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Bulimia Nervosa


The Manual's Editorial Staff

Reviewed/Revised Jan 2024
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What is bulimia?

Bulimia is an eating disorder in which you:

  • Eat lots of food at one time (binge)

  • Then do things to make up for overeating (purge)

To make up for overeating, most people make themselves throw up and exercise heavily. However, some people take laxatives to give themselves diarrhea. Or they may take water pills (diuretics) to make themselves urinate. Usually, they end up pretty close to an average weight.

Bulimia usually starts in the teen or young adult years and is more common in girls and women. It may be caused by social pressures to be thin. Bulimia may run in your family.

What are the symptoms of bulimia?

The main symptom is repeated binge eating and purging.

When you binge, you may:

  • Eat much more food at one time than most people, sometimes several times a day

  • Eat when you aren't hungry

  • Eat so much that you have belly pain

  • Eat in secret and feel that your eating is out of control

  • Often eat sweet, high-fat foods (like cake and ice cream)

  • Feel very guilty about eating too much

After binge eating, you may purge to make up for having eaten too much, so you may:

  • Force yourself to throw up

  • Take laxatives to make yourself have a bowel movement (poop)

  • Not eat at all (fasting) or diet too much

  • Exercise too much

You pay more attention to your weight and body shape than you should. You often feel badly about how your body looks even when other people think you look fine.

Unlike in other eating disorders, people with bulimia are often an average weight. But their weight may go up and down more than normal.

Can bulimia cause other problems?

Yes. Purging to make up for overeating can hurt your body. If you purge a whole lot, you can become sick and even die. Making yourself throw up a lot can cause:

  • Scars on your knuckles from putting your fingers down your throat to force yourself to throw up

  • Damage to your teeth from stomach acid

  • Swelling of the glands in your cheeks

  • Damage to your esophagus (the tube connecting your mouth to your stomach) from stomach acid

  • Rarely, tearing of your stomach or esophagus, which can be life-threatening

Taking too many laxatives or water pills and throwing up too much all can throw off the chemical balance in your body. The abnormal chemical balance can badly affect your heart rhythm.

How can doctors tell if I have bulimia?

Doctors do a physical exam to look for the symptoms of bulimia. Doctors will diagnose bulimia if you:

  • Base your self-image largely on your weight and shape

  • Binge eat at least once a week for 3 months

  • Purge to make up for overeating by doing such things as throwing up

How do doctors treat bulimia?

Doctors treat bulimia with counseling and medicines.

Counseling can be one-on-one with a therapist or in a group. The goals are:

  • To motivate you to change

  • To establish a regular and flexible pattern of eating

  • To lessen your focus on body weight and shape

Doctors may also prescribe a type of antidepressant medicine to help lessen how often you binge and purge. This medicine also treats anxiety and depression, which are common in people with bulimia.

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