Bulimia Nervosa


Bulimia nervosa is an eating disorder. People who have bulimia are overly concerned with weight and body image. They eat very large amounts of food (called binge eating) and use inappropriate means to rid their bodies of the food (called purging). Purging may be done through vomiting, laxatives, or water pills. Excessive exercise or fasting may replace or be used along with purging. This cycle of binge eating and purging is used to prevent weight gain.


The exact cause of bulimia is unknown. Factors that may contribute to this condition include:

  • Cultural bias toward thinness
  • Changes in the level of brain chemicals
  • Emotional stress
  • Disturbed self-image

Risk Factors

Bulimia is more young women, especially between 11-20 years old. Other factors that may increase your chance of bulimia include:

  • History of obesity
  • Anxiety
  • Mood disorders
  • Family members who have had an eating disorder or mood disorder
  • Low self-esteem
  • Unhappiness with weight and size
  • Career in which physical appearance is important
  • Substance abuse


Behavioral symptoms include:

  • Eating unusually large amounts of food at one time
  • Feeling like eating is out of control
  • Intentional/forced vomiting
  • Taking laxatives, enemas, water pills, or diet pills
  • Exercising excessively
  • Having dramatic changes in mood
  • Having symptoms of depression
  • Having difficulty controlling your impulses
  • Abusing alcohol or drugs

Physical symptoms include:

  • Abdominal pain and heartburn
  • Menstrual problems
  • Swollen cheeks and jaw
  • Sore throat
  • Swollen salivary glands (in the mouth and throat)
  • Bloating
  • Stained or chipped teeth (due to contact with stomach acid)
  • Cuts or scars on back of hands (from scraping skin on teeth during forced vomiting)

Bulimia may lead to other problems, including:

  • Dental and throat problems from stomach acid that rises during vomiting
  • Changes in body chemistry and fluids due to vomiting and abuse of laxatives or water pills

Symptoms of these complications include:

People with bulimia have a high incidence of psychiatric conditions, including:


The doctor may suspect bulimia after a physical exam and medical history. The doctor may ask about your dietary and exercise habits..

Once bulimia is suspected other tests may be done to determine if the bulimia has caused an imbalance in the blood or heart. Tests may include:

  • Blood tests—to look for chemical imbalances
  • Electrocardiogram (EKG)—to check for abnormal heart rhythms
  • Drug screening—to check for drug use
Heart EKG
Bulimia can lead to severe heart problems.
Copyright © Nucleus Medical Media, Inc.

A mental health professional may also perform a psychiatric exam and/or psychological tests. Drug screening may also be done.


Immediate care may be needed to stabilize chemical imbalances in the body and manage changes to the heart.

Overall goals of treatment are to stop harmful behaviors and thought patterns.

Treatments may include:

Nutritional Support

A registered dietitian can create a healthy nutrition plan and create reasonable weight and calorie goals. The plan may also help avoid electrolyte imbalances.


Therapy can help reshape behaviors by helping to:

  • Gain insight into the problem
  • Recognize what triggers binging and purging
  • Develop new coping skills
  • Learn and practice stress-management techniques
  • Talk about feelings
  • Develop a more appropriate idea of thinness
  • Develop healthier attitudes about eating
  • Learn to eat regularly to reduce the urge to binge

One type of behavior called cognitive behavioral therapy (CBT) can be very effective, especially when combined with medication. Therapy may be one on one, group, family, or a combination of therapies.

For children, the school system should also be included. The school can provide special accomodations like snack breaks in class.


Antidepressants medication may help reduce the urge to binge and purge. Medication is most effective when combined with therapy.


Healthy attitudes about food and your body help prevent bulimia nervosa. Suggestions include:

  • Maintain a rational approach to dieting and food.
  • Accept a realistic body image.
  • Take pride in what you do well.
  • Set realistic goals.
  • Talk to your doctor or a mental health professional if you think:
    • Your desire to be thin is getting out of control
    • You may be developing an eating disorder
  • If you have a friend/family member who may have bulimia, encourage this person to get help.


Please note, not all procedures included in this resource library are available at Allegiance Health or performed by Allegiance Health physicians.

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Eating one or two servings of fish rich in Omega-3 fatty acids per week, like salmon or tuna, decreases your risk for heart disease and even heart attack.