The Dangers of Bulimia Nervosa and Alcohol Abuse

Many people with one mental health condition will be diagnosed with a comorbid, or co-occurring, disorder. One of the more common comorbid diagnoses is bulimia nervosa (BN) and substance use disorder (SUD).

Bulimia and alcohol abuse

In particular, bulimia nervosa frequently co-occurs with alcohol use disorders. But even if someone’s drinking has not been officially designated as alcohol addiction, it may still present in troubling ways, including:

  • Binge drinking
  • Heavy drinking
  • Other unhelpful relationships with alcohol

In any case, the combination of disordered alcohol use and bulimia nervosa can have a major impact on someone’s physical and mental health, and it could lead to potential complications when it comes to treatment. 

Still, some therapies may be particularly helpful for people with these co-occurring conditions.

Bulimia and Alcohol Abuse

Eating disorders are heavily associated with substance use issues, including alcohol use disorder (AUD), often just referred to as alcohol addiction or alcoholism.

By some counts, the overlap of these co-occurring disorders is staggering. 