Bulimia Nervosa: Causes, Dangers, And How To Begin Your Recovery Journey

Uncomfortable feelings around food may emerge frequently or only occasionally, for some; possibly surfacing during the holidays, on special occasions or during a particularly stressful season of life. Others may report feeling full all the time, even when they restrict their food intake—which may prompt cycles of bulimia or eating disorders (EDs) to begin. 

When people regularly consume large quantities of food at once and then “purge” through vomiting or laxatives, they may be diagnosed with bulimia nervosa, which is generally defined as an eating disorder characterized by this binge-purge cycle. 

Below, we’ve summarized what can cause bulimia, possible associated risks, and supportive, recovery-oriented therapies. 

What is bulimia nervosa (and what does it look like)?

Even if you’ve never experienced an eating disorder, it can be tempting to “remedy” the fullness that big meals can leave by restricting or purging the next day. This is not generally recommended, as a first attempt to “get rid” of fullness through purging can catalyze an unhealthy cycle of restricting, binging and purging.

In popular media, eating disorders might often be associated with models, celebrities and other people in the entertainment industry. But despite these depictions, people might find that many can develop an eating disorder; regardless of their age, gender, sexual orientation, or ethnicity.  

Understanding the many appearances and experiences that can be associated with bulimia can lead to a more empathetic society, validating the experiences of survivors and possibly reducing the rates of occurrence over time—which can promote a higher quality of life for all. 

The dangers of purging and restricting

To fully understand the dangers of purging and restricting, it can be helpful to take an objective look at associated eating disorder-related processes. 

For example: To ”purge” food, an individual may actively engage the gag reflex to induce vomiting—or one might instead use a stimulant laxative. While this may not seem harmful, habitual vomiting can cause damage to the stomach lining, the throat, and teeth, as well as acid reflux from stomach acid. 

Over time, regular vomiting can also promote more severe stomach, digestive, and dental problems. 

Occurrence rates of bulimia 

Although eating disorders can occur in teens, there is thought to be a growing number of adult women who are being diagnosed with eating disorders across the world, according to a 2019 literature review. 

Additionally, the National Eating Disorder Association reports that hospitalizations for male-identifying patients with eating disorders were thought to have increased by 53% from 1999 to 2009. 

Since the COVID-19 pandemic, healthcare professionals have also noted an overall increase in eating disorders across age groups and gender identities.  

Common types of eating disorders

According to the DSM-5, healthcare providers might commonly see and diagnose the following eating disorders:

Anorexia nervosa is generally known as an illness that can be characterized by:

• A restriction of food intake can lead to significantly lower body weight.
• An intense fear of gaining weight or becoming overweight, even when underweight.
• Inaccurate perception of weight or body shape.
• Excessive thoughts about body weight or shape and highly critical evaluation of physical appearance. 
• Unsafe eating or exercise behaviors may be conducted even if the person is thought to be at a dangerously low body weight.

Bulimia nervosa is generally known as an illness that can be characterized by:

• Recurring episodes of binge eating in which a person might eat large quantities of food within a 2-hour period.
• Feeling a lack of control over overeating or feeling that they cannot control the amount of food consumed at any given time. 
• Critical self-evaluation, which can be heavily influenced by concerns about body weight and shape.
• Recurring behaviors to prevent weight gain such as self-induced vomiting, fasting, excessive exercise and misuse of laxatives, diuretics or other medications. 
• Recurrent binges or behaviors that can occur at least once a week for three months.

Binge eating is thought to have many of the same diagnostic criteria as bulimia nervosa, such as:

• Eating a large amount of food within a 2-hour timeframe.
• Eating more rapidly than normal.
• Eating until uncomfortably full or when not physically hungry. 
• Eating alone due to possible feelings of embarrassment, or feeling marked distress during and after the episode.
• Binges that occur, on average, at least once a week for 3 months.

Possible causes and treatments for eating disorders

Once you've made the decision to seek professional help for an eating disorder, you may find that one of the first steps you take is to schedule an appointment with a doctor. Because eating disorders can affect both your mental and physical health, your doctor might complete a full examination which can inform their approach and connect you to personalized care and support. 

As you work on your physical health, your doctor may recommend that you see a mental health professional. Working closely with a therapist and formulating a self-care plan can be a foundational part of your recovery from an eating disorder. 

Licensed therapists can also support many via mindfulness- and compassion-based interventions to help patients examine their core beliefs, develop self-compassion and increase their mindfulness—all of which can sustain long-term recovery from an eating disorder.  

