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Bulimia Nervosa

Medically reviewed by Last updated on Aug 31, 2022.

What is bulimia?

Bulimia nervosa is an eating disorder. You eat a large amount of food in a short period of time. This is called binging. You then vomit, use laxatives, starve, or exercise for hours to prevent weight gain. This is called purging. You do this at least 1 time each week for several months.

What increases my risk for bulimia nervosa?

Bulimia usually begins between the ages of 13 and 28. You may continue to have bulimia as an adult. You may have episodes of binging and purging only when you are feeling stressed. The following may increase your risk for bulimia:

  • Being overweight or thinking you are too heavy
  • Not feeling good about your body
  • A need to be perfect, or setting high goals
  • Participation in a sport or activity that values thinness, such as gymnastics, wrestling, or modeling
  • A history of anxiety, depression, or obsessive-compulsive thoughts
  • A family history of an eating disorder, obesity, or problems with substance abuse
  • Not having good relationships with family members, or stress or trauma

What are the signs and symptoms of bulimia nervosa?

  • Not being able to stop eating, usually secretly or when you are alone
  • Worrying that you are fat even if your weight is healthy or too low, or your weight goes up and down often
  • Often being bloated and having constipation or diarrhea
  • A sore throat and tooth decay caused by vomiting
  • A puffy face and throat, dehydration, or thinning hair
  • Calluses or cuts on your knuckles if you use your hand to make yourself vomit
  • In girls, monthly periods that are irregular or stop completely
  • Feeling cold all the time, or tired, weak, dizzy, or lightheaded
  • Being moody and depressed, believing self-worth is tied to weight, or talking about food and weight all the time

How is bulimia nervosa diagnosed?

Your healthcare provider will examine you and check your height and weight. Your provider may ask you to fill out forms about your eating habits. You may have a hard time talking about your weight or about bingeing and purging. You may also have trouble asking for help. Your provider may recommend you work with an eating disorder specialist. The following tests can help your provider understand how bulimia may be affecting your body:

  • Blood tests will show if you are getting enough iron, calcium, and other nutrients.
  • Urine tests may be used to check for signs of dehydration.
  • Bone density pictures may show bone loss that bulimia can cause. Your risk for bone loss is higher if you are female and no longer have a monthly period.

  • An EKG may be used to check your heart's electrical activity. Bulimia can lead to heart rhythm problems.

How is bulimia nervosa treated?

Bulimia is a life-threatening medical condition. Treatment may need to take place in a hospital or clinic. Treatment will be more effective if you understand the seriousness of the condition and truly want to get better.

  • Counseling is an important part of treatment. You may work with healthcare providers alone or in a group. Group counseling is a way for you to talk with others who have bulimia. Counseling may center on helping you replace negative thoughts with positive thoughts. Family sessions can help everyone in the family understand bulimia and what to do to help you.
  • Nutrition therapy means you will meet with a dietitian. Others in your family may also meet with the dietitian. Together you will develop a healthy meal plan. It is important to eat 3 to 5 structured meals a day to reduce the urge to binge. You might need to learn how to prepare healthy food. You might also need to relearn what it feels like to be hungry and full. You may be asked to keep a food diary and bring it to future visits.
  • Medicines are sometimes used to help treat bulimia or the health problems it causes. You may get medicine to help improve your mood, control mood swings, and decrease obsessive thoughts. Vitamin or mineral supplements may also be needed if your nutrient levels are low because of bulimia.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

View more treatment options

What can I do to help myself?

  • Be patient. Recovery from bulimia is a process that takes time. You may have a binging and purging episode after a long period of healthy eating. This is common. Work with family members and healthcare providers to get back on track with healthy eating and healthy exercise. Try not to be angry with yourself for the episode. It might help to talk about your feelings with someone you trust.
  • Focus on a healthy self-esteem. Think about everything you like about yourself. For example, you may be a talented artist, or you may write well. Focus on those skills or talents instead of on appearance. Ask others not to comment on your weight or shape. Your healthcare provider can tell you healthy weight ranges for your age and height. It may take time before you are comfortable knowing your weight or seeing your weight as healthy. Remember your goals to build a healthy self-esteem. Be patient with yourself as you change your thinking.
  • Have regular family meals. This can help change your thinking by preventing you from eating alone. Focus on spending time with others. Do not focus on your food choices. For example, do not worry that you should take a larger portion or another helping. It may take time before you are ready to eat like others at the table.
  • Spend time doing things you enjoy. Make family time about being together, not about meals. Try to go to places other than restaurants, movies, and other places that feature food.

Where can I find support and more information?

  • National Institute of Mental Health (NIMH), Office of Science Policy, Planning, and Communications
    6001 Executive Boulevard, Room 6200, MSC 9663
    Bethesda , MD 20892-9663
    Phone: 1- 301 - 443-4513
    Phone: 1- 866 - 615-6464
    Web Address:
  • The National Women's Health Information Center
    8270 Willow Oaks Corporate Drive
    Fairfax , VA 22031
    Phone: 1- 800 - 994-9662
    Web Address:

Call your local emergency number (911 in the US) if:

  • You want to harm or kill yourself.
  • You have pain when you swallow, or severe pain in your chest or abdomen.
  • Your heart is beating very fast or fluttering, or you feel dizzy or faint.

When should I seek immediate care?

  • Your muscles feel weak, and you have pain and stiffness.
  • You cannot stop vomiting.
  • You vomit blood or see blood in your bowel movements.

When should I call my doctor?

  • You are constipated.
  • You have tingling in your hands or feet.
  • You have pain in your teeth, mouth, or gums.
  • You have new pain in your abdomen.
  • Your monthly period is very light or has stopped completely.
  • You are planning to get pregnant and want to develop a safe eating plan.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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