Bulimia nervosa

Bulimia nervosa is a mental health condition involving a cycle of binge eating and compensatory behaviors. During a binge, a person eats an amount of food that feels large and out of control. Afterward, intense guilt, shame or fear of weight gain leads to purging or other attempts to undo the binge.

This binge and purge cycle is usually closely tied to how a person values themselves: self-worth becomes heavily linked to body shape and weight.

Bulimia can affect people of any gender, age, body size or background. It often begins in adolescence or early adulthood. Because the behaviors are usually done in secret and weight may stay within a typical range, it can go unnoticed for a long time, even by close family members. A diagnosis can only be made by a qualified health professional.

Bulimia symptoms include both behaviors and emotional signs:

• Recurrent episodes of eating large amounts of food with a sense of loss of control.
• Purging: self-induced vomiting, or misuse of laxatives, diuretics or other medications.
• Fasting, strict dieting or compulsive exercise after binges.
• Intense preoccupation with weight, body shape and food.
• Going to the bathroom right after meals.
• Hiding food or eating in secret.
• Mood swings, anxiety, low mood or irritability.

Physical signs of bulimia may include swollen cheeks or jaw, damaged tooth enamel, calluses on the knuckles, frequent sore throats, bloating, fatigue and irregular periods.

If you notice several of these signs in yourself or someone you care about, it is important to talk to a doctor or mental health professional.

Purging can disrupt the body's balance of electrolytes, such as potassium, which the heart needs to function properly. This can lead to serious complications, including irregular heartbeat. Other risks include dehydration, damage to the esophagus, digestive problems and dental damage.

Seek emergency care right away, by calling 911 in the US or your local emergency number, if you or someone else experiences:

• Chest pain, a racing or irregular heartbeat, or fainting.
• Vomiting blood or severe abdominal pain.
• Confusion, extreme weakness or signs of severe dehydration.

Eating disorders are also linked to a higher risk of suicidal thoughts. If you are thinking about ending your life, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the US, or call Samaritans on 116 123 in the UK and Ireland. You deserve help immediately.

There is no single cause of bulimia. It usually develops from several interacting factors:

• Genetic and biological vulnerability: eating disorders can run in families.
• Dieting: restrictive eating can trigger intense hunger and binges, which then fuel the cycle.
• Psychological factors: low self-esteem, perfectionism, difficulty managing emotions, anxiety or depression.
• Life experiences: trauma, bullying, teasing about weight or major stress.
• Social pressures: messages that link worth to thinness or a certain body type, including on social media.
• Certain activities or careers where weight or appearance is emphasized.

Binge eating often becomes a way to cope with difficult feelings, and purging brings temporary relief from guilt. Understanding these patterns, without blame, is an important part of recovery.

Bulimia is treatable, and early help leads to better outcomes. Treatment usually involves a team that may include a clinical psychologist, psychiatrist, primary care doctor and dietitian.

Evidence-based approaches include:

• Cognitive behavioral therapy for eating disorders (CBT-E): the most studied treatment for adults. It helps establish regular eating, break the binge and purge cycle, and change beliefs about weight and shape.
• Family-based treatment: particularly recommended for adolescents, involving parents in supporting recovery.
• Interpersonal therapy and dialectical behavior therapy (DBT) skills for emotion regulation.

A psychiatrist may prescribe medication in some cases, especially when depression or anxiety is also present. A doctor will monitor physical health, including blood tests when needed.

In a first appointment, expect questions about your eating, purging, mood and health. Honesty helps professionals keep you safe, and they are there to help, not to judge.

If you are struggling, reaching out to one trusted person or a doctor is a brave first step. While you seek treatment:

• Try to eat regular meals and snacks rather than skipping food, which can trigger binges.
• Notice emotional triggers and write them down.
• Reduce exposure to content that fuels comparison or dieting.
• Be gentle with setbacks; recovery is rarely a straight line.

If you are worried about someone else, choose a calm, private moment. Express concern about specific behaviors and how they seem, rather than commenting on weight or appearance. Avoid blame, ultimatums or arguments about food. Encourage them to see a professional and offer practical help, such as finding a clinician or going with them.