Bulimia Nervosa

Recognizing and Addressing the Disorder

What is Bulimia Nervosa?

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Bulimia Nervosa is characterized by a cycle of bingeing and purging, most commonly through self-induced vomiting. Bulimia Nervosa is diagnosed based on four criteria according to the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5):

1. Recurrent episodes of binge eating, where a binge is characterized by both (1) eating in one episode more than what most individuals would normally eat in similar circumstances, and (2) feeling out of control while eating.

2. Recurrent inappropriate behaviors intended to compensate for the eating and prevent weight gain, such as self-induced vomiting; misuse of diet pills, laxatives, diuretics, or other medications; fasting; or excessive exercise.

3. Episodes of bingeing and purging occur, on average, at least once a week for three or more months.

4. Self-evaluation is overly influenced by body weight and shape.

In addition to the above criteria, people with bulimia nervosa will often show the following signs:
  • Swollen cheeks and salivary glands
  • Social isolation and withdrawal
  • Frequent fluctuations in weight
  • Tooth decay or discoloration
  • Irregular menstrual cycle in females
  • Obsession with food, diet, and/or exercise
  • Irregular heartbeat
  • Dehydration
  • Irregular bowel movements and/or constipation due to laxative abuse
  • Depression and/or anxiety
  • Difficulty regulating emotions
  • Perfectionistic, all-or-nothing thinking
Who is at risk for bulimia nervosa?
There is no single cause for bulimia nervosa. Instead, like all eating disorders, bulimia nervosa is the result of a combination of biological, sociocultural, and environmental factors. Certain circumstances, however, create a greater risk of developing bulimia for some people.

Biological risk factors for bulimia include genetics and family history. Recent research has shown that there may be specific genes involved in the development of bulimia. Because of this, you are at a higher risk of developing the disorder if your parent, sibling, or child is a sufferer. Research also suggests that early puberty (prior to that of peers) puts women at risk of developing bulimia.

Sociocultural risk factors include living in a culture where thinness is idolized and extreme diets and fitness routines are commonly in the media. Internalizing this thin body ideal (and consequently finding oneself not living up to this standard) is common in men and women who go on to develop bulimia.

Environmental risk factors include one’s upbringing and experiences. Like anorexia, those in jobs where a lot of attention is paid to weight and shape (such as dance, gymnastics, acting, wrestling) are at an increased risk of developing bulimia. Significant traumas, transitions, and losses can also trigger the development of bulimia. Compared to other eating disorders, those with bulimia nervosa have a higher incidence of trauma and/or sexual abuse in childhood.