The Chief Causes and Types of Bulimia Nervosa

Bulimia nervosa or simply bulimia is a grave eating disorder that affects a significant proportion of the population, particularly young women, and can sometimes get fatal. An individual with bulimia tends to binge or eat gluttonously during a sitting, much more than what one would consume normally. Majority of bulimics also resort to purging or regurgitating after a round of gorging.

At a larger social level are the influences of pressure and advertisements on children and adults of what constitutes a perfect body and the ways that food, or lack thereof, may achieve that. — Leslie E. Korn Ph.D., MPH, LMHC, ACS, NTP

Bulimic individuals usually follow the cycle of bingeing and vomiting with the sole objective of staying as slim as possible and checking weight gain. Bulimics find themselves torn apart by an irrepressible urge to eat on one hand, and on the other, an irresistible desire to purge or vomit the excess food consumed. However, there is a proportion of bulimics who exploit other ways in order to shed the excessive intake of calories, instead of purging, like dieting, starvation, and intensive workouts.

It is estimated that 0.1-0.5% of males and 1.1-4.6% of females in the US may have or have had bulimia at some point in their life.


Symptoms and Signs of Bulimia

Unlike anorexics, bulimics tend to be have a normal weight and a very few bulimic persons are obese or overweight. Bulimics, on the other hand are also more likely to indulge in substance abuse, including narcotics, banned prescription drugs, tranquilizers, and alcohol. A typical bulimic might be difficult to identify as the usual signs or symptoms associated with the eating disorder are barely noticeable.

Physical signs generally include:

  • Fluctuating body weight
  • Acute dehydration
  • Malnutrition causing one to remain in poor health
  • GERD (gastro esophageal reflux disease)
  • Irregularity in menstruation
  • Teeth damage and sore throat owing to acid refluxes

And the behavioral symptoms entail:

  • Gorging
  • Eating all by oneself
  • Stashing food in unlikely places
  • Visiting the bathroom right after bingeing
  • Being finicky about gaining weight
  • Starving or dieting intensively followed by binge eating and vice versa

Bulimics are in the habit of taking emetics and laxatives that stimulate purging urges and usually keep such medications hidden. These persons also are adversely affected by sudden mood swings, and often diagnosed with depression or anxiety disorder. A bulimic might feel inhibited to talk about his or her eating disorder despite being acutely aware of the same.

Newsflash: purging food was discovered eons ago by patients suffering from eating disorders—no surgical procedure required. — Alexis Conason Psy.D.

Causes of Bulimia

The causes behind bulimia nervosa that have not yet been traced may help diagnosticians and medical scientists to work out an effective treatment plan. However, most dieticians, nutritionists, and medical professionals are of the opinion that a combination of genetic, environmental, and behavioral or temperamental factors are responsible for causing bulimia. Bulimics subjecting themselves to bingeing followed by a phase of purging is usually a means of dealing with emotional and psychological stress.

Bulimia patients are constantly troubled by feelings, usually bordering on irrationality that they are putting on undue weight and becoming obese. Consequently, they develop a sort of love-hate relationship with everything related to obesity including food. What starts as a simple way for managing emotional stress soon burgeons into an infatuation that bulimics find difficult to control.

A bulimic often indulges in self-destructive behavior leading to chronic psychological issues including anxiety disorder, bipolar disorder, and depression.

Oftentimes, symptoms and behaviors are rationalized and minimized by the person who engages in them. — Lisa Ferentz LCSW-C, DAPA

Risk Factors

Researchers and scientists are yet to pin down a single, palpable risk factor that might cause an outbreak of bulimia. It is generally alleged that there could be a set of environmental, psychological, biological, behavioral, and genetic factors working in coordination. Women are more prone to exhibiting symptoms of bulimia, compared to men, mostly during puberty when they experience physical and mental changes as a result of increased hormonal secretions.

More often, an obsession to emulate the dietary styles of celebrities, results in the young female being diagnosed with bulimia.



 The treatment procedure or plan for breaking the destructive cycle of binging and purging is protracted, lasting for nothing less than 4-6 months. A judicious blend of nutritional counseling, cognitive and behavioral therapy, medications, interpersonal therapy and the support of near and dear ones are instrumental for remitting symptoms of bulimia.

The Risks of Physical Harm Arising out of Bulimia

 It seems counterintuitive to think about how many people are willing to put their emotional and physical health at risk in order to lose weight when one of the main reasons that people state for wanting to lose weight is to improve their health and feel better about themselves. — Alexis Conason Psy.D.

Bulimia nervosa is regarded as a serious eating disorder where the patient indulges in successive phases of bingeing, gorging on food, and purging or regurgitating with the aim of keeping self extremely lean. Though bulimia apparently is associated with recurring cycles of eating excessively and then dieting or starving, there’s much more to the eating disorder than you might think. Bulimia can play havoc with one’s physical and mental well-being, and in the worst case scenario, lead to the patient’s death.

