Bulimia nervosa is an eating disorder that is often greatly misinterpreted and misunderstood by society and the media. The desire to be thin can be overwhelming due to the pressures of everyday life and it is important to understand bulimia nervosa is a serious disease that can be potentially fatal if not treated in a timely manner by a professional. According to studies, there is a 3.9 percent mortality rate for individuals with bulimia nervosa and an increased incidence for suicide among this population. Knowing the causes and risk factors of bulimia nervosa and helping to spread awareness of the disease can work to end stigma and help many others in recovery.

Bulimia nervosa is a serious emotional eating disorder that involves eating excessive amounts of food in a short period (binging) followed by guilt and shame leading to self-induced vomiting, extreme exercise, or laxative abuse (purging). Many refer to it as the binge and purge eating disorder. Bulimia nervosa is often associated with depression, anxiety and self-harm behaviors such as cutting. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM5), defines bulimia nervosa by the five following criteria:

  • Eating excessive amounts of food in a two-hour period (binging) accompanied by feelings of loss of self control
  • Repetitive inappropriate self-induced compensated behaviors such a vomiting, diuretic use, laxative use and extreme exercise (purging) in order to avoid weight gain potentially causes by the binging episodes
  • These behaviors occur at least once a week for at least three months in duration
  • Body shape and weight are the main influencing factors of this binging and purging behavior
  • These behaviors do not occur specifically with anorexia nervosa and these disorders must be completely separated

Causes and Risk Factors of Bulimia Nervosa

Bulimia nervosa, like other eating disorders, are multifactorial, meaning there are many causes that can contribute to this disease and they can include genetic factors, neurochemical imbalances, and environmental stressors such as exposure to trauma or abuse. Other psychological and emotional issues such as an anxiety disorder, depression and low self-esteem are also known triggers in a person who is predisposed to having an eating disorder. The nature of our culture that is hyperfocused on thin-ideal internalization and general social pressure for thinness can also serve as a trigger for susceptible individuals. Other risk factors that have been identified for bulimia nervosa include substance abuse, feelings of inadequacy, experiencing early puberty, having too little to eat during childhood, psychiatric symptoms, and low appetite and emotional awareness.

Individuals with bulimia nervosa will often try to hide their disorder out of fear of being judged or rejected by others and therefore it may be difficult to recognize if a suspected eating disorder is present within this population unless you are well versed in recognizing the warning signs and risk factors.

  • Social isolation
  • Change in mood or personality
  • Refusing to eat in front of people
  • Constantly talking about weight or food
  • Impulsive behaviors
  • Excessive or new substance or alcohol use
  • Striving for perfectionism
  • Intense fear of weight gain
  • Obsession with body image
  • Compulsive behaviors such as counting calories and tracking weight
  • Distorted body image
  • Participating in ritualistic behaviors while eating a meal
  • Frequently weighing oneself
  • Isolating oneself from the outside world
  • Refusing to wear revealing or bright colored clothing
  • Food hiding or hoarding
  • Obsession with neutral and baggy clothing

The importance of seeking treatment

Recognizing warning signs associated with bulimia nervosa and understanding the underlying causes can help individuals seek out early treatment interventions that can significantly improve the outcomes for those struggling with bulimia nervosa. Since this a multifactorial disease, treatment approaches are multidisciplinary meaning there are a number of treatment modalities available in order to reach the best prognosis.