June 27, 2025, 9:04 am | Read time: 6 minutes
Bulimia nervosa, commonly known as “bulimia,” is an eating disorder characterized by recurring binge eating episodes followed by measures to control weight. Those affected often resort to methods that can be life-threatening. FITBOOK has compiled essential information about the disorder.
The pressure to be thin is often pervasive, especially among adolescents. During dieting attempts, many young women and men develop disordered eating behaviors. In the worst cases, this can lead to an eating disorder like bulimia (bulimia nervosa). Those affected try to rid themselves of the consumed food through vomiting, fasting, excessive exercise, or laxatives. The illness is accompanied by immense psychological distress, and weight-controlling measures often dominate the lives of those affected. To recognize early warning signs of bulimia in oneself and loved ones, it’s important to know which symptoms to watch for.
Overview
What Are the Symptoms of Bulimia?
Bulimia is categorized into the “purging type” and the “non-purging type.” In the “purging type,” individuals with bulimia nervosa consume large amounts of food at once and then “cleanse” themselves by vomiting or abusing laxatives. This process can repeat several times a day, depending on the severity of the disorder. In the “non-purging type,” affected individuals fast and engage in excessive exercise. Bulimia manifests in typical symptoms, such as:
- panic fear of weight gain
- obsessive focus on weight and body image
- very poor self-image
- binge eating episodes
- self-induced vomiting
- laxative abuse
- excessive and extreme exercise
- damaged, yellow teeth due to stomach acid
- swollen face, “chipmunk cheeks”
- heartburn
- bloating
- social isolation
If bulimia remains untreated for a long time and the severity of the disorder increases, it also leads to a significant loss of control. In other words, individuals become addicted to the cycle of binge eating and subsequent weight-regulating behaviors.1,2
Causes and Risk Factors for Bulimia
In principle, anyone, regardless of age, can develop bulimia. While a higher percentage of young girls and women are affected, the number of men developing bulimia has also increased significantly in recent decades. Factors contributing to the development of the disorder can include:
- an existing eating disorder, such as anorexia
- social factors
- traumatic experiences
- biological predispositions
- genetic predisposition
- psychological factors, such as depression or low self-esteem
The feeling of control is an important aspect of the disorder. Especially during puberty or times of social, emotional, or psychological turmoil, when a sense of loss of control prevails, individuals with bulimia see self-determined eating and weight regulation as something they can control and use it to manage their emotions. It is not uncommon for psychological disorders, such as depression or borderline personality disorder, to accompany bulimia, as these behaviors serve as very unhealthy forms of emotion regulation.
What Are the Consequences and Risks?
Primarily due to vomiting and laxative abuse, bulimia can have severe, irreversible, and life-threatening consequences. Self-induced vomiting disrupts the body’s mineral balance and strains the stomach, esophagus, and heart. Even the brain can be affected by this self-destructive behavior. Possible consequences of bulimia can include:
- malnutrition
- a weakened heart muscle due to low potassium levels in the blood
- kidney damage due to electrolyte imbalance
- stomach rupture from overeating large amounts of food, causing the stomach to bloat and tear
- constipation or intestinal issues due to slowed food transport and/or laxative abuse
- osteoporosis due to calcium deficiency
- irreversible dental damage from stomach acid
- esophagitis from constant vomiting and irritating stomach acid
- gastritis
- pancreatitis
- hormonal changes, such as missed periods
- dry skin, as well as brittle hair and nails
- morphological changes in the brain, where the composition of brain matter changes and/or shrinks, leading to concentration difficulties and headaches
- brain edema due to sodium loss
In the worst case, the disorder can lead to death or severe illness due to the damage incurred. Frequent or persistent inflammation of the esophagus or pancreas, as well as gastritis, can promote the development of cancer.3,4
Diagnosis of the Disorder
Anyone experiencing symptoms of bulimia or who knows they have an eating disorder should first consult their primary care physician. This is especially important for those with public health insurance, as finding a therapy spot can be challenging. The primary care physician can assist with a physical examination and blood test and may help find a psychiatrist, therapist, or other specialist. The disorder is diagnosed based on the criteria for bulimia outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V-5):
- recurrent binge eating episodes, where large amounts of food are consumed uncontrollably in a short period (about two hours)
- weight-regulating behaviors following binge eating, such as vomiting, laxative abuse, exercise, or fasting
- the cycle of binge eating and regulating behaviors occurs at least once a week for three months
- self-worth is heavily influenced by body image and weight
- symptoms do not occur exclusively during anorexic episodes
The disorder is also classified by severity. It ranges from “mild” bulimia, where the “binging-and-purging” cycle occurs one to three times a week, to “extreme” bulimia, where individuals experience binge eating episodes 14 times or more and then engage in unhealthy measures.5
What Are the Treatment Options?
The longer the disorder persists, the harder it is to completely abandon the behaviors. Therefore, it is crucial for those affected to seek professional help as early as possible to prevent bulimia from becoming chronic. While recovery is possible, it typically requires multiple attempts and several years of therapy for patients to fully recover. Treatment options include approaches such as:
- psychotherapy
- behavioral therapy
- group therapy
- hospitalization
- relaxation therapy
- nutritional counseling
- medication, such as antidepressants
Often, these approaches are combined. A therapy solely with antidepressants is not promising in the long term, as behavioral therapy measures must also be learned to manage eating and self-image differently and more healthily. In cases of severe bulimia and additional psychological or physical disorders, hospitalization may be necessary.
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Self-Help and Resources
Bulimia nervosa, or bulimia, is a serious disorder that significantly impacts the lives of those affected and causes immense psychological distress. Anyone suffering from bulimia should seek professional help in the form of psychotherapy, group therapy, from their primary care physician, and/or through nutritional counseling. Since therapy spots are unfortunately limited, self-help books and support groups can be a first step toward recovery as support or guidance.
The Federal Association for Eating Disorders, the Federal Center for Health Education, and the Federal Ministry of Health provide information on their websites about bulimia and other eating disorders and offer literature, information on support and counseling centers, and information on therapy spots for those affected and their families. Additionally, there are organizations like ANAD, which are solely dedicated to providing information to those affected and their families about all the options available to aid recovery.6,7