Bulimia: Symptoms, Treatments, and Prevention

Medically Reviewed by Zilpah Sheikh, MD on June 26, 2024
8 min read

Bulimia is a psychological eating disorder in which you have episodes of binge eating (having a large amount of food in one sitting) followed by steps to compensate for overeating, known as purging. During binges, you feel like you have no control over your eating, and may feel ashamed or embarrassed. Afterward, you try to get rid of what you ate by doing things such as:

To be diagnosed with bulimia, also called bulimia nervosa, you must have bingeing and purging episodes at least once a week for 3 months.

Bulimia tends to start in late childhood or early adulthood. People with the disorder can be any size, but their self-esteem is closely tied to their body image. They may fear gaining weight, want to lose weight, or feel very unhappy with their bodies.

We don't know the exact cause of bulimia. But research suggests it's a mixture of things, including certain personality traits, emotions, and thinking patterns. People with eating disorders appear to have brain differences that may affect how they understand signals coming from their body. Social and environmental influences, such as the way you were raised and stereotypical beauty standards, also play a role.

Bulimia risk factors

The fact that bulimia tends to run in families suggests that you might inherit a risk for the disorder. Other risk factors include:

The main symptoms of bulimia are episodes of bingeing followed by purging. That can lead to many different health problems, including:

Someone with bulimia will typically binge and purge in secret. And unlike someone with the eating disorder anorexia, they may not lose a lot of weight. That can make it harder for friends and family to tell what’s going on. However, there are signs that may indicate someone you care about has the disorder. They include:

  • Hoarding or stealing food
  • Food rituals, such as eating only certain foods, chewing more than necessary, or not allowing foods to touch
  • Skipping meals or eating only small portions during meals
  • Bloodshot eyes
  • Scrapes or calluses on their knuckles or backs of their hands (from making themselves throw up)
  • Gaining and losing weight often
  • Using the bathroom frequently after meals
  • Excessive exercising
  • Preoccupation with body weight
  • Drinking large amounts of water or calorie-free beverages
  • Often using mints, gum, or mouthwash
  • Habit changes, such as avoiding friends or usual activities

Bulimia can cause serious health problems. They include:

Dental issues. When you throw up a lot, stomach acid can damage your tooth enamel. That can lead to cavities and sensitivity, and eventually discolor your teeth. You may also have gum loss and infections.

Digestive tract problems. Bulimia can affect all parts of your digestive system. Repeated throwing up increases the size of the glands that make saliva, making your face and jaw appear swollen.

It also causes irritation in your throat, esophagus (the tube connecting your mouth and stomach), stomach, and intestines. You may have reflux, where stomach acid backs up into your esophagus and throat. Overuse of laxative medications can cause constipation.

Dehydration. Loss of fluid from throwing up or other ways of purging can cause imbalances in certain minerals, called electrolytes, including calcium and potassium. Low levels of potassium or sodium can cause potentially life-threatening heart or kidney problems. Abnormal electrolyte levels and drops in blood sugar levels can also cause seizures.

Mental health conditions. It's not uncommon for people with bulimia to have other mental health issues, including anxiety, depression, bipolar disorder, or alcohol or drug misuse. You're also at higher risk for suicidal behavior and self-harm, such as cutting yourself.

Long-term effects of bulimia

If bulimia goes on for a long time without treatment, the consequences can be life-threatening. It can lead to:

If your doctor thinks you might have bulimia, they'll probably ask you about your eating habits, if you've lost or gained weight, and whether you have any physical symptoms. They may also:

  • Give you a complete physical exam
  • Do blood and urine tests
  • Give you a heart test called an echocardiogram (EKG) to see if you have heart problems resulting from bulimia
  • Do a psychological exam that includes questions about your body image

You may also have other tests to rule out medical causes for weight loss or gain.

Bulimia vs. anorexia

Bulimia is similar in some ways to anorexia nervosa. They both involve a preoccupation with food and a compulsion to be thin. People with anorexia will strictly limit what they eat, to the point of becoming underweight. 

Someone with anorexia may have bingeing and purging episodes from time to time. But that isn't the main feature of the disorder, like it is with bulimia.