This eating disorder takes a tremendous toll not only on the patient’s physical well being but also on his mental health. Bulimics, are more often than not, diagnosed with OCD (obsessive compulsive disorder), anxiety disorder, and depression. They are subjected to extreme irritability and mood swings owing to malnutrition, lack of sleep, dehydration caused by electrolyte imbalance, IBS, and other issues.


Physical Side Effects

Following are some of the adverse side effects arising out of Bulimia


Electrolyte Imbalances and Abnormalities

As a bulimic patient usually escapes to the bathroom to vomit after a round of bingeing, he or she loses a high amount of fluids leading to electrolyte imbalance. Owing to electrolyte imbalance, the patient’s body becomes deficient of vital minerals including sodium, calcium, potassium, and magnesium. Abnormal decreases in the levels of these minerals or electrolytes can lead to chemical imbalances ultimately causing a heart attack or malfunctioning of other bodily organs.

Eating disorders are highly comorbid with obsessive-compulsive disorder, and the  functional nutritional treatment  for both is very similar. — Leslie E. Korn Ph.D., MPH, LMHC, ACS, NTP

Digestive and intestinal issues

Both binge eating and purging causes a heavy strain on the digestive system and metabolism of the bulimic individual. All organs associated with digestion and ingestion starting from the teeth, tongue, esophagus, and stomach to liver, kidney, and intestines are overworked as abnormal amounts of food have to be broken down for assimilation. Additionally, self-induced regurgitation leads to further straining of these organs.

Initially, the patient will experience abdominal pains, heartburns, bloating, and stomach cramps. In the long run, it is not unusual for the bulimic to be diagnosed with peptic or gastric ulcers, tooth decay, enamel erosion, and gingivitis. Long-term laxative and emetic abuse leads to diarrhea, constipation, and rupturing of the esophageal wall. GERD or acid reflux also has the potential of damaging the small and large intestines, trigger blood vomiting, and cause distended salivary glands.


Unfavorable effects on the circulatory system

Purging on a recurrent basis results in undue loss of fluids and electrolytes like potassium, sodium, and calcium eventually causing dehydration. Dehydration and electrolyte imbalance causes the muscles, ligaments, tendons, and tissues to become weak leading to muscle cramps. All these issues have a bearing on the normal functioning of the heart making the blood pumping and purifying organ to miss regular heartbeats-a medical condition termed arrhythmia.

Arrhythmic pulsations put a heavy stress on the heart, and in the worst case scenario, lead to a heart attack because of fatigued cardiac muscles. On the other hand if the patient is severely dehydrated, he or she might lose consciousness or faint, may suffer falls, feel dizzy, and over time, the kidneys might get damaged permanently. Bulimia nervosa may cause optic blood vessels to rupture, lead to hypertension and anemia.


Integumentary system takes a beating as well

The side effects of bulimia are across-the-board and does not even spare the organs categorized under integumentary system, like the nails, skin, and the hairs. Dehydration resulting from periodic spells of regurgitation leads to a decreased level of water in the body which implies that all bodily organs including the nails and the hairs have to make do with less water. Consequently, hairs dry up and turn frizzy, the skin wrinkles, and the nails become brittle.


 And the reproductive system also

Bulimic individuals deprive their bodies of essential nutrients, causing hormonal imbalance eventually leading to decreased appetite for coitus. Pregnant and lactating women continuing with their binging and purging behaviors also face several complications.

Anyone who is has an eating disorder is very invested in maintaining the thoughts and behaviors that fuel it, so when a loved one expresses concern they may be met with anger or defensiveness. — Lisa Ferentz LCSW-C, DAPA


Bulimia nervosa, despite its severity, is very much treatable. However, bulimics need to be very patient as the treatment process is long drawn, spread over a period of 3-6 months. A combination of treatment plans including behavioral and cognitive therapies, medications, and interpersonal therapies needs to be resorted to for healing.


Amazing Facts About Bulimia Nervosa



People generally use carbohydrates as their food of choice in bulimia, though they may choose fatty foods as well. These are mood altering by way of the serotonergic system, and they also lead to a sense of fullness by filling the stomach and putting pressure on the diapgragm. — Leslie E. Korn Ph.D., MPH, LMHC, ACS, NTP

If you are a bulimic, you’d have an irrepressible and unmanageable urge to gorge followed by a relentless impulse to spew out the large quantity of food consumed. Almost all bulimics follow a similar pattern like yours, of first bingeing and thereafter purging, all with the sole objective of staying as slim as possible. Bulimia nervosa, like anorexia, is more of a psychological disorder that is brought about by the interaction of an array of risk factors, including genetic, environmental, societal, and behavioral.

