What Is Bulimia Nervosa?

About halfway into 2020, medical professionals realized that the COVID-19 pandemic was uniquely affecting people with eating disorders. As a result of changes such as sheltering in place or feeling isolated from family, friends, and outside activities, many people were struggling with disordered eating. A July 2020 study published in the International Journal of Eating Disorders found that people with bulimia and binge eating disorder were reporting increases in their binge eating episodes and urges to binge. Some felt the need to stockpile food due to potential shortages in the food supply. Others were anxious about not being able to go to the gym and began exercising excessively at home.

An eating disorder is marked by an unhealthy relationship with food. This might mean that a person diets or exercises excessively, as someone with the eating disorder anorexia nervosa might do. It may mean patterns of extreme eating (also called bingeing) followed by compensating for overeating such as purging, as some people who have bulimia nervosa may do. It may simply be periods of overeating, which characterizes binge eating disorder.

Eating disorders are more than just problems with food. Having negative feelings about food can seriously affect not only how you eat but also how you interact with your friends, family, and everyone else around you. Your unhealthy relationship with food can harm both your body and your emotions.

The word “bulimia” comes from the Greek words buos (“ox”) and limos (“hunger”), which together mean “hunger of an ox.” People who have bulimia eat a lot of food at once (called bingeing) and then try to get rid of that food (called purging) so that they don’t gain weight.

Eating disorders are more common than you might think. According to the National Eating Disorders Association (NEDA), about twenty million women and ten million men in America will have an eating disorder at some point in their lives. Canada’s National Initiative for Eating Disorders (NIED) estimates that about one million Canadians have a diagnosis of an eating disorder such as anorexia or bulimia. Although eating disorders are far more likely to affect young girls and women, NEDA estimates that, at any given point in time, 1.0 percent of young women and 0.1 percent of young men will meet diagnostic criteria for bulimia nervosa.

The reasons why a person develops an eating disorder are complex. They involve eating habits, attitudes about weight and food, attitudes about body shape, and psychological factors, especially the need for control.

The Definition of Bulimia

Doctors and psychiatrists rely on the Diagnostic and Statistical Manual of Mental Disorders (frequently known as the DSM) for the definitions they use in diagnosing conditions. According to the fifth edition of the DSM, the official diagnostic criteria for bulimia nervosa include:

• Repeated episodes of binge eating. (An episode of binge eating is characterized by eating, within a period of time, an amount of food that is definitely larger than most people would eat during a similar period of time, and feeling like you can’t stop eating or control how much you’re eating.)

• Repeated inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting; misusing laxatives, diuretics, or other medications; fasting; or excessive exercise. (Compensatory behaviors are things that are meant to “un-do” eating and consuming calories.)

• The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.

• The patient’s self-esteem is too closely tied to their body shape or weight.

About Bulimia Nervosa

Although it was first diagnosed in the 1950s, and was most certainly around even before then, bulimia nervosa wasn’t really understood until the 1980s. Since then, we have learned of famous people who struggled with it, including Demi Lovato, Lady Gaga, Zoë Kravitz, Candace Cameron Bure, Elton John, Russell Brand, and the late Princess Diana. Researchers also found that substance abuse problems often go hand in hand with eating disorders.

Today, bulimia is a major social concern. It can have devastating effects on the mind and body. Many eating disorder experts believe that images in the media put a lot of pressure on young people to reach an “ideal” body shape—one that is impossible for most to achieve. This is especially true on social media platforms like Instagram, TikTok, and YouTube. Filtered, edited, and curated versions of people—especially young women—can encourage viewers to strive for flawlessness that doesn’t exist in real life. While social media has many benefits, its effect on people’s mental health can’t be ignored. One study, according to NEDA, found that teen girls who use social media were significantly more likely to have internalized a drive for thinness and to engage in body surveillance than non-social media users.

Two Types of Bulimia

Bulimia nervosa is a type of eating disorder in which a person binges and purges. Bingeing means eating a large amount of food in a short period of time. Purging means getting rid of all the food by self-induced vomiting; abuse of laxatives, diet pills, and/or diuretics; excessive exercise; or fasting.

Bingeing can mean eating a lot of calories—as many as 5,000 or more at a time. People with bulimia can binge once in a while, or twenty times each day or more. Then they will purge to rid their bodies of the extra calories. They may purge even after eating small amounts of food.

There are two types of bulimia: purging and non-purging. People with the purging type get rid of food in different ways. Some people purge by self-inducing vomiting. Others use drugs, such as diuretics (pills that increase urination), diet pills, laxatives (usually mild drugs that induce bowel movements), or enemas (liquids injected into the anus for cleansing the bowels) to clear the digestive tract. Both bingeing and purging can be experienced as intense, overwhelming urges that become uncontrollable. People with the non-purging type of bulimia may exercise compulsively to get rid of the extra food they’ve eaten or rely on fasting, stimulants, or diet pills.

