Bulimia nervosa stands out as one of the most widespread eating disorders, accounting for 19% of all diagnosed cases within this category.

Determining whether someone has bulimia solely based on their appearance is highly unlikely, as the secretive nature of this eating disorder makes it challenging to detect.

However, with proper education and access to appropriate treatment, the chances of achieving a complete recovery from bulimia are significantly promising.

What is bulimia?

Bulimia nervosa, formally recognised as bulimia, manifests as an eating disorder marked by repetitive episodes of excessive eating, accompanied by compensatory actions aimed at averting weight gain.

Those with bulimia often consume large amounts of food in a short period, feeling a lack of control during these episodes. Subsequently, they engage in behaviours such as self-induced vomiting, excessive exercise, fasting, or misuse of laxatives to counteract the effects of overeating.

The diagnostic criteria in the DSM-V for bulimia?

According to the DSM-5, the diagnostic criteria for bulimia nervosa include the following:

  • Recurrent episodes of binge eating, characterised by both of the following:
    • Eating, in a discrete period of time (e.g., within any 2 hours), an amount of food that is larger than most people would eat during a similar period and under similar circumstances.
    • 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).Repetitive inappropriate compensatory actions to avert weight gain, such as self-induced vomiting, improper use of laxatives, diuretics, or other medications, periods of fasting, or excessive exercise.
  • The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of anorexia nervosa.
Source: NCBI


It’s important to remember that the information provided here is a summary, and the complete diagnostic criteria may involve additional details. Qualified mental health professionals should conduct accurate diagnoses and treatments based on a comprehensive assessment of symptoms and history.

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Are there different types of bulimia?

While there are general diagnostic criteria for bulimia nervosa, some people may experience the disorder in various ways, leading to the identification of different subtypes or presentations. That said, some clinicians and researchers may use terms like ‘purging’ and ‘nonpurging’ to describe different presentations of bulimia, although it’s important to note that the DSM-V doesn’t formally recognise these subtypes.

  • Purging type: People with this subtype regularly engage in self-induced vomiting or misuse of laxatives, diuretics, or enemas as a way to compensate for the calories consumed during binge eating episodes.
  • Non-purging type: People with this subtype use other inappropriate compensatory behaviours to prevent weight gain, such as excessive exercise or fasting, but do not regularly engage in vomiting or the misuse of laxatives.

The different levels of bulimia

It’s important to note that the severity of bulimia is often assessed based on the frequency of binge eating and inappropriate compensatory behaviours:

  • Mild: 1-3 episodes per week
  • Moderate: 4-7 episodes per week
  • Severe: 8-13 episodes per week
  • Extreme: 14 or more episodes per week
Source: NCBI

These severity levels help guide treatment planning and interventions.

What are the causes of bulimia?

The causes of bulimia are complex and multifaceted, involving a combination of genetic, psychological, biological and environmental factors. Some of the key factors include:

Psychological factors

Psychological factors are significant contributors to bulimia. Low self-esteem, body dissatisfaction and a distorted body image can contribute to the development of the disorder.

It’s also worth noting that those with an eating disorder scored higher on measures of personality disorders, impulsivity, obsessive-compulsive traits and perfectionism compared to those with no eating disorders.

Genetic factors

There is evidence that genetics play a role in the development of eating disorders, including bulimia. Studies have shown that people who have a relative with bulimia are at an elevated risk for developing an eating disorder.

Heritability also plays a factor too. Some studies estimated that the heritability rate of bulimia is estimated to be up to 62%, a shockingly high number.

Traumatic experiences

Individuals who have experienced trauma, such as physical, emotional, or sexual abuse, may be at a higher risk of developing bulimia. Research showed that 25.5% of bulimia patients fulfilled the study definition for Post Traumatic Stress Syndrome (PTSD).

The finding suggests a potential association between bulimia and PTSD, highlighting a co-occurrence or interplay between eating disorders and trauma.

Environmental factors

Societal and cultural pressures to conform to certain body standards and ideals can contribute to the development of bulimia. Media images, societal expectations and peer pressure may shape individuals’ perceptions of their bodies.

In a 2023 study of participants aged 14-25, 42% exhibited probable eating disorders and 41.7% displayed signs of social media addiction. The findings imply a possible connection between social media use and body image concerns, with societal pressures and unrealistic beauty standards on these platforms playing a role.

