Do you struggle with an eating disorder like anorexia nervosa or bulimia nervosa? Then you are not alone. According to the National Association of Anorexia Nervosa and Related Disorders, at least 30 million people in the United States alone suffer from an eating disorder. Eating disorders are serious medical conditions that warrant seeking treatment right away: every 62 minutes, a person will die as a direct result of an eating disorder, emphasizing the importance of seeking help.

Bulimia nervosa, or bulimia for short, is one of the most common eating disorders. At some point or another, you have probably heard about bulimia from reading books or magazines, watching television or movies or from someone you know who suffered from this disorder. Like all eating disorders, bulimia nervosa is serious — but recovery is possible for those who aim to achieve it.

Suspect that you or someone you love may be suffering from bulimia? Here is everything you need to know about bulimia nervosa — and what it means to aim for bulimia recovery in a world that constantly tells us we aren’t good enough.

What is Bulimia Nervosa?

While the media tells us lots about bulimia nervosa, not everything you think you know about it may be true. Movies, television, and books tend to exaggerate or stereotype when it comes to talking about eating disorders like bulimia. So, before we get into the signs and symptoms of bulimia nervosa, let’s talk about what bulimia is — and what it isn’t.

Bulimia is a life-threatening eating disorder characterized by an alternating pattern of binging and purging. It affects people of all genders, races, classes, ages shapes and sizes — which contradicts what you may have heard.

Some people believe that eating disorders only affect wealthy, thin, white females, in their teens and twenties, but that couldn’t be farther from the truth. 1.5% of American women will suffer from bulimia nervosa in their lifetime — but bulimia also affects men, especially athletes, and people who are transgender. In fact, 16% of transgender college students met the criteria for an eating disorder when surveyed.

Signs and Symptoms of Bulimia

People with bulimia nervosa will binge eat, meaning they eat larger than normal quantities of food in shorter than normal periods of time, followed by purging. Many people believe that purging refers exclusively to vomiting after eating, but that is also untrue. Purging may take the form of laxative or diuretic abuse, excessive compensatory exercise or fasting after binge-eating.

How can you tell if a loved one may be engaging in binge eating or purging? According to the National Eating Disorders Association, these signs and symptoms may help you recognize if you or someone you love could be struggling with bulimia:

• Excessive worry about weight, dieting and control of food
• Large amounts of food disappearing in a short amount of time
• Lots of empty wrappers or containers indicating the rapid consumption of large amounts of food
• Eating in secrecy or skipping mealtimes
• Appears uncomfortable eating around others
• Trying fad diets like veganism, keto diet or Whole30, or cutting out entire groups of food (i.e. “no sugar” or “no carbs”)
• Stealing food or hoarding it in strange places
• Callouses on the backs of the hands or knuckles from self-induced vomiting
• Discolored or stained teeth from vomiting
• Withdrawing from friends or activities, or making time for binge-purge sessions
• Frequent checking in the mirror for perceived flaws in appearance
• Noticeable fluctuations in weight, both up and down
• Stomach cramps, constipation, reflux or other non-specific gastrointestinal complaints
• Thinning of hair on head and/or body; dry and brittle fingernails
• Menstrual irregularities, such as missing periods or only having a period on hormonal contraceptives (as this is not considered a “true” period, but withdrawal bleeding)

Binging and Purging Without a Bulimia Diagnosis

Psychologists and therapists use the DSM-V handbook to formally diagnose eating disorders like bulimia nervosa. The DSM-V requires that binge eating and purging episodes occur at least once a week for three months in order to qualify for a diagnosis of bulimia nervosa. When patients exhibit binge eating and purging behaviors less frequently than that or purge without recurrent episodes of binge eating, they may qualify for a diagnosis of Eating Disorder Not Otherwise Specified (EDNOS).

Up to 70% of all eating disorders fall under EDNOS, meaning they do not completely meet the criteria for a particular eating disorder diagnosis. It is both the most common and deadliest eating disorder, with the most common cause of death being suicide. According to the National Eating Disorders Association, rates of EDNOS are climbing, while the rate of bulimia has remained steady over time.

What is Diabulimia?

There is also another form of bulimia, known colloquially as “diabulimia,” found exclusively in patients with Type I diabetes. These patients may deliberately underuse insulin for the purposes of controlling their weight, which can be extremely dangerous to their health. As many as 38% of females and 16% of males with Type I diabetes have been found to engage in eating disorder behaviors like these. According to the National Association of Anorexia Nervosa and Related Disorders, insulin omission increases the risk of neuropathy, retinopathy and diabetic ketoacidosis, and raises the risk of mortality threefold — making diabulimia an especially threatening form of this eating disorder.