Who Struggles with Bulimia?

It is difficult to say exactly how many people struggle with bulimia because doctors are not required to report it to health agencies. In addition, many who struggle with bulimia do not seek help. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), eating disorders affect at least 9 percent of the population worldwide. ANAD found that 35–57 percent of adolescent girls engage in crash-dieting, fasting, self-induced vomiting, or laxatives, and an alarming number of children want thinner bodies and fear gaining weight. Boys who are involved in activities that have them gain and lose weight quickly, such as wrestling and gymnastics, are most at risk. While most people with bulimia are in their late teens and early twenties, the disorder is affecting people at younger ages. Therapists are also seeing an increase in the numbers of middle-aged women with bulimia.

Symptoms of Bulimia

It can be difficult to tell if a person has an eating disorder. Bulimia can be hard to diagnose because people may hide their symptoms and bulimic behaviors are often done in secret.

Many people struggle with their relationship to food. They may have been taught from an early age to feel anxious or guilty about eating certain foods or to worry about gaining weight. People who are in the early stages of bulimia (or another eating disorder) may be overly concerned with their weight, but that isn't out of the ordinary. Unfortunately, negative attitudes about body weight still exist around the world.

Being thin is not the sole indicator of bulimia. People with bulimia can be underweight, of normal weight, or slightly overweight.

Warning Signs

Even though people with bulimia may may maintain a normal body weight, there are warning signs of the condition. A person with the disorder may use extreme methods to lose weight, and they may act different from how they used to act. It's important to recognize these warning signs so that you can help yourself or help someone else who is struggling with bulimia. An eating disorder left untreated can be life threatening.

Some of the emotional and behavioral signs of bulimia include:

• Being preoccupied with body weight and shape

• Having severe mood swings

• Skipping meals or making frequent trips to the bathroom after eating

• Alternating between strict dieting and overeating

• Exercising all the time

• Buying, stealing, or hoarding large amounts of food

• Buying certain products, such as laxatives or syrup of ipecac (used to induce vomiting)

• Having or hiding evidence of binge eating, such as empty containers and wrappers

• Having cuts or calluses on their knuckles and fingertips from using their fingers to induce vomiting

• Using excessive amounts of gum, mints, or mouthwash

• Showing other types of impulsive behavior, such as abusing drugs, going on shopping sprees, and/or shoplifting.

How Is Bulimia Different from Anorexia and Orthorexia?

Although they are different disorders, anorexia and bulimia share many of the same symptoms. This is the reason why “nervosa” is part of both terms. In fact, about 50 percent of people who have bulimia had anorexia first. In both cases, the person is preoccupied with dieting, food, weight, and body size. Another eating disorder in which sufferers share these preoccupations is orthorexia nervosa. According to NEDA, people with orthorexia develop an unhealthy obsession with healthy or “clean” eating to the point that it becomes detrimental to their physical and mental health.

But there are also a few differences. People with anorexia avoid food, severely restrict food, or eat very small amounts of certain foods. They may deny to themselves and to others that there is a problem. People with bulimia usually eat, but then purge. They may be aware that there is a problem, even though they may try to keep it a secret from others.

Emotions and Bulimia

For some people with bulimia, purging is not just getting rid of food. They are also trying to cover up or get rid of unwanted feelings like anxiety, anger, guilt, panic, and stress. It may not take very long for the bingeing and purging habit to become an addictive pattern.

Although scientists are still researching this idea, some believe purging may affect chemicals in the brain, causing a person to feel satisfied after an episode. Comedian Russell Brand mentioned that he felt “euphoric” after purging. A person with bulimia may repeat the cycle to feel the same rush after purging.

Who Is at Risk?

Bulimia is an eating disorder that can affect anyone. Society puts a lot of pressure on people—especially young people—to look a certain way, with an emphasis on being thin. People of any age and every economic group can be affected by these images and attitudes and, coupled with other factors, may develop an eating disorder. Statistics show that bulimia most often affects women and starts in their teen years, but it is also increasing among young men. People with a family history of eating disorders or mental health problems are also more at risk, as well as people who have substance abuse disorders or people who connect weight with performance, such as dancers or athletes.

Research by NEDA also shows that LGBTQ+ individuals may be at higher risk of binge eating and purging than their straight peers. There are unique factors that can lead to an LGBTQ+ person developing an eating disorder, such as the fear or stress of coming out, rejection from friends or family members, bullying, discrimination at school or work, and homelessness. Additionally, LGBTQ+ teens may have more trouble getting the support and treatment they need. They may not feel comfortable asking for help, especially if they have been rejected by family members or other trusted adults. They may live in a place where LGBTQ+ people are denied health care or discriminated against in clinics, hospitals, or doctors’ offices, or they may not be able to find a health care provider who understands or accepts their sexual orientation or gender identity.