A severe and potentially life-threatening psychological eating disorder, bulimia nervosa, also called bulimia, is characterized by episodes of bingeing.

This is followed by compensatory behavior to overcome the effects of binge eating. Some compensatory behaviors include fasting, self-induced vomiting, enema, compulsive exercising, and excessive use of laxatives.

Diagnostic Criteria

DSM-5 diagnoses bulimia nervosa as:

Recurrent binge eating episodes

A binge eating episode is characterized by:

Eating, within a short period (normally a 2-hour episode), an enormous amount of food which is more than what a normal person will eat during the same time frame and under similar circumstances.

A feeling of loss of control over what one is eating during the binge eating episode.

Recurrent inappropriate compensatory behaviors

Involving in compensatory behavior, after an episode, to prevent weight gain. Some examples of compensatory behavior are self-induced vomiting, fasting, misusing diuretics, laxatives, or any other medications, or excessive exercise.

Occurring on a repeated basis

Occurrence of both binge eating episodes and compensatory behaviors, on average, once a week for three months.


Self-evaluation, which is unduly influenced by weight and body shape.

No episodes during anorexia nervosa

The episodes do not occur during anorexia nervosa.

Causes of Bulimia Nervosa

While scientists and doctors are not clear about what causes bulimia nervosa, but research has shown that a combination of several factors causes it.

These factors include certain emotions, personality traits, thinking patterns, along with environmental and biological factors.

According to researchers, this disorder might start with dissatisfaction over one’s body as well as excessive worries about body size and shape.

A person suffering from bulimia nervosa typically has low self-esteem and fears gaining weight. Some researchers also believe that this might be an inherited disorder based on cases where it was reported to run in the family.

Symptoms of Bulimia Nervosa

Some of the common bulimia nervosa symptoms include:
  • Uncontrolled eating followed by purging
  • Vomiting or misusing diuretics or laxatives while attempting to lose weight
  • Frequent use of the bathroom, especially after meals
  • Indigestion, heartburn, and bloating
  • Swollen facial and neck glands
  • Sore throat
  • Irregular periods
  • Bloodshot eyes, exhaustion, and weakness
  • Preoccupied with bodyweight
  • Sense of lack of control
  • Excessive exercising
  • Mood swings or depression

Treatments for Bulimia Nervosa

When it comes to treating bulimia nervosa, there is no one line of treatment. This disorder is treated by combining medications and psychotherapy.

Treatment of bulimia typically involves a team approach that includes you, your primary care, your family, a dietitian experienced in treating eating disorders, and mental health professional.

Sometimes, a case manager may also get involved for better care coordination.

Bulimia treatment options include:


Psychotherapy, also called psychological counseling or talk therapy, involves discussing bulimia and other related problems with a mental health professional.

Some common types of psychotherapy include:
  • Cognitive-behavioral therapy which helps in normalizing eating patterns and identification of negative and unhealthy beliefs and behaviors and replacing it with more positive and healthier beliefs
  • Family-based treatment to train parents to identify and intervene in their child’s unhealthy eating behaviors and help them regain control over their eating. It also helps in dealing with problems that can arise out of bulimia
  • Interpersonal psychotherapy that addresses difficulties cropping up in close relationships, and assisting in improving your problem-solving and communication skills
Check with the mental health professional on the type of psychotherapy they will be using and the evidence that the particular line of treatment is beneficial in treating your bulimia.

Medications for Bulimia

As mentioned above, besides psychotherapy, doctors also include medications such as SSRIs (selective serotonin reuptake inhibitors) to address bulimia nervosa.

Besides psychotherapy, doctors are also prescribing antidepressants such as Celexa, Prozac, Lexapro, and Zoloft for treating bulimia therapy.

Doctors, however, do not prescribe Wellbutrin despite its low risk of weight gain, because it can cause seizures in people who suffer from electrolyte abnormalities due to repeated vomiting.


One should remember that there is no quick-fix to bulimia nervosa. Treatment is required over a long period to address all the issues and retraining on how you think about your body, food, and eating.