Bulimia Nervosa

Full description of Bulimia Nervosa. Signs, symptoms, causes of Bulimia Nervosa.

Description of Bulimia Nervosa

Individuals with Bulimia are usually aware they have an eating disorder. Obsessed with food, they often focus on and enjoy discussing diet-related issues. The Bulimic may engage in self-starvation between binge-purge episodes thus presenting the same dangers as the anorexic, in addition to the ones presented by the binging and purging. Recurring episodes of rapid food consumption followed by tremendous guilt and often purging, a feeling of lacking control over his or her eating behaviors, regularly engaging in stringent diet plans and exercise, the excessive use of laxatives, diuretics, and/or diet pills and a persistent concern with body image can all be warning signs someone is suffering from Bulimia Nervosa.

It is important to realize that those suffering from Bulimia manifest symptoms in different ways. The Bulimic has binge and purge episodes whereas purging can be different things to different people. After binging, some will exercise compulsively, in an attempt to burn off the calories of a binge. Others will self-induce vomiting or take laxatives, or to "fast" for days following a binge. Some take diet pills in an attempt to keep from binging or to use diuretics to try to lose weight. Bulimics will often hide food for later binges and often eat in secret.

Defining Characteristics of Bulimia Nervosa

Individuals with bulimia nervosa regularly engage in discrete periods of overeating, which are followed by attempts to compensate for overeating and to avoid weight gain. There is variation in the nature of the overeating but the typical episode of overeating involves the consumption of an amount of food that would be considered excessive in normal circumstances. The bulimic is dominated by a sense of a lack of control over the eating. Binge eating is followed by attempts to undo the consequences of the binge through self-induced vomiting, misuse of laxatives, severe caloric restriction, diuretics, enemas, or excessive exercising, etc.

The bulimic's self-evaluation is centered on the individual's perceptions of his/her body image. Concerns about weight and shape are characteristic of those with bulimia nervosa. The diagnostic criterion of bulimia nervosa requires that the individual not simultaneously meet criteria for anorexia nervosa. (If an individual simultaneously meets criteria for both anorexia nervosa and bulimia nervosa, only the diagnosis of Anorexia Nervosa, binge-eating/purging type is given.) The formal diagnosis also stipulates minimal frequency and duration cut-offs. The diagnosis requires that individuals must binge eat and engage in inappropriate compensatory behavior at least twice weekly for three months.

There are also two subtypes of bulimia nervosa. The Purging Type describes individuals who regularly compensate for the binge eating with self-induced vomiting, laxative abuse, diuretics, or enemas. The Non-Purging Type is used to describe individuals who compensate through dietary fasting or excessive exercising.

Definition/Facts: Bulimia Nervosa

  • There are two types of bulimia nervosa - purging and non-purging.
  • It occurs in 0.5% to 2.0% of adolescents and young adult women.
  • It is usually preceded by dieting behavior.
  • Bulimics are usually of average or above average weight.
  • Self-evaluation is unduly influenced by size and weight.
  • A complex lifestyle develops to accommodate eating disorder behaviors.
  • There are ongoing feelings of isolation, self-deprecating thoughts, depression, and low self-esteem.
  • It typically develops in early to mid-adolescents.
  • There is full recognition of the behavior as abnormal.
  • Statistics indicate it is relatively uncommon in men.

DSM IV Diagnostic Criteria: Bulimia Nervosa

The following definition of Bulimia Nervosa is used to assist mental health professionals in making a clinical diagnosis. The clinical definitions are usually not representative of what a victim feels or experiences in living with the illness. It is important to note that you can still suffer from Bulimia even if one of the below signs/symptoms is not present. If you think you have Bulimia, it is dangerous to read the diagnostic criteria and think if you do not have one of the symptoms, you, therefore, must not be Bulimic.

Recurrent episodes of binge eating.

A. An episode of binge eating is characterized by both of the following:

  1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
  2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Both Anorexia and Bulimia

Eating disorders are very complex emotional issues. Though they may seem to be nothing but a dangerously obsessive dietary concern on the surface, for most men and women suffering with an eating disorder there are deeper emotional conflicts to be resolved.

Causes of Bulimia Nervosa

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.

For comprehensive information on bulimia and other eating disorders, visit the Eating Disorders Community.

Source: American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association.

APA Reference
Writer, H. (2009, January 2). Bulimia Nervosa, HealthyPlace. Retrieved on 2019, September 22 from

Last Updated: July 5, 2019

Medically reviewed by Harry Croft, MD

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