bulimia nervosa

Source: Office on Women's Health in the U.S. Department of Health and Human Services

Bulimia (buh-LEE-me-ah) nervosa is a type of eating disorder. It is often called just bulimia. A person with bulimia eats a lot of food in a short amount of time. This is called binging. The person may fear gaining weight after a binge.

Binging also can cause feelings of shame and guilt. So, the person tries to "undo" the binge by getting rid of the food. This is called purging. Purging might be done by:

making yourself throw up
taking laxatives (LAX-uh-tiv) — pills or liquids that speed up the movement of food through your body and lead to a bowel movement
exercising a lot
eating very little or not at all
taking water pills to urinate

Who becomes bulimic?

Many people think that only young, upper-class, white females get eating disorders. It is true that many more women than men have bulimia. In fact, 9 out of 10 people with bulimia are women. But bulimia can affect anyone: Men, older women, and women of color can become bulimic. It was once thought that women of color were protected from eating disorders by their cultures. These cultures tend to be more accepting of all body sizes. But research shows that as women of color are more exposed to images of thin women, they are more likely to get eating disorders. African-American, Latina, Asian/Pacific Islander, and American Indian and Alaska Native women can become bulimic.

What causes bulimia?

Bulimia is more than just a problem with food. A binge can be set off by dieting or stress. Painful emotions, like anger or sadness, also can bring on binging. Purging is how people with bulimia try to gain control and to ease stress and anxiety. There is no single known cause of bulimia. But these factors might play a role:

Culture. Women in the U.S. are under constant pressure to be very thin. This "ideal" is not realistic for most women. But seeing images of flawless, thin females everywhere can make it hard for women to feel good about their bodies. More and more, men are also feeling pressure to have a perfect body.
Families. It is likely that bulimia runs in families. Many people with bulimia have sisters or mothers with bulimia. Parents who think looks are important, diet themselves, or judge their children's bodies are more likely to have a child with bulimia.
Life changes or stressful events. Traumatic events like rape can lead to bulimia. So can stressful events like being teased about body size.
Psychology. Having low self-esteem is common in people with bulimia. People with bulimia have higher rates of depression. They may have problems expressing anger and feelings. They might be moody or feel like they can't control impulsive behaviors.
Biology. Genes, hormones, and chemicals in the brain may be factors in getting bulimia.

What are signs of bulimia?

A person with bulimia may be thin, overweight, or normal weight. This makes it hard to know if someone has bulimia. But there are warning signs to look out for. Someone with bulimia may do extreme things to lose weight, such as:

using diet pills, or taking pills to urinate or have a bowel movement
going to the bathroom all the time after eating (to throw up)
exercising too much, even when hurt or tired

Someone with bulimia may show signs of throwing up, such as:

swollen cheeks or jaw area
rough skin on knuckles (if using fingers to make one throw up)
teeth that look clear
broken blood vessels in the eyes

Someone with bulimia often thinks she or he is fat, even if this is not true. The person might hate his or her body. Or worry a lot about gaining weight. Bulimia can cause someone to not seem like him or herself. The person might be moody or sad. Someone with bulimia might not want to go out with friends.

What happens to someone who has bulimia?

Bulimia can hurt your body. Look at the picture to find out how bulimia harms your health.

Diagram of how bulumia affect the body

Can someone with bulimia get better?

Yes. Someone with bulimia can get better with the help of a health care team. A doctor will provide medical care. A nutritionist (noo-TRISH-un-ist) can teach healthy eating patterns. A therapist (thair-uh-pist) can help the patient learn new ways to cope with thoughts and feelings.

Therapy is an important part of any treatment plan. It might be alone, with family members, or in a group. Medicines can help some people with bulimia. These include medicines used to treat depression. Medicines work best when used with therapy.

Chances of getting better are greatest when bulimia is found out and treated early.

Can a woman who once had bulimia but is now better get pregnant?

Active bulimia can cause a woman to miss her period sometimes. Or, she may never get her period. If this happens, she usually does not ovulate. This makes it hard to get pregnant. Women who have recovered from bulimia have a better chance of getting pregnant once their monthly cycle is normal. If you're having a hard time getting pregnant, see your doctor.

How does bulimia affect pregnancy?

If a woman with active bulimia gets pregnant, these problems may result:

miscarriage
high blood pressure in the mother
baby isn't born alive
baby tries to come out with feet or bottom first
birth by C-section
baby is born early
low birth weight
birth defects, such as blindness or mental retardation
problems breastfeeding
depression in the mother after the baby is born

What should I do if I think someone I know has bulimia?

If someone you know is showing signs of bulimia, you may be able to help.

Set a time to talk. Find a time to talk alone with your friend. Make sure you talk in a quiet place where you won't be bothered.
Tell your friend about your concerns. Be honest. Tell your friend that you are worried about her or his not eating or exercising too much. Tell your friend that you think these things may be a sign of a problem that needs professional help.
Ask your friend to talk to a professional. Your friend can talk to a counselor or doctor who knows about eating issues. Offer to help your friend find a counselor or doctor and to make an appointment. Offer to go with her or him to the appointment.
Avoid conflicts. If your friend won't admit that she or he has a problem, don't push. Be sure to tell your friend you are always there to listen if he or she wants to talk.
Don't place shame, blame, or guilt on your friend. Don't say, "You just need to eat." Instead, say things like, "I'm concerned about you because you won't eat breakfast or lunch." Or, "It scares me to hear you throwing up."
Don't give simple solutions. Don't say, "If you'd just stop, then things would be fine!"
Let your friend know that you will always be there no matter what.

Adapted from "What Should I Say? Tips for Talking to a Friend Who May Be Struggling with an Eating Disorder" from the National Eating Disorders Association.

For more information…

You can find out more about bulimia from womenshealth.gov at 1-800-994-9662 or from these organizations.

National Institute of Mental Health (NIMH), NIH, HHS
Phone: (866) 615-NIMH (6464)
Internet Address: http://www.nimh.nih.gov

National Mental Health Information Center, SAMHSA, HHS
Phone: (800) 789-2647
Internet Address: http://www.mentalhealth.org

Academy for Eating Disorders
Phone: (847) 498-4274
Internet Address: http://www.aedweb.org

National Association of Anorexia Nervosa and Associated Disorders
Phone: (847) 831-3438
Internet Address: http://www.anad.org

National Eating Disorders Association
Phone: (800) 931-2237
Internet Address: http://www.nationaleatingdisorders.org

All material contained in this FAQ is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the U.S. Department of Health and Human Services. Citation of the source is appreciated.

This FAQ was reviewed by:

Barbara Wolfe, PhD, APRN, FAAN
Professor
William F. Connell School of Nursing
Boston College
Chestnut Hill, MA

Posted January 2005
Updated January 2007