Understanding Bulimia Nervosa: Causes, Symptoms, and Treatment

We know how terrifying and lonely it can be to struggle with an eating disorder. You may feel overlooked, misunderstood, or lost about where to start when searching for support. You may even be confused about what an eating disorder is, or what kind of disorder you are personally facing. 

To help answer some of these questions, we have created informational pages that break down different types of eating disorders while answering common questions that come up at the beginning of the recovery process. Below you will find a wide variety of information on the eating disorder, bulimia nervosa. 

What is Bulimia Nervosa?

Bulimia nervosa is an eating disorder characterized by episodes of binge eating followed by compensatory, or purging, behaviors aimed at preventing weight gain. If you are struggling with bulimia, your self-perception may be negatively impacted by a critical view of body shape and weight. This fixation on weight and shape can commonly lead to, or be exacerbated by, co-occurring mood disorders. 

Eating disorders affect individuals both mentally and physically. This can make the illnesses complicated to treat, which is why finding a practice that specializes in eating disorders, such as Hilltop Behavioral Health, is so helpful. Many times, bulimia can co-occur with other mental health disorders, such as depression, anxiety, bipolar, or PTSD. But when treatment involves a multidisciplinary team of professionals and supportive loved ones we see many individuals achieve full recovery. 

Clinical Definition of Bulimia Nervosa

According to the DSM, the clinical definition of bulimia nervosa involves the following diagnostic criteria: 

  • Repeated binge eating episodes. What makes an episode a binge? A binge has both of the following characteristics:
    • Within two hours, eating a quantity of food that is objectively more than what would normally be consumed during a similar period.
    • Feeling that you cannot stop or control how much or what you are eating during the binge eating episode.  
  • Recurrent, inappropriate compensatory behaviors aimed at preventing weight gain. These behaviors can include self-induced vomiting, misusing laxatives, diuretics, or other medications, fasting, or engaging in excessive exercise. 
  • The binge eating episodes and compensatory behaviors both occur an average of once a week for three months. 
  • Self-evaluation is unjustifiably influenced by the perception of body shape and weight. 
  • Binging or purging behaviors do not occur during behaviors commonly associated with anorexia nervosa. 

Signs and Symptoms of Bulimia

Warning Signs

The warning signs of bulimia can vary from person to person. However, if you are concerned about your loved one, here are some common signs associated with this disorder you can look for: 

Evidence of a Binge:

  • Finding food in strange spaces (hidden under the bed, buried in a laundry bin, tucked away in dresser drawers)
  • Wrappers and containers in the garage can
  • large quantity of items missing from the fridge or pantry
  • Making excuses for missing food, or money taken to pay for binge foods
  • Eating until the point of physical discomfort or pain

Evidence of Purging (Compensatory Behavior):

  • Boxes of laxatives or diuretics
  • Frequent bathroom breaks
  • Locked bathroom door for long periods
  • Running water when going to the bathroom
  • Fasting, or refusal to eat
  • Spending inappropriate amounts of time at the gym
  • injuries from vomiting, including scabs on knuckles, voice changes, burst blood vessels in the eyes, dental changes.

Additional Warning Signs:

  • Withdrawing from friends and family
  • Changes in mood
  • Changes in routine, such as missing class, work, or appointments
  • New topics of conversation, typically revolving around food or body image
  • Negative self-talk


Symptoms of bulimia can be expansive and specific to each person. However, here are some common symptoms that you may develop if you are struggling with bulimia: 

  • Headache
  • Abdominal pain 
  • Bloating 
  • Acid reflux 
  • Intestinal irritation and distress 
  • Increased and chronic fatigue
  • Irregular menstruation in females  
  • Inflamed and sore throat  
  • Swollen salivary glands 
  • Enamel erosion and tooth decay due to stomach acid 
  • Electrolyte imbalances 
  • Heart arrhythmias 
  • Low blood pressure 
  • In severe cases – heart attack, stroke, and even death can occur 

What Causes Bulimia?

If you are struggling with bulimia, or have a loved one who is, you may wonder what causes this disorder to develop. We wish the answer to this question could be simple. But, after working with many individuals on their recovery and studying the research around eating disorders, we understand that bulimia is typically caused by a combination of factors. 

