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Learn about bulimia

Updated: May 5

Bulimia Nervosa 101

You may have heard of bulimia. Perhaps you’re wondering what the difference between bulimia and binge eating is. It’s easy to be overwhelmed with all the information out there.

We’ve compiled a list of some common questions about bulimia nervosa and an overview of our non-diet approach to bulimia recovery.

What is Bulimia Nervosa?

Bulimia Nervosa, to give it its full name, is an eating disorder characterised by a cycle of binge eating and compensatory behaviour, known as purging. Such cycles are often accompanied by feelings of a lack of control over episodes of eating.

Throughout this article bulimia nervosa will be referred to as both bulimia nervosa and bulimia as the terms are often used interchangeably.

Common causes of Bulimia Nervosa

The exact cause of bulimia is unknown, it is instead contributed to a range of factors all interacting. Bulimia may also develop over time so the original cause is forgotten or unknown.

Some contributing factors in bulimia development are:

  1. Genetics: people with first degree relatives may be more likely to develop an eating disorder (different papers / studies estimate anything from 30-80%). There has been no precise gene identified currently but familial links have been found.

  2. Neurological: the neurotransmitters dopamine and serotonin - aka the happy hormones - have both been linked to bulimia. They are also linked with depression which often co-occurs with bulimia, the crossover element of the venn diagram of bulimia and other mental health disorders perhaps?

  3. Personality traits: commonly found traits in those experiencing bulimia include: impulsivity, unstable moods, emotional intensity and a lack of mental flexibility. This is often coupled with perfectionism - a strive for flawlessness. This perfectionism may mean mistakes are seen as personal failures to be avoided at all costs.

  4. Dieting: people who diet are at a higher risk of developing an eating disorder. Dieting and strict restriction may lead people to enter the binge-restrict cycle which can cause bulimia.

  5. Childhood trauma: there is a strong link between childhood trauma and eating disorders. This can include divorce, loss of parents, abuse (including sexual, emotional, physical etc.) as well as bullying and neglect.

  6. Co-occurring mental illness: 95% of respondents with eating disorders met the criteria for at least one co-occurring disorder. Many individuals also engage in self-harm behaviours. The chicken or the egg? What came first - the same can be said for bulimia and many co-occurring conditions such as depression and anxiety.

  7. Sociocultural: we live in a time of societal pressure and the ‘thin ideal’ being promoted. It’s easy to internalise these beliefs and feel not enough when we do not meet them. Societal and peer pressure can crossover.

  8. Stressful life events: can include a breakup, new job, moving house, leaving for university, experiencing puberty etc. For some young people moving up from primary to secondary school can be enough to trigger bulimia.

Is social media to blame?

Recently there’s been a renewed look into the effect of social media on our mental health. But social media affects everyone differently, some people are considered more susceptible than others in the research. And it may be that social media triggers something from the above list.

Social media promotes body objectification and comparison. It’s easy for you to assess your body as not good enough and start to be more critical of your self image. It can also be easy to find people to promote pro eating disorder views, through hashtags, forums and message boards. Fortunately companies have been held a little more accountable but tags such as ‘thinspiration’ still exist.

What are the signs of Bulimia Nervosa?

The DSM-5, which is used by doctors to diagnose eating disorders, has the following criteria for a diagnosis of Bulimia Nervosa (BN):

  1. Recurrent episodes of binge eating (binge eating refers to eating a large quantity of food in a certain time period that is larger than most people would eat during a similar time period / under similar circumstances). Binge eating is also defined by a lack of control over eating during bingeing episodes.

  2. Recurrent compensatory behaviours such as self-induced vomiting, laxative misuse, use of diuretics, medication use, fasting or excessive exercise. These are often seen as means to prevent weight gain, feel less full, or to relieve discomfort.

  3. On average this cycle of binge eating and inappropriate compensatory behaviours happens, on average, at least once a week for three months.

