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Understanding Bulimia Nervosa: What It Is, Symptoms, and Treatment

Bulimia nervosa is a serious and complex mental health condition that can affect anyone regardless of age, gender, body shape, or any other factor. 

Individuals with bulimia engage in recurrent binge eating episodes followed by the regular use of compensatory or purging behaviors in an attempt to prevent any weight gain. Oftentimes, the binging and purging episodes are accompanied by feelings of anxiety, shame, guilt, or distress, causing significant emotional turmoil for the individual struggling.

Let’s talk more about what bulimia nervosa is, its most common warning signs and symptoms, and what treatment can look like for individuals to achieve a lasting, successful recovery.

What is Bulimia Nervosa?

Bulimia nervosa is an eating disorder characterized by a cycle of binge eating followed by compensatory behaviors usually used to prevent weight gain. Individuals with bulimia often experience a lack of control during binge-eating episodes, consuming large amounts of food in a short period of time, and feeling a sense of guilt, shame, or distress afterward. Unlike binge eating disorder, which consists of repeated binge eating episodes, bulimia nervosa must entail the regular use of compensatory or purging behaviors.

In individuals with bulimia, inappropriate compensatory behaviors or purging are typically done in an attempt to rid the body of excess calories and prevent possible weight gain. There are several types of purging behaviors associated with bulimia nervosa including self-induced vomiting, excessive exercise, and misusing laxatives or diuretics. Both binge eating episodes and these compensatory behaviors are often done in secret, causing the harmful cycle of binging and purging to become a regular pattern.

Furthermore, individuals with bulimia nervosa often experience multiple challenges simultaneously, so there may be other co-occurring mental health conditions present such as, but not limited to, depression, anxiety, or obsessive-compulsive disorder. Importantly, bulimia nervosa is a complex mental health condition that can have serious physical and psychological consequences, so early intervention and treatment are key to achieving a successful, lasting recovery.

How Bulimia Nervosa is Diagnosed

According to the DSM-5, the criteria to be diagnosed with bulimia nervosa include:

  • Recurrent episodes of binge eating: Eating, within a discrete period of time (any 2-hour period), an amount of food that is significantly larger than what most people would eat during a similar time period and under similar circumstances.
  • Feeling a lack of control during binge episodes: There is a sense of lack of control or that one cannot stop eating during binge eating episodes.
  • Recurrent inappropriate compensatory behaviors: To prevent weight gain, the individual engages in recurrent inappropriate compensatory or purging behaviors, such as self-induced vomiting, misuse of laxatives/diuretics, fasting, or excessive exercise.
  • Self-evaluation is influenced by body shape and weight: The individual predominantly judges themselves in terms of their body shape and weight, and this also negatively impacts their self-esteem.

To be officially diagnosed, binge eating and compensatory behaviors must both occur, on average, at least once a week for at least three months. Also, the severity of bulimia nervosa is classified based on the frequency of compensatory behaviors noted in the following:

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

It’s important to note that an accurate diagnosis and adequate treatment plan should always be conducted by qualified professionals who specialize in treating eating disorders to have the best chance at a successful recovery.

Not sure if it’s an eating disorder? Take our eating disorder screener to gain a better understanding of whether you or a loved one may be struggling.

Warning Signs and Symptoms of Bulimia Nervosa

In addition to the diagnostic criteria outlined in the DSM-5, there are several common warning signs and symptoms associated with bulimia nervosa that may indicate that an individual is struggling with an unhealthy relationship with food, body image, and weight. Although not everyone with bulimia nervosa will necessarily display every one of these symptoms, the most common warning signs to be aware of include:

  • Evidence of binge eating: Disappearance of large amounts of food in a short period of time, or hidden food wrappers/empty containers
  • Frequent trips to the bathroom after meals: May indicate the individual is engaging in self-induced vomiting or misusing laxatives or diuretics
  • Physical signs: Swollen cheeks, calluses or scars on the knuckles or hands, and dental problems are all possible signs of repeated self-induced vomiting
  • Changes in weight: Fluctuations in weight, including periods of weight loss and weight gain
  • Preoccupation with food, dieting, and body weight: Constantly talking about food, calories, and weight, and expressing dissatisfaction with their body size or shape
  • Rituals around eating: Eating in secret or avoiding social situations where food will be involved
  • Excessive or rigid exercise routines: Engaging in intense and frequent exercise as a way to “burn off” unwanted calories
  • Mood and emotional changes: Mood swings, irritability, or anxiety related to food and body image, and feelings of guilt, shame, or distress after eating
  • Social withdrawal: Avoidance of social activities that may potentially involve eating and isolation from friends and family

Recognizing these warning signs early on and seeking professional help is essential for effective intervention and treatment. If you suspect that you or someone may be struggling with bulimia nervosa, we highly encourage seeking professional support right away.

Overcoming Bulimia Nervosa

Treatment for bulimia nervosa usually varies from person to person depending on their unique needs, individual circumstances, and the severity of the disorder. Oftentimes, this will include a multi-disciplinary treatment team that works to address all physical and psychological concerns. This team may consist of a therapist, dietitian or nutritionist, primary care physician, psychiatrist, and other specialized healthcare professionals.

Here at VERY, our virtual eating recovery treatment is designed to help individuals with all types of eating disorders achieve a lasting, successful recovery. Supported by a team of compassionate and specialized professionals, our goal is for individuals struggling with an eating disorder to regain a healthy relationship with food and live a life filled with purpose and meaning.

Having the right support system is another crucial part of the recovery process, which is why we’ve created our RecoVERY community to better support individuals with community support, beneficial resources, and valuable coping skills. Start your 30-day free trial to see how our community can complement your healing journey.

Have questions? Schedule a free consultation to learn more about how our team can help best support you along your recovery journey.