To treat bulimia, your doctor will consider your physical and psychological needs. Your treatment may include counseling and medications. Often, it involves a team of medical, nutritional, and mental health professionals. They'll try to help you restore your health and healthy eating patterns.


The antidepressant fluoxetine (Prozac) is FDA-approved for the treatment of bulimia. Doctors sometimes recommend other antidepressants or types of medicines.

Psychotherapy(talk therapy)

Therapy is a key component of treatment for bulimia. This can take several forms, including:

Cognitive behavioral therapy (CBT). This type of therapy teaches you to recognize and change the thoughts, feelings, and behavior patterns that lead you to binge and purge. It also helps you develop coping skills.

Family-based treatment (FBT). Often used in children and teens with bulimia, it helps the family deal with the illness and issues it can cause.

Interpersonal psychotherapy (IPT). This focuses on problems in your relationships with other people in your life. The way you interact with others can affect your emotional state and mental health.

Nutritional counseling

The goal is to teach you good eating habits. You work with a dietitian to learn to recognize your body's signals of hunger and fullness. They help you stabilize your weight and gain a healthier attitude toward food.


This doesn't happen often. But with serious cases of bulimia, you might be treated in a hospital for a short time. Most eating-disorder programs offer outpatient treatment.

Treatment can help people with bulimia get back to healthy eating patterns. But it's not uncommon to go through periods where symptoms come back after improving, known as relapse. This may happen if you're under a lot of stress, for example.

It's important to let your doctor know if you start having problematic thoughts and behaviors around eating so you can get help.

Because we don't know exactly why people get bulimia, it's hard to know how to prevent it. But there are ways to teach children and teens healthy attitudes and behaviors about food and body image. They include:

  • Have regular family mealtimes as often as possible.
  • Don't label foods as either "good" or "bad."
  • Focus on building healthy habits rather than being concerned with weight.
  • Try to promote a realistic, positive body image in your kids.
  • Discourage fad dieting.

Call your doctor if:

  • You find yourself secretly binge eating, then vomiting or using laxatives.
  • You avoid eating in front of other people.
  • Your child expresses fear of being fat or has a distorted body image.
  • Your child avoids eating with others or often visits the bathroom immediately after meals.

Along with following your treatment and therapy plan, you can take steps to care for yourself:

Look after your body. Include healthy foods in your diet to make sure you're getting the nutrients you need. Ask your doctor whether supplements are right for you. And check with your doctor about how much exercise is healthy for you.

Connect with others. Support from friends and family can help you overcome unhealthy habits and feel better about yourself. A support group might help, too. The National Association of Anorexia Nervosa and Associated Disorders lists several such groups. The National Alliance for Eating Disorders also offers a helpline.

Avoid your triggers. Don't linger over social media images of people with bodies that are unrealistic for you. Stay on top of hunger with regular meals. If stress or boredom triggers bingeing, practice using healthier ways to deal with them.

Adjust your self-image. Your looks take on outsized importance when you have bulimia. Therapy can help you understand that your weight doesn't define you.

Sometimes, people with bulimia also have depression at the same time. Call 911 if you or someone who has this condition is thinking about suicide.

You can also call or text 988 to get help from a network of local crisis centers known as the 988 Lifeline.

Bulimia is an eating disorder in which you eat large amounts of food at once, called bingeing, then take extreme steps to compensate for that, called purging. It can cause serious problems for your digestive system and dental health, and even lead to an irregular heartbeat or heart failure. Treatment usually involves therapy and antidepressant medication.

What's the difference between bulimia nervosa and binge eating disorder?

Both disorders involve eating unusually large amounts of food at once, known as bingeing. But someone with binge eating disorder won't take steps to compensate for that overeating the same way someone with bulimia will. They won't purge, for example, by making themselves throw up or exercising too much.

What's the difference between anorexia and bulimia?

People with anorexia and bulimia have many of the same thoughts and behaviors, including a preoccupation with food and weight. However, people with bulimia regularly eat to excess, then take unusual measures to get rid of what they ate. That can happen with anorexia, but it's more typical to strictly limit what you eat to the point of becoming underweight.