Bulimia as an eating disorder usually predominates in women compared to men, particularly when they are in their teens, twenties, and thirties. However bulimics can expect a full recovery, thanks to the availability of advanced inpatient and outpatient treatment options. Following are some startling facts about bulimia nervosa:


  • Bulimia nervosa is idiopathic, i.e. there is no single cause which can be held responsible for triggering the outbreak or development of the disorder in an individual
  • The eating disorder could be genetic-You’re at greater or higher risk of developing the disorder if someone in your immediate family or a close relative has any type of eating disorder

Bulimia nervosa afflicts approximately 4% of women and 0.5% of men in the US. Nearly 4% of those suffering from bulimia will die from the disease and nearly all struggling with the illness experience serious medical and/ or emotional effects. — Alexis Conason Psy.D.

  • It is the society, you stupid-Western societies tend to be obsessed with slimness and always urge individuals to keep weight as low as possible. Obesity is considered a taboo. Therefore people, mostly women are fixated with maintaining a reed thin figure in order to make selves more appealing, and often end up developing detrimental eating habits.
  • The disorderliness exists more in the mind-Apparently, bulimia is an eating disorder but in reality, the disorderliness is mental. Bulimics find bingeing as a means of escapement from feelings of shame, guilt, or suicide that cause emotional turmoil. Bulimia is often co-morbid or in other words, bulimia patients often suffer from an additional health issue or issues that could be physical or mental or both.


If the statistic published by ‘National Association of Anorexia Nervosa and Associated Disorders’ is to be believed, then bulimia along with anorexia and binge-eating disorder are amongst the most fatalistic mental disorders in the US.

  • Bulimics find themselves trapped in a web of obsessive habits-As a bulimic you’d find yourself struggling hard to contain your food cravings. You’d be storing food items in the unlikeliest of places (apart from the regular ones) so that you can access the same whenever you wish to. At the same time, you’ll be continually stocking up on laxatives, diuretics, and emetics-medicines that induce regurgitation.

You’d also have the compulsive need to exercising strenuously in order to burn calories. To accelerate the calorie torching process, you may also resort to starving, doing without big meals and surviving on tidbits.

  • Bulimia can prove to be very damaging for women-Female bulimics will experience problems with menstrual cycles often missing periods. Pregnant women could be at risk of suffering miscarriages, giving birth to stillborns or giving birth to babies with congenital defects, and so on

The person restricting calories, bingeing, purging, or excessively exercising may become anxious about getting caught or irritable when accusing a loved one of being unfairly suspicious or “controlling.” — Lisa Ferentz LCSW-C, DAPA

  • Bulimia can play havoc with the well-being of the affected person-Individuals with bulimia will have weakened digestive and metabolic systems. Electrolyte imbalance, anemia, dehydration, dry skin, ulcers, kidney failure, gastrointestinal issues, and esophageal ruptures are some common problems that bulimics face.
  • A good proportion of bulimics happen to be men-Though members of the opposite sex are more vulnerable to bulimia nervosa, men are equally at risk of developing the eating disorder. 15% of individuals undergoing treatment for various eating disorders happen to be men, as per reports released by ANAD.
  •  The road to recovery is a long one and can be challenging-It might take months, if not years for a bulimic to recuperate fully and get back to living a healthy life.




Patients of bulimia need to realize that a combination of effective treatment plans that integrate supervised dietary regimen, scientific workout schedule, psychotherapy sessions, and an appropriate medication system will help them to recover.

Is Bulimia Nervosa Treatable?

Nowadays, the increasing pressure to have this hourglass, model-like body is very observable. Even little kids already know what is physically attractive and what is not. This unrealistic notion influences the youth to pursue these outrageous standards. Hence, several problems such as eating disorders, depression, and obsession arise.

Someone who is struggling with an eating disorder may attempt to eat “normally” in the presence of others, and then look for opportunities to be alone to find ways to binge or purge. — Lisa Ferentz LCSW-C, DAPA

It is totally fine to be physically fit and healthy, but if you are overdoing it, that’s a different discussion. One of the most common problems that this specific standard of having an hourglass figure creates is an eating disorder.

Different Types of Eating Disorder

There are three major types of eating disorders. Anorexia nervosa is the condition wherein the individual restricts the intake of food to avoid being fat when in reality, the person is already thin. The second one is called binge eating disorder which is characterized by an uncontrollable urge to eat despite being full or not being hungry. Lastly, bulimia nervosa is characterized by purging, vomiting, or exercising excessively after binge eating.


Let’s Focus on Bulimia Nervosa

Apparently, you should know that there are two common types of bulimia nervosa. The first one is the purging type which is characterized by self-induced vomiting or abuse of laxatives to compensate after a binging episode. The second type is the non-purging bulimia nervosa. This form does not engage in self-induced vomiting. Rather, the individual who has this condition compensates by exercising excessively or fasting for extended periods of time.