There is not thought to be a singular attributed cause to bulimia at the time of this publication.  Rather, there can be many possible causes of the condition that can be unique to an individual’s disposition, and physical or mental health profile. 

Some variables that can influence a person’s susceptibility to developing an eating disorder might include their early home environment, relationships with family, and friends, and genetics. 

More research is underway, however. Current scientific literature suggests that anorexia nervosa, bulimia nervosa, and binge-eating disorder run in families and are heritable, according to a 2019 literature review. 

Beyond genetics, parents’ attitudes toward food can shape their children’s eating-related habits. Many children whose parents used more controlling feeding practices may be likely to have stricter eating habits—which can lead to eating disorders later on. 

How online therapy can help your eating disorder recovery

Regardless of how your eating disorder manifests, a therapist can help you unravel the connection between your eating-related behaviors and the experiences that might have shaped them.

Therapists can also help you unpack stubborn beliefs about food and body image, develop your self-esteem, and find self-worth in hobbies that might be unrelated to food and exercise. 

Experiencing an eating disorder and making the decision to recover can be a lonely and scary experience, which can make early treatment through online therapy even more important. Not only can your counselor provide helpful emotional support, but they also can support you in developing a treatment plan that works best for you, from the comfort of your own home or safe place.

At-home strategies for eating disorder recovery

If you feel overwhelmed with the concept of when, where, and how much to eat, you may want to try intuitive eating. With time and practice, intuitive eating can help you heal your relationship with food, possibly leading to feelings of peace and neutrality around mealtimes. 

The ultimate goal of intuitive eating for many is to learn to honor hunger, feel fullness, and allow one’s mind and body to enjoy the nutrients (and treats!) that both need to live well. 

Embracing intuitive eating: Where & how to start

Here are 10 key principles of intuitive eating, which you can practice at home and with the support of your therapist, family, and other loved ones.

• Reject diet culture. This can feel easier said than done, as most of us may have been steeped in diet culture since childhood. Some simple yet powerful forms of rejection can include throwing out any diet books, unfollowing social media accounts that focus on diets, and getting rid of the scale.
• Eat when you're hungry. When you listen to (and honor) your body’s hunger cues, you can begin to rebuild trust in your body.
• Make peace with food. Many, if not all foods can fit into a healthy, well-rounded diet for most, excluding any food allergies. You can try to start slowly and consider giving yourself permission to try and enjoy foods that may have caused guilt in the past. 
• Say goodbye to the food police. There’s not generally room for a “food police” attitude on an intuitive eater’s plate. Previous versions of yourself might have deemed some foods “good” and others “bad”—but foods don’t have to have moral value, and your food choices don’t generally make you a “better” or “lesser” version of yourself. 
• Find satisfaction. After a long period of disordered eating, rediscovering satisfaction in food can take time. Whenever you eat, you may try to enjoy each bite and actively feel yourself becoming full—which can eventually lead to you having a better sense of when you’ve had “enough”.
• Feel fullness. Fullness is not necessarily something you need to run away from: it can be a sign that you’re nourished and in tune with your body.  As you eat, you can take pauses to consider your hunger level and learn the feeling of satisfaction. 
• Honor your body. Genetics can play a role in shaping the body you’re in. It can take time, but accepting your genetic blueprint can be the catalyst for food freedom. 
• Move in ways that feel good to you.  It can be helpful to forget the calories and shift your focus to physical activities that are fun, convenient, and easy enough to incorporate into your schedule. Early-morning walks and late-night dance parties can all “count,” and can be a helpful way to reconnect you to the joy of being in your body.
• Consistency. This can be an important element to consider in your health and wellness journey. Not every meal or snack will be “perfect” in terms of nutrition, and that can be perfectly okay. The long-term goal that many may have is to eat things that taste good, fuel our bodies, and align with our lifestyles. 

Using these 10 principles as a framework to begin your healing process can support you in finding freedom in your relationship with food and exercise.

How BetterHelp can support you: Is online therapy really effective?

When you're just starting your journey, the prospect of intuitive eating can feel overwhelming. It's okay to feel overwhelmed and unsure of your next right step. However, moving through these feelings can be an important step to your long-term health and success. For many, this “step” may look like online therapy services with a licensed counselor.    

In addition to traditional in-person talk therapy, online therapy can be a strong supportive option to consider for people experiencing eating disorders. For example, recent research published in Eat Weight Disorders found that the effects of online CBT for eating disorders showed long-term success that designated it as an equally effective modality as traditional face-to-face therapy. 

Online CBT also has the potential to be delivered at a lower cost and with more convenience for many, with positive effects extending past the one-year post-treatment threshold.