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Bulimia Nervosa

Bulimia nervosa, commonly referred to as “bulimia,” is an eating disorder characterized by episodes of eating that feel out of control (binge eating) and purging (compensating to get rid of the extra calories from food). Bulimia differentiates from binge eating disorder (BED) when consistent purging episodes occur. The binge-purge cycle can happen anywhere from several times per month to several times daily. The latest version of the Diagnostic Statistical Manual, the DSM-5, classifies bulimia when binging and purging occur once weekly for three months. Bulimia is thought to occur in 1.5% of the female population and .5% of the male population. This means that about 6 million people will suffer from this eating disorder throughout their lifetimes.

What is a Binge?

Binging refers to eating a large amount of food in a single sitting, typically an amount that makes a person uncomfortable and overly full, even when they may not be hungry. While no exact amount of food defines a binge, it is usually considered to be an amount that makes a person feel as if they are “stuffed” or can’t eat anymore, usually eaten in a short period of time (2 hours or less). This eating type differs from occasionally overeating in that binging happens frequently and can be very distressing. This eating often happens alone or in secret due to guilt or shame—which may also lead to hiding or sneaking food. A binge may be triggered by stress, restrictive dieting, negative emotions, or trauma. Bingeing often makes people feel out of control around food as if they can’t stop eating. Though binge eating is hard to specify and often very subjective, many individuals can identify when a meal turns into a binge based on how they feel after they eat.

What is a Purge?

Purging means getting rid of something unwanted and is a response to the binge to counteract the amount eaten. Purging often happens right after a binge episode and may also be a response to guilty feelings. Purging may be self-induced vomiting, laxative use, or enemas. In some cases, overexercising may be considered a form of purging if the intention is to “burn off” any extra calories eaten during a binge. Fasting, or intentionally not eating for an extended time, may also be used as a form of purging. Some people use just one form of purging, while others use various methods to “fix” the problem they believe overeating caused. A common misconception is that these forms of compensation are effective ways to lose weight, but they do not contribute significantly to weight loss. Instead, they often keep an individual trapped in a cycle of overeating and then trying to get rid of the extra calories.

Negative Consequences

The negative side effects of bulimia vary based on the type of purging and the severity of the eating disorder. Binge eating can contribute to many GI-related side effects related to eating more than is comfortable for their stomach. These side effects include stomach cramping, diarrhea, gallstones, or insulin resistance with prolonged purging behavior. Some individuals may also experience acid reflux. While these side effects are unpleasant, the purging complications are much more severe and can be life-threatening. Consistently vomiting after meals can lead to hormone fluctuations, low blood pressure and heart rate, tooth decay, oral bleeding, tears in the esophagus, and kidney failure. Other forms of purging, such as overexercise, can also lead to nutritional deficiencies and dehydration. This can cause electrolyte imbalances which can fatally damage the heart.

Bulimia is often associated with negative body image and a desire to lose weight. This eating disorder may often be a response to help cope with emotions by overeating and then purging to numb the negative feelings of these emotions. Many people suffering from bulimia do not seek treatment due to the negative stigma surrounding the disease, yet so many face struggles related to bulimia. Like any eating disorder, bulimia is a coping mechanism and may be a way for an individual to help handle life’s stressors by seeing their eating habits and body as the only things they have control over.

Treatment for Bulimia

Treatment for bulimia will often include medical intervention, which depends on the severity of the eating disorder. Most individuals with an eating disorder also struggle with at least one other mental health condition, which is a key focus of recovery. Eating disorder recovery would include goal-focused nutrition counseling, group and individual therapy, and medical supervision. This may include meal planning, monitoring after eating, and working towards more intuitive eating habits and mindfulness. Therapy focusing on body image concerns is also key when treating an eating disorder.

The Bottom Line

Since many people with bulimia also struggle with anxiety, depression, body dysmorphia, or other mental health disorders, eating disorder recovery is about the journey, not the destination. Bulimia, like other eating disorders, functions as a coping mechanism for difficult emotions. While we don’t know the exact cause of eating disorders, a person is more likely to develop bulimia if their family has a history of eating disorders or if they grew up in a household that tried to control their eating habits. However, the cause of an eating disorder is a combination of genetic, biological, and social factors.

Since most people with bulimia are at “normal” body weight, many struggle for years, as they do not “look” or feel that they have an eating disorder. This, combined with the shame that often occurs with binging/purging, can make a person more hesitant to seek help. However, full recovery is possible for anyone struggling with this eating disorder. By working directly with a trained team of medical staff and licensed therapists, individuals struggling with bulimia can begin to overcome their disordered eating habits and move forward on their path toward healing.


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