Bulimia Nervosa

What Is It?

Bulimia nervosa is an eating disorder that involves binge eating: eating large quantities of food at one sitting, regardless of hunger. Most often, the condition also involves purging -  the use of self-induced vomiting and/or abusing laxatives, suppositories, enemas or diuretics -  after a binge. Rather than purging, some people compensate for episodes of bingeing with other behaviors, such as fasting or over-exercising.

About 80 percent to 90 percent of all people who have bulimia nervosa are women. In men, the nonpurging form of bulimia is more common than the purging form.

On average, bulimia appears between the ages of 18 and 20, but it can develop earlier or later. The condition affects 1 percent to 4 percent of college-aged women and under 3 percent of younger women. In a 1990 study of high school seniors, approximately 11 percent reported having either bulimia or anorexia.

Although people with bulimia are afraid of becoming fat, most are of normal weight or slightly overweight.

People with bulimia eat huge quantities of food -  sometimes up to 20,000 calories at a time. The foods on which they binge tend to be “comfort foods”  -  sweet foods, foods high in calories, or smooth, soft foods like ice cream, cake and pastries. People with bulimia may binge anywhere from a few times a week to several times a day.

Like anorexia, bulimia wreaks havoc on the body. It can lead to dehydration from purging, chronic bowel problems from laxative use, Tooth decay from excessive vomiting and gastrointestinal difficulties. At its most destructive, bulimic behavior can lead to an irregular heartbeat, permanent heart damage and even death.

People with bulimia usually feel ashamed of their bingeing and purging behavior. They are often impulsive and likely to be involved in other addictive behaviors.

Many people with bulimia also have a history of anorexia or obesity. They also may have undiagnosed major depression, anxiety disorder, social phobia or panic disorder.

There is almost certainly a genetic predisposition to the disorder. In addition, people with bulimia may have a problem involving nerve pathways in which serotonin is active. Serotonin is a neurotransmitter thought to be involved in depression and other mood disorders, as well as hunger, aggressive behavior and the onset of sleep.


Symptoms include:

  • Extreme concern over body weight or body shape
  • Eating large quantities of food over a short time period (binge eating), usually in secret
  • Following binge eating with purging -  it can take the form of self-induced vomiting or the use of laxatives, diuretics, enemas or suppositories -  or with fasting, restrictive dieting or excessive exercise

Bulimia can lead to:

  • Tooth decay and erosion
  • Constant sore throat
  • Low blood pressure
  • Constipation or other bowel problems
  • Swollen salivary glands
  • Gastrointestinal problems
  • Irregular heartbeat


A diagnosis of bulimia is made when you are obsessed with weight and body image and have severe eating binges at least twice a week for three months, along with compensating behavior such as purging, exercise or excessive dieting.

To help in the diagnosis, your doctor will take a medical history and examine you to look for the physical signs of bulimia. Blood tests can tell the doctor whether vomiting or using diuretics or laxatives has caused you to be dehydrated or depleted of electrolytes and other significant nutrients.

Expected Duration

Bulimia can last for a short time or can continue for many years. Even after successful treatment, bulimia can return.


There is no way to prevent bulimia. Treatment can be easier if the problem is detected early.


An eating disorder is a complex mix of physical and emotional problems. Both must be addressed successfully for treatment to work.

Treatment can include psychological counseling, nutritional counseling and medication, such as antidepressants. Psychotherapy helps people with bulimia create a healthy body image, understand and deal with their emotions, change their obsessive-compulsive behaviors related to food, and gain healthy eating behaviors. Nutritional counseling can help people choose healthy foods. Treatment with medication often helps to decrease the urge to binge and purge. Since depression and anxiety are often part of the eating problem, medication can help with these related problems.

Because many people with bulimia also may be depressed, antidepressant medication can help. Other medications can reduce obsessive-compulsive thoughts.

When To Call A Professional

Contact a health care provider (physician, counselor, psychiatrist) if you think you have, or are at risk of, bulimia. If you do not feel comfortable doing this, talk to a trusted friend or family member about your concerns and ask them to contact someone for you.

If someone you know shows signs of bulimia, contact a physician or mental health professional. Confronting someone with bulimia can be difficult. He or she may deny the problem or become defensive. For more information on how to talk to someone you suspect is bulimic, see the Additional Info section.


People with eating disorders have an excellent chance of recovery, especially if their condition is recognized early. In up to 50 percent of people, treatment may not eliminate all problems.

Johns Hopkins patient information

Last revised:

Diseases and Conditions Center

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.