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The damaging effects of bulimia

Unfortunately, bulimia nervosa brings about numerous effects that can impact both your physical and psychological well-being. Below are some of the effects categorised into physical and psychological aspects:

Physical effects of bulimia nervosa

Here are the potential physical effects that can arise from bulimia:

  • Bloating
  • Swollen hands and feet
  • Trouble sleeping
  • Sore throat and swollen salivary glands
  • Decline in skin condition
  • Damage to vocal cords
  • Stomach pains and gastrointestinal issues
  • Constipation
  • Fatigue
  • Issues with menstruation
  • Electrolyte imbalances
  • Acid reflux
  • Oral health issues
  • Changes to blood sugar levels
  • Nutrient deficiencies
  • Weight fluctuations
  • Dehydration
  • Damage to kidneys
  • Increased risk of heart issues

Psychological effects of bulimia nervosa

Unfortunately, bulimia is associated with a whole range of damaging psychological risks. These include:

  • Distorted perception of body image
  • Increased risk of mental health issues, including anxiety and depression
  • Feeling shame and guilt about eating
  • Lack of confidence and low self-esteem
  • Increased risk of suicidal ideations

It is crucial to recognise that these physical and psychological consequences may lead to irreversible and long-term damage to health. Despite the daunting nature of treatment and recovery, it is entirely possible with the right support.

Bulimia recovery is more than achievable

While it poses significant risks to physical and mental health, it is encouraging to note that many of those who seek help for bulimia are able to make a full recovery.

The journey to recovery from bulimia often involves a combination of medical, psychological and nutritional interventions. Seeking professional help from healthcare providers, including therapists, nutritionists and medical professionals, is crucial for developing a comprehensive treatment plan.

A closer look at the positive stats

Early intervention and treatment play pivotal roles in bolstering the chances of overcoming bulimia. Studies reveal a promising 55% recovery rate after just five years of dedicated intervention. The trajectory becomes even more encouraging, with half of individuals achieving full recovery within a decade.

Emphasising the profound impact of timely support, the mortality rate remains impressively low at 0-3% when interventions are initiated promptly. This underscores the significance of early detection and intervention in creating a positive path toward sustained recovery, fostering resilience and enabling individuals to reclaim their lives from the grips of bulimia with a high probability of success.

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How is bulimia treated?

Bulimia nervosa can significantly impact both mental and physical well-being, but the encouraging news is that effective treatment options are accessible. Various programmes offer you the necessary resources to embark on a journey toward recovery.

These comprehensive programmes typically encompass a range of therapeutic approaches delivered in both individual and group settings.

Some common therapies include:

Through engaging in therapy and rehabilitation, you’ll have the opportunity to uncover the reasons behind your unhealthy relationship with food and develop coping mechanisms for handling stress and negative emotions. It’s not just about addressing the symptoms; it’s about building confidence and rediscovering your sense of self-worth.

Spotting the signs of bulimia in a loved one

Identifying the signs of bulimia in a loved one can be challenging, as those with this disorder often go to great lengths to hide their behaviours.

Here are some signs that may indicate someone is struggling with bulimia:

  • Fluctuations in weight: While not everyone with bulimia will experience extreme weight changes, noticeable fluctuations in weight (both up and down) could be a sign. This can result from the cycles of binge eating and purging.
  • Frequent trips to the bathroom: Those with bulimia often purge to eliminate the calories consumed during a binge. Frequent trips to the bathroom, especially after meals, may indicate purging behaviours such as vomiting or laxative use.
  • Evidence of binge eating: Discovering large amounts of food wrappers or empty containers, particularly high-calorie or sweet foods, may suggest episodes of binge eating.
  • Physical signs: Bulimia can have physical manifestations such as swollen glands, tooth decay and calloused knuckles due to induced vomiting. These signs may be subtle but can be indicative of purging.
  • Social withdrawal: People with bulimia may become socially withdrawn, avoiding social events that involve food. This can be an attempt to conceal their disordered eating habits and maintain secrecy.
  • Obsessive concern with body image: A preoccupation with body weight, shape and appearance can be a sign of bulimia. Constantly talking about dieting or expressing dissatisfaction with one’s body may indicate an unhealthy relationship with food.

What are the next steps?

If you or someone you care about currently has bulimia, taking proactive steps is crucial. Begin by reaching out to a healthcare or mental health professional to initiate a discussion about potential symptoms, binge-purge patterns and related emotional challenges.

A thorough assessment will shape a personalised treatment approach, which may include a range of therapies and medical assistance.

Remember that timely intervention plays a pivotal role in effectively managing bulimia, meaning that the quicker help is sought, the quicker the recovery phase begins. We understand that reaching out for help could be daunting, but doing this marks a significant stride toward achieving a healthier and more harmonious life.

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Is bulimia a mental illness?
Yes, bulimia nervosa is a mental illness characterised by recurring episodes of overeating followed by compensatory behaviours.
What causes bulimia?
The causes of bulimia involve a combination of genetic, environmental, and psychological factors, including genetics, societal pressures, and issues related to body image and self-esteem.
Can you die from bulimia?
Yes, bulimia nervosa can be life-threatening due to potential complications, including electrolyte imbalances, cardiac issues, and nutritional deficiencies. Seeking professional treatment is crucial.
Did Diana have bulimia?
Princess Diana, the late Princess of Wales, publicly disclosed her struggles with bulimia nervosa in the early 1990s. She spoke candidly about her experience with the eating disorder and its impact on her mental and physical well-being. Diana’s openness about her struggles with bulimia contributed to increased awareness and understanding of eating disorders.
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