Opposing and competitive opinions and theoretical perspectives in conjunction with discrepancies and inconclusive outcomes in quantitative and qualitative research continue to make it difficult to understanding causation and therefore establish solid treatment protocols. — Judy Scheel Ph.D., L.C.S.W., CEDS


The typical causes of bulimia are usually stress, negative body image, low self-esteem, history of abuse or trauma, and/or other related factors. Despite these known factors, the specific cause of bulimia nervosa is not yet identified.

What can we do to treat Bulimia Nervosa?

Given the knowledge that you already know about bulimia nervosa, you probably have an idea what you can do to prevent it. Since one of the underlying factors for this condition is low self-esteem and the need to be thin just to be accepted by the society, it is understandable that doing activities to boost your morale can help. These activities, such as playing sports, joining a club, and others can help in increasing self-esteem, therefore lowering the risk for bulimia nervosa.

Another helpful treatment would be to discontinue the binge-purge cycle and to improve your negative thoughts so you won’t feel guilty about yourself and end up purging or over-exercising again. Re-establishing the way that you view yourself can help you erase the irrational beliefs about your weight or your body shape. As long as you are healthy, you are perfect the way you are.



The truth is: weight is a lousy indication of health. — Alexis Conason Psy.D.

The most important treatment is to seek out a professional that can help you through the process of dealing with bulimia nervosa. This kind of disorder can lead to serious medical complications. Delaying to seek out for help is a really bad idea.

If you know anyone who is having a hard time dealing with their eating habits, he or she might be at risk of developing bulimia nervosa. Don’t hesitate to reach out and ask for help.

Bulimia: Knowing When To Seek Treatment


Deciding when to seek treatment is probably the hardest step in the recovery process. It requires you to realize that you need help and that you can’t beat your eating disorder alone. Seeking professional assistance is necessary because of the life-threatening status of eating disorders. When your eating disorder is in control, you lose the ability to think rationally and to see the damaging effects it has on your physical and mental health. A therapist can help you look at the situation logically and learn coping skills to deal with stress or poor self-esteem associated with your disorder.

The lack of seriousness taken by many patients regarding the medical sequeale of Anorexia and Bulimia, contributes to the inability to choose the best protocol for care and therefore increases the likelihood of treatment failure. — Judy Scheel Ph.D., L.C.S.W., CEDS

When deciding if therapy is the right option for you, it is important to ask yourself these questions:


Is It Causing You Harm?


Eating disorders isolate you from your loved ones and cause you to doubt your own views and beliefs. Your insecurity and poor self-image is in control of your actions and behaviors.

Harm doesn’t necessarily mean physical symptoms, though these are also a cause for concern. Harm can refer to emotional and social harm. One example of this is that your mental state can be altered by low self-esteem and negative self-talk, both of which can lead to a damaging body image.

Bulimia nervosa will also manifest physically. This can be through harmful weight loss or acid reflux disorder. These disorders can cause pain to the individual.

Anyone who is has an eating disorder is very invested in maintaining the thoughts and behaviors that fuel it, so when a loved one expresses concern they may be met with anger or defensiveness. — Lisa Ferentz LCSW-C, DAPA

Is It Affecting The People Around You?

Your eating disorder will affect you and everyone around you. It will put a strain on your relationships. When someone’s friend or family member is hurting themselves and not seeking to change, it’s stressful for the individual. It’s unbelievably hard to watch someone you love damage himself in permanent ways because he won’t admit he has a problem.

Your eating disorder will make you to act out and become isolated from the people around you. This is because your disorder is in control of your decisions, not you. You will find yourself making excuses and avoiding interaction because you’re too afraid of getting caught. You dread to face the consequences.

If you notice that you are pulling away from your friends and family, it’s time to seek treatment and professional help. The situation gets much more dangerous when you lack a support system to encourage you and provide strength when things get really hard.


Is It Preventing You From Living A Normal Life?


Your eating disorder can potentially prevent you from experiencing a normal life. You will become so focused on what food you are consuming and the act of purging that you will neglect your daily tasks and the jobs that need to be completed.

The truth is: weight is a lousy indication of health. — Alexis Conason Psy.D.

Bulimia is a very secretive disorder, as mentioned earlier. You will hide your behavior around food and it will cause you to isolate yourself from the society. Professional help is needed to go on living a normal life while battling your disorder. You need to be equipped of the tools to cope with your poor self-image and low confidence levels.

If you find yourself unable to attend school or work, you are in a dangerous territory because you/re losing control. Once you neglect the activities you love, you have reached life-threatening waters and should seek help immediately. It’s important to reach out for treatment, even if you’re scared of people finding out about you. Your mental health is the most important thing and should be your priority.