The risk factors could include but aren’t limited to:  


  • Family history of an eating disorder or bulimia
  • Family history of mental illness or substance use
  • Natural sensitivity to reward-systems 
  • Struggles with impulsivity 


  • Prior history of mental illness
  • History of trauma 
  • Negative self-image 
  • Low self-esteem
  • Career, hobby, sport, or family with a heavy focus on physical appearance 

Behavioral and/or Social

  • History of dieting is strongly associated increased risk of developing bulimia
  • History of engaging in restrictive and binging cycles 
  • Values tied to Euro-centric beauty standards, known as the thin ideal 
  • Teasing and bullying due to weight 

Who Develops Bulimia?

It’s important to first note that bulimia doesn’t affect just one type of person, nor can the disorder be seen by looking at a person. Those who struggle with bulimia can be: 

  • Any age
  • Any shape
  • Any gender identity or expression 
  • Any ethnicity
  • Any religion
  • Any race
  • Disabled or abled 
  • Neurodivergent or neurotypical 

However, below are some specific statistics regarding certain populations that are at a higher risk of developing this disorder: 

  • In the US, about 1.5% of females and 0.5% of males will develop bulimia in their lifetime. 
  • The median age of onset for bulimia is 12.4 years old. 
  • Sexual and gender minorities are at a higher risk of developing bulimia. 
  • In the US, about 3% of transgender men and women will develop bulimia in their lifetime. 
  • Athleticism in both females and males can put individuals at a higher risk of developing bulimia. The risk is increased for individuals who are participating in sports that have a high emphasis, or preference, on body type and/or weight requirements. 

How Loved Ones Can Support

If you’re a loved one of someone struggling with bulimia, you may feel lost and confused about how to support their recovery. At Hilltop, we understand how lonely and scary this place can be. We want to remind you that your worries make sense and that you aren’t alone. Eating disorders are complicated illnesses that can leave loved ones feeling helpless and scared. The disorder can even begin to cause conflicts in families and strain relationships. 

Even knowing all this, research does show that loved ones are crucial assets in a person’s recovery because you already have an established emotional connection that professionals don’t. You can use this connection with your loved one to support them in their recovery process. This article called Supporting a Child with an Eating Disorder guides caregivers, and loved ones, through simple steps to use when supporting their loved one.   

When to Reach Out for Help?

If you, or a loved one, suspects that they may be struggling with bulimia please reach out for support. We understand this can be a scary step, but we also know that early intervention gives us the best chance at recovery. It can be common for you to question whether you are “sick enough” to reach out to a professional, but if you’re struggling you are deserving of help. No matter what questions you may have, Hilltop Behavioral Health is willing to meet you where you’re at in the process. 

Hilltop’s Approach

At Hilltop, we want to make sure you don’t feel alone. Our team of professionals are all trained in the treatment of eating disorders and empathize deeply with how challenging the recovery process can seem. We integrate a variety of therapeutic interventions into our sessions to create a support system that works for you.  

Interventions Used

Hilltop’s expert team is certified in various interventions, which means they can build a treatment plan specific to your situation and needs. Some of the interventions proven to be more effective in treating bulimia are: 

  • Cognitive behavioral therapy for eating disorders (CBT-E)
  • Adolescent & family-based treatment for eating disorders (FBT) 
  • Integrative psychodynamic approaches 
  • Free group therapy 

For individuals with co-occurring trauma: 

  • Cognitive processing therapy (CPT) 
  • Safe and sound interventions (SSP)
  • Somatic resilience therapy


We work with a spectrum of eating disorder severities. However, due to the nature of eating disorders, untreated bulimia can lead to dangerous medical and psychological complications, which can result in unwanted hospital stays. Our team of professionals works hard to prevent this from happening by attempting to stabilize a situation before it leads to a dangerous spot. 

We want to work with you to avoid as much unnecessary pain as possible. However, if we think your safety is in danger we may have to refer to a high level of care, but know that these moments aren’t taken lightly by our team and truly break out hearts. 

The important thing to remember is recovery is more accessible the sooner you come in for support. 

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