Signs and symptoms of bulimia

It can be hard to read a doctor's symptom list and wonder what that actually means. Below are some common signs and symptoms. However, know that each person is individual, and if you feel you are experiencing bulimia then seek help. Don’t feel as if you have to tick off a certain number of symptoms before you’re ‘sick enough’.

Behaviours of bulimia:

  • Food rituals

  • Skipping meals and/or consume small portions

  • Disappearing quickly after eating, often to the bathroom

  • Hoarding food

  • Excessive use of mouthwash, mints, gum etc.

  • Wearing baggy clothes to hide body

  • Maintaining a very rigorous exercise routine regardless of weather, illness etc.

  • Frequently checking in the mirror for perceived flaws

Emotional signs of bulimia:

  • Frequent mood swings

  • Low self-esteem

  • A lack of self-control

  • Denial of binging, purging etc.

  • Feelings of shame after binging and/or purging

Diet behaviours seen in bulimia:

  • May practice different diets such as Intermittent Fasting, low carb, low sugar, etc.

  • Drinking excessive amounts of water, low calorie drinks, or caffeinated drinks

  • All or nothing with eating

Physical signs of bulimia:

  • Unusually swollen cheeks and jaws

  • May have calluses on the back of hands if vomiting (known as Russels’ sign)

  • Teeth may be discoloured, stained, or decaying

  • May be bloated from fluid retention

  • May have noticeable fluctuations in weight - this can be up or down

  • Stomach cramps and/ other gastrointestinal issues such as acid reflux, constipation etc.

  • Can experience anaemia, low thyroid hormone levels, low potassium

  • Dry skin, sometimes yellowing of skin

  • Thinning of hair on the head

  • Poor wound healing and impaired immune functioning

Cognitive signs of bulimia:

  • Difficulty concentrating

  • Obsession and pre occupations with food, weight, and body shape

  • Poor impulse control

  • A desire to control situations and environment

Hormonal signs of bulimia:

  • Menstrual irregularities - missing periods or only having a period while on hormonal contraceptives

  • More cortisol - sleep problems, feeling stressed, anxious and maybe depressed

Social signs:

  • Avoiding social gatherings involving food

  • May appear uncomfortable eating around others

  • Eat meals in secrecy

  • Creation of a lifestyle to fit food rituals and exercise

Psychological signs:

  • May have suicidal tendencies

  • Low self-esteem

  • Can also experience depression, anxiety and sleep disorders

What are the risks of Bulimia Nervosa?

Bulimia affects everyone differently, but can have serious consequences for the body.

Physically, those experiencing bulimia can experience electrolyte imbalances in the body, affecting the heart and other major organs.

Other physical effects include:

  • Medical complications due to self-induced vomiting including oral trauma, erosion of tooth enamel and rupturing of the oesophagus.

  • Effects on fertility, especially if the menstrual cycle is lost in women. Bulimia during pregnancy may put the baby at risk. Bulimia may also decrease the sex drive.

  • Digestive tract issues especially if using vomiting or laxatives as a form of purging.

  • Extreme fatigue, dizziness and even fainting.

The effect of prolonged stress may also affect individuals mental health, which can have lasting effects. This is due to a focus on body image as an indicator of self worth. Especially if bulimia is kept a secret, then someone is struggling in secret.

A compassionate approach to Bulimia Nervosa recovery: A whole approach for long-term recovery

At Ease Nutrition Therapy, we don't believe in part recovery. We want to help you fully heal your relationship to food. To live a full meaningful life.

Read about how we can help you here.


We are a specialist eating disorders and disordered eating online clinic. We support people with troubled relationships to food with expert Nutrition Counselling.

Founded by Shannon Western in 2019. The team has grown to welcome wonderful Dietitians and Nutritionists all to help you feel better with food.

Are you:

  • Struggling with feeling overwhelmed or out of control with eating?

  • Unsure about when, why, and how much to eat?