Last Updated:

January 30th, 2026

Bulimia

Bulimia nervosa is one of the more common eating disorders, yet despite how well-known it is, recognising it in someone’s day-to-day life is rarely straightforward. Bulimia thrives in secrecy, and many people who struggle with it work hard to keep their behaviours hidden from view.

Understanding what bulimia looks like and how it develops is often the first step toward identifying and treating it.

young woman suffring bulimia

What is bulimia?

Bulimia nervosa is an eating disorder that involves repeated episodes of eating large amounts of food in a short space of time, followed by actions designed to prevent weight gain. These actions are known as compensatory behaviours. During a binge, the person often feels unable to stop, even if they want to and may eat far beyond the point of physical comfort.

To counteract the binge, they may purge through self-induced vomiting, or misuse laxatives or they may restrict food afterwards or turn to extreme exercise. This cycle can become deeply ingrained, creating emotional distress as well as significant risks to physical health.

Are there different types of bulimia?

Although bulimia has standard diagnostic criteria, the way it presents can vary between people. This has led some clinicians to describe two broad presentations. These are not officially listed as subtypes in the DSM-5, but they are useful for understanding how behaviours differ.

Purging presentation

This involves behaviours such as self-induced vomiting or the misuse of laxatives, diuretics or enemas. The goal is to quickly remove calories consumed during a binge.

Non-purging presentation

Here, the person compensates in other ways. This might include long periods of fasting or long, intense exercise sessions as a way to “balance out” the binge.

Both presentations can be equally distressing and equally harmful, and both need proper treatment and support.

What are the causes of bulimia?

Bulimia does not emerge from a single cause. Instead, it tends to be influenced by a mixture of psychological, genetic, biological and environmental factors that interact over time.

Psychological factors
Low self-esteem, negative body image and a sense of never feeling “good enough” are common emotional foundations of bulimia. Some research also shows that people with eating disorders may display higher levels of perfectionism, impulsivity and obsessive-compulsive traits than those without an eating disorder. These traits can amplify anxiety around food and shape unhealthy beliefs about weight, which make binge-purge cycles harder to break.
Genetic factors
Genetics appears to play an important role too. People with a close relative who has bulimia have a higher likelihood of developing an eating disorder themselves. Studies suggest that the heritability of bulimia may be as high as 62%.

While this does not mean bulimia is predetermined, it does suggest that some people may be more vulnerable to developing it when other stressors or environmental pressures are present.

Traumatic experiences
For some, bulimia is linked to past trauma. Experiences of physical, emotional or sexual abuse can significantly increase the risk of developing an eating disorder. Research shows that around 25.5% of people with bulimia meet criteria for post-traumatic stress symptoms, indicating a strong connection between trauma and disordered eating patterns.

In these cases, bulimia may act as a coping mechanism for overwhelming emotions that feel difficult to manage in other ways.

Environmental factors
Societal messages about appearance have a powerful influence, especially for younger people. Social media platforms often showcase carefully curated bodies and lifestyles that set unrealistic standards. In a recent study of individuals aged 14-25, 42% showed signs of potential eating disorders and 41.7% displayed patterns associated with social media addiction.

This highlights how constant exposure to appearance-focused images can fuel dissatisfaction, intensify comparison and reinforce disordered eating behaviours.

The damaging effects of bulimia

Bulimia affects far more than eating patterns. Its impact reaches across the body and mind and the consequences can become serious if the disorder continues without support.

Physical effects of bulimia

The physical toll can build gradually or appear suddenly, depending on the frequency and intensity of behaviours. Possible physical effects of bulimia include:

  • Bloating
  • Swollen hands and feet
  • Sore throat and swollen salivary glands
  • Digestive problems
  • Constipation
  • Fatigue
  • Electrolyte imbalances
  • Acid reflux
  • Oral health issues
  • Dehydration
  • Kidney strain or damage
  • Menstrual disturbances

bulimia symptoms tooth ache

These issues arise because repeated binge-purge cycles place stress on multiple systems in the body and some of these effects can be long-lasting without intervention.

Psychological effects of bulimia

The emotional impact can be equally difficult. Many people describe feeling trapped between the urge to binge and the fear of gaining weight, creating a cycle of shame, anxiety and self-criticism. Possible psychological effects of bulimia include:

  • Distorted body image
  • Increased vulnerability to anxiety and depression
  • Intense feelings of shame or guilt around food
  • Reduced confidence and self-esteem
  • Heightened risk of suicidal thoughts

The longer bulimia continues, the more these emotional struggles can deepen, making early support essential.

How is bulimia treated?

Treatment for bulimia usually brings together several forms of support, with therapy at the centre. Cognitive behavioural therapy designed specifically for bulimia is considered the first option, as it helps someone recognise unhelpful thoughts around weight and food while building steadier eating habits.

 

Other therapies, including interpersonal psychotherapy and dialectical behaviour therapy, can be used when emotional difficulties or relationship stress play a role. For younger people, family-based approaches or CBT adapted for caregivers can make a meaningful difference. These therapies take time, involving a number of sessions, so changes to patterns and coping styles can properly take shape.

Medication may be added when needed. Antidepressants, particularly SSRIs, are used alongside therapy rather than on their own. Fluoxetine is the most researched option and can reduce binge-purge cycles when combined with therapeutic work. Other medications have been explored in difficult cases, though the evidence supporting them remains limited.

Many people with bulimia live with another mental health condition, so part of treatment includes screening for difficulties such as depression, anxiety, trauma or substance use. Supporting these areas alongside the eating disorder often leads to stronger, more stable progress.

What are the next steps?

If you or someone close to you is struggling with bulimia, reaching out for help is one of the most important steps you can take. A healthcare or mental-health professional can begin by discussing binge-purge habits and looking at how these patterns are affecting daily life. This assessment shapes a personalised treatment plan that may include therapy, nutritional support and medical monitoring where needed.

The sooner support begins, the stronger the chances of reversing the physical and emotional effects of bulimia. Asking for help may feel daunting, but it signals courage rather than weakness. With the right guidance, recovery becomes possible, and life can start to feel steady again. Contact us today!

Frequently Asked Questions

What makes bulimia different from anorexia?
Bulimia involves cycles of binge eating followed by compensatory behaviours like purging, while anorexia centres on severe food restriction and significant weight loss. Both are serious but present in distinct ways.
Can bulimia be fatal if left unaddressed?
Bulimia can be life-threatening because repeated purging disrupts electrolytes, strains the heart and damages organs. Without treatment, these complications can escalate into dangerous medical emergencies.
What is ‘bulimia face’?
‘Bulimia face’ refers to swelling in the cheeks and jaw caused by enlarged salivary glands after repeated vomiting. The swelling can become more noticeable when purging continues over time.

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