Facts about Bulimia Nervosa

The National Eating Disorders Association and similar organizations around the globe have dedicated lots of time, money and research to learning more about the prevalence, causes and effects of bulimia nervosa and other eating disorders. Previously, we also discussed some of the misconceptions of bulimia nervosa and eating disorders in general.

Some interesting facts and statistics are included below to give you more information about the prevalence, causes and effects of bulimia and also help set the record straight when it comes to misconceptions about bulimia and other eating disorders:

Prevalence of Bulimia

• At any given point in time, 1% of women and 0.1% of men will meet the diagnostic criteria for bulimia nervosa (National Eating Disorders Association)
  • Lifetime prevalence is higher for Black and Latinx populations (Mirror Mirror)
• 25% of college-aged women reported engaging in bingeing and purging as a method of controlling their weight.
• Subclinical bulimia occurs in about 2% to 5.4% of adolescent females (National Eating Disorders Association)
• Rates of bulimia increased drastically in the 1980s and 1990s and have remained the same or increased slightly since (National Eating Disorders Association)

Facts About Bulimia

• Only 1 in 10 patients with bulimia will receive treatment (Mirror Mirror)
• The mortality rate of bulimia is 3.9% (Mirror Mirror)
• The average age of onset for bulimia is 18 years old (National Institute of Mental Health)
• Based on the Sheehan Disability Scale, 78% of those with bulimia suffered impairment (National Institute of Mental Health)

Misconceptions About Bulimia

• Patients with bulimia are often normal weight or even overweight, rather than underweight (Mirror Mirror)
• Over the past 25 years, male dissatisfaction with body image has risen from 15% to 45%.
• Gay and bisexual boys were found to be significantly more likely to have fasted, vomited or taken diet pills or laxatives to control their weight in the last 30 days (National Eating Disorders Association)
• Women who identify as gay, bisexual or mostly heterosexual were twice as likely to report binge eating in the past month than those who identify as heterosexual (National Eating Disorders Association)
• As many as 70% of athletes in weight class sports suffer from disordered eating behaviors.

Co-occurring Conditions

• Nearly half of patients with bulimia have a comorbid mood disorder, and more than half have a comorbid anxiety disorder (National Association of Anorexia Nervosa and Related Disorders)
• 11% of patients with bulimia also have obsessive-compulsive disorder, and 28% also have borderline personality disorder (National Eating Disorders Association)
• 30-70% of those with bulimia nervosa also have an addictive disorder, such as substance use disorder or gambling disorder (Mirror Mirror)

How to Recover from Bulimia Nervosa

Once you suspect that you or someone you love is suffering from bulimia nervosa, what can you do to help yourself or your loved one feel better? There are a number of steps to recovering from any eating disorder, including bulimia nervosa. If you suspect you or someone you love is suffering from bulimia, we encourage you to seek professional guidance, as a trained therapist or psychologist can support you through the steps to recovery.

Still, there are steps you can take on your own to try and recover from bulimia nervosa. Bulimia recovery takes significant effort on your part, and will present with many ups and downs along the way. Remember: these steps toward recovery are not linear — but even though you may relapse, your recovery journey is far from over!

That being said, here are some steps you can take now to jumpstart your recovery from bulimia nervosa:

1. Interrupt the binge-purge cycle. Bingeing often occurs after a new diet begins. Calorie deprivation then leads us to binge eat as much as we can. The feeling of fullness that follows can result in guilt and self-loathing, which leads us to purge and restrict. Purging then begins the cycle all over again — which is why interrupting this cycle is a key part of bulimia recovery. Try establishing a regular eating schedule to cease deprivation and interrupt the cycle of binging and purging. Help from a therapist or dietician can be incredibly useful in creating a schedule of regular eating, as well as a meal plan to keep you on track.
2. Break up with your scale. Stop weighing yourself in bulimia recovery. Unless your doctor requires you to weigh yourself regularly, the only thing weighing yourself will do is send you on an emotional rollercoaster that can trigger the cycle of binging and purging. In order to interrupt this cycle, it’s important that you practice self-love and learn to accept yourself as you are, at any weight. Looking into the Health At Every Size community may help you find body acceptance in your bulimia recovery.
3. Tell someone you are struggling. Whether it is a parent, best friend, significant other, therapist, doctor or even your dog, vocalizing your struggles out loud can help you find peace when healing from your eating disorder. Guidance from a professional is especially useful for overcoming bulimia nervosa, as a doctor or therapist can help you establish a meal plan and learn to challenge disordered ways of thinking. However, telling a friend or loved one can also help, since that person can hold you accountable in your recovery and make sure you are taking the steps you need to take to start feeling better.

Aiming for Bulimia RecoveryIf you are struggling to recover from bulimia nervosa, The Meadowglade’s trained professionals can help. Contact us today in order for us to help you create a treatment plan that works for you and start helping you recover from bulimia nervosa.