure.”
  • Catastrophizing. You jump to the worst-case scenario. If you backslide in recovery, for example, you assume that there’s no hope you’ll ever get better.

Put your thoughts on the witness stand

Once you identify the destructive thoughts patterns that you default to, you can start to challenge them with questions such as:

  • “What’s the evidence that this thought is true? Not true?”
  • “What would I tell a friend who had this thought?”
  • “Is there another way of looking at the situation or an alternate explanation?”
  • “How might I look at this situation if I didn’t have bulimia?”
  • As you cross-examine your negative thoughts, you may be surprised at how quickly they crumble. In the process, you’ll develop a more balanced perspective.

Helping a person with bulimia

If you suspect that your friend or family member has bulimia, talk to the person about your concerns. Your loved one may deny bingeing and purging, but there’s a chance that he or she will welcome the opportunity to open up about the struggle.

Either way, bulimia should never be ignored. The person’s physical and emotional health is at stake. While you can’t force anyone to get better, there are things you can do to help.

If your loved one has bulimia

  • Offer compassion and support. Keep in mind that the person may get defensive or angry. But if he or she does open up, listen without judgment and make sure the person knows you care.
  • Avoid insults, scare tactics, guilt trips, and patronizing comments. Since bulimia is often caused and exacerbated by stress, low self-esteem, and shame, negativity will only make it worse.
  • Set a good example for healthy eating, exercising, and body image. Don’t make negative comments about your own body or anyone else’s.
  • Accept your limits. As a parent or friend, there isn’t a lot you can do to “fix” your loved one’s bulimia. The person with bulimia must make the decision to move forward.
  • Take care of yourself. Know when to seek advice for yourself from a counselor or health professional. Dealing with an eating disorder is stressful, and it will help if you have your own support system in place.

If you want tools for learning how to feel better about yourself and others, FEELING LOVED can help.

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Resources and references

Generation information about bulimia

Bulimia Nervosa – Reference article on the signs, symptoms, causes, and treatment of bulimia. Includes information on complementary and alternative therapies. (University of Maryland Medical Center)

Eating Disorders: Anorexia and Bulimia – An easy-to-understand article, written for teens. Discusses symptoms, causes, effects, and treatment. (TeensHealth)

Bulimia Nervosa – Covers the self-esteem and emotional issues underlying bulimia, as well as the signs, symptoms, and diagnostic criteria. (The Something Fishy Website on Eating Disorders)

Effects of bulimia

Health Problems Resulting from Eating Disorders – Overview of the effects of bulimia, severe dieting. purging, and laxative use. (Somerset and Wessex Eating Disorders Association)

Vomiting and Your Health (PDF) – Fact sheet on the dangers of chronic vomiting. Includes myths about self-induced vomiting. (Centre for Clinical Interventions)

Bulimia causes and risk factors

Understanding Eating Disturbances and Disorders – A helpful guide geared towards family and friends wanting insight into the psychology behind bulimia and other eating disorders. (University of Illinois McKinley Health Center)

Factors That May Contribute to Eating Disorders – Learn about the different factors that may contribute to bulimia and other eating disorders. (National Eating Disorders Association)

Bulimia treatment and recovery

Promising Treatments for Anorexia and Bulimia – Article from Monitor on Psychology on effective treatments for bulimia and anorexia. (American Psychological Association)

Bulimia Nervosa Resource Guide – Provides information on treatment options for bulimia, maximizing health insurance benefits for bulimia, and finding a treatment center. (ECRI Institute)

Finding bulimia treatment providers

Eating Disorder Treatment Finder – Searchable directory of eating disorder treatment providers, including doctors, therapists, dieticians, and support groups. (The Something Fishy Website on Eating Disorders)

EDReferral.com – Comprehensive, easy-to-search database of eating disorder and bulimia treatment providers. (The Eating Disorder Referral and Information Center)

Information & Referral Helpline – Eating disorders helpline offers advice and referrals. Includes an online directory of treatment providers and support groups. (National Eating Disorders Association)

Authors: Melinda Smith, M.A. and Jeanne Segal, Ph.D. Last updated: April 2016.