What You Need to Know About Bulimia

Learn about the eating disorder and why people binge and purge.

Medically reviewed in June 2022

The signs of bulimia may not be as clear as you think. Unlike anorexia, people who have bulimia generally eat enough, or more than enough. However, after eating, those who have bulimia force themselves to throw up, use laxatives or exercise excessively to purge the calories from their bodies.

Women are far more likely than men to be bulimic—one study puts the risk for women at five times greater than for men. Researchers believe that 0.6 percent of the adult US population will have bulimia at some point in their lives which is more than 1.4 million. What’s more, less than half of the people who experience bulimia will ever receive treatment for their condition.

Bulimia is a disease that affects the body, but starts in the mind. Here’s what you need to know.

The binge and purge cycle
The exact cause—or, more likely, causes—of bulimia is unknown. Eating disorders generally begin with a profoundly unhealthy relationship with food. Those who have eating disorders fear gaining weight and may hate the way their bodies look.

People with bulimia overeat, or binge, then purge, most often by vomiting, but also by using laxatives or extreme exercise.

Mental and physical symptoms
Bulimia often goes hand-in-hand with mental illness, like depression and anxiety. A person with bulimia may also have dysmorphia, in which the person’s perceptions of his body don’t match reality. The media’s constant portrayal of skinny people can help drive a person to bulimia, as can demanding sports or artistic endeavors, such as dance. Additionally, bulimia is also associated with attention deficit hyperactivity disorder (ADHD) and other attention problems.

The purging could cause different symptoms depending on the method used. People who purge by vomiting will have symptoms caused by caustic stomach acid. These can include:  

  • Dental problems: cavities and dry mouth
  • Throat problems: chronic cough, hoarseness, sore throat
  • Gastrointestinal problems: acid reflux, esophagitis, Barrett’s esophagus
  • Electrolyte imbalances
  • Dehydration
  • Cardiovascular disease, including arrhythmia, low blood pressure and heart failure

People who take laxatives may be frequently constipated if they’re taking stimulant-based laxatives. Electrolyte imbalances can also occur in people who use laxatives to purge.

Treatment and support
Because bulimia is a multifaceted condition involving both physical and mental aspects, its treatment should be multifaceted, as well. The treatment team should include a primary care provider, a mental health provider and a nutritionist or dietician. A dentist may be necessary as well, given the effects chronic vomiting has upon the mouth. 

If someone you know has bulimia, your support will be crucial to their recovery. Family-based therapy or cognitive behavioral therapy are mainstays of mental health treatment and recovery for bulimia. Don’t try to guilt your loved one or offer a flippant solution. You can help find a therapist or treatment team, or just let your loved one know that he or she has your support. 

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