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Bulimia Nervosa

What is Bulimia Nervosa?

Bulimia nervosa, usually referred to as bulimia, is a serious, potentially life-threatening eating disorder that is characterized by:

  • Frequent and recurrent episodes of uncontrolled overeating (binge eating)
  • Purging (behavior that is used to compensate for binge eating) can consist of forced vomiting, misuse of laxatives, enemas, diuretics (medications that cause increased urination), fasting, excessive exercise, or a combination of these behaviors.
  • Basing self-esteem (how a person feels about oneself) on body shape and weight

How common is Bulimia?

Individuals with bulimia may be slightly underweight, normal weight or overweight. Bulimia typically has an onset late in adolescence or early adulthood and is more common in females. Younger children, adults and males can also develop bulimia. At any one given time, 1.0% of young women and 0.1% of young men struggle with bulimia. Bulimia occurs with similar frequencies in most industrialized countries including the United States, Canada, many European countries, Australia, Japan, New Zealand and South Africa.

Signs and Symptoms of Bulimia

Emotional and behavioral

  • Behaviors and attitudes that show control over food, weight loss and dieting is a primary concern
  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding lots of empty food wrappers and containers
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and / or smells of vomiting, wrappers or packages from laxatives or diuretics
  • Appears uncomfortable eating around others or fears eating in public places
  • Develops food rituals (e.g. eats only a particular food or food group, excessive chewing, does not allow foods to touch)
  • Skips meals or takes small portions of food at regular meals
  • Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism / veganism)
  • Steals or hides food in strange places
  • Drinks excessive amounts of water or non-caloric beverages
  • Uses excessive amounts of mouthwash, mints, and gum
  • Hides body by dressing in baggy clothes
  • Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off” calories
  • Shows unusual swelling of the cheeks or jaw area
  • Keeping strict schedules to make time for binging and purging
  • Tends to isolate or avoid usual friends and activities
  • Looks bloated from fluid retention
  • Frequently diets
  • Shows extreme concern with body weight and shape
  • Frequent checking appearance in the mirror.
  • Has secret recurring episodes of binge eating (eating a larger amount of food than most individuals would eat under similar circumstances and eating it within a short amount of time) and feeling a lack of control over stopping it
  • Recurring episodes of purging
  • Extreme mood swings


  • Noticeable fluctuations in weight, both up and down
  • Stomach cramps or other vague stomach complaints (constipation, acid reflux, etc.)
  • Difficulties concentrating
  • Abnormal medical test results such as anemia, low thyroid and hormone levels, low potassium, low blood cell counts, or slow heart rate
  • Dizziness
  • Fainting
  • Feeling cold all the time
  • Sleep problems
  • Cuts and calluses across the top of fingers from forced vomiting
  • Dental problems including discolored or stained teeth
  • Dry skin, brittle nails
  • Fine hair on body and face
  • Thinning of hair on head
  • Muscle weakness
  • Cold, splotchy hands and feet or swelling of feet
  • Menstrual irregularities
  • Poor wound healing
  • Impaired immune functioning (getting sick often)

The symptoms of bulimia may resemble other medical problems or psychiatric conditions. Always consult your child's physician for a diagnosis.

Causes of Bulimia

Researchers are finding that bulimia and eating disorders, in general are caused by a complex interaction of biological, behavioral, psychological, and social factors.

The socio-cultural focus on thinness is an environmental contributor to developing bulimia.

Treatment of Bulimia

Specific treatment for bulimia will be determined by your child's doctor based on:

  • Age, overall health, and medical history
  • The severity of the symptoms
  • Tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition

Parents and family play a vital role in the treatment and recovery process. Bulimia is treated with counseling that usually involves a combination of individual therapy, family therapy, behavior modification and nutritional rehabilitation. Treatment should always be based on an overall evaluation of the adolescent and family. Several different medicines have proven helpful in decreasing the frequency of the binge-purge episodes and in the improvement of mood.

Binge-Eating Disorder

Binge-eating disorder is characterized by frequent and recurrent episodes of uncontrolled overeating (binge eating). This results in a great deal of stress for the individual.

Binge eating is different from bulimia in that binge eating is NOT followed by purging behavior or behavior that is used to undo the effects of binge-eating.

Last Updated 04/2022

Reviewed By Sara Hughes, RN

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The Eating Disorders Program at Cincinnati Children's treats patients who have significantly unhealthy eating behaviors.