Bulimia nervosa is a serious eating disorder marked by recurrent bingeing and purging. Because both bingeing and compensatory behaviors (including vomiting, diuretic or laxative abuse, or excessive exercise) are typically done in secret, it is easy to ignore and overlook the seriousness of this eating disorder. However, we need to talk more about it. Here are a few essential teen bulimia statistics:

Teen Bulimia Statistics

  • At any given time, 1.0% of young women and 0.1% of young men meet diagnostic criteria for bulimia nervosa, which makes it more common than anorexia nervosa.1
  • The lifetime prevalence for bulimia in women is estimated between 1.2% to 4.6%.2
  • The median age of onset is 18 years old.3
  • The lifetime prevalence for subthreshold bulimia in women by age 20 is 6.1%.2 “Subthreshold” refers to meeting all symptoms of bulimia, except one or more symptoms do not quite meet the diagnostic requirements. For example, bingeing or purging less than once a week on average.
  • 95% of people with bulimia have at least one co-occurring mental health disorder. Between 36% and 50% of individuals with bulimia also have major depressive disorder, while between 54 and 81% are also diagnosed with anxiety disorder.3
  • High school students with disordered eating are more likely to use alcohol and other substances.4

Why We Need to Talk More About Teen Bulimia

To a large extent, bulimia is a hidden eating disorder. You cannot tell if someone has bulimia based on their appearance, and it is unlikely that you will directly witness someone either bingeing or purging. The activities of bulimia (bingeing plus compensatory behavior such as vomiting or excessive exercise) are done in secret, with accompanying feelings of shame. For this reason, bulimia can be harder to diagnose than other eating disorders. Those who have bulimia feel isolated and are unlikely to ask for support or professional help. Talking about teen bulimia will help bring it into the light, reduce shame, and increase rates of treatment.

Even if an individual with bulimic behaviors does not meet the full diagnosis, attention and treatment are still warranted. As mentioned earlier, 6.1% of women will have subthreshold bulimia by age 20.2 Do not mistake “subthreshold” or subclinical as being benign. It merely means the teen’s symptoms do not neatly fit the criteria outlined in the DSM-5,5 which is the text used to diagnose psychiatric disorders. The more appropriate diagnosis, Other Specified Feeding or Eating Disorder (OSFED), also reflects clinically significant distress, where a teen’s school, family, and social functioning are affected. One study found that three-fourths of participants who did not meet the full criteria for anorexia or bulimia still met the criteria for other mental health disorders.6 One-fourth of those participants reported suicidality.

One of the drivers of bulimia is a desire to be thinner. The thin ideal is prevalent throughout our culture but is especially common on social media. One of the criteria for a bulimia diagnosis addresses this desire to be smaller, specifying self-evaluation is unduly influenced by body shape and weight. Because the majority of teenagers use social media, this is an area where communication and discussion can be helpful. Higher levels of social media use are associated with greater internalization of the thin ideal.7 To counteract this onslaught of unrealistic body messages, talk with your teen about the unrealistic portrayals. Help them curate their social media feed to feature body positivity and other interests instead of focusing on body size and shape.

Barbara Spanjers, MS MFT is a therapist and wellness coach who helps people feel more attuned with food and their body. Learn more.

Citations

1 Hoek, HW, van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 34(4), 383-96. PMID: 14566926 Retrieved August 25, 2019.

2 Stice, E., Marti, C. N., Shaw, H., & Jaconis, M. (2009). An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. Journal of Abnormal Psychology118(3), 587–597. PMID: 19685955 Retrieved August 25, 2019.

3 Hudson JI, Hiripi E, Pope HG Jr, Kessler RC (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry, 61(3), 348-58. PMID: 16815322 Retrieved August 25, 2019.

4 Pisetsky, E. M., May Chao, Y. , Dierker, L. C., May, A. M. and Striegel‐Moore, R. H. (2008), Disordered eating and substance use in high‐school students: Results from the youth risk behavior surveillance system. Int. J. Eat. Disord., 41, 464-470. doi:10.1002/eat.20520 Retrieved August 25, 2019.

5 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. Arlington, VA, American Psychiatric Association, 2013.

6 LeGrange, D, Swanson SA, Crow, SJ and Merikangas, KR (2012). Eating disorder not otherwise specifed presentation in the US population. Int J Eat Disord 45(5), 711-8. doi:10.1002/eat22006 Retrieved August 25, 2019.

7 Mingoia, J, Hutchinson, AD, Wilson, C, & Gleaves, DH (2017). The relationship between social networking site use and the internalization of a thin ideal in females: A meta-analytic review. Frontiers in Psychology8, 1351. doi:10.3389/fpsyg.2017.01351 Retrieved August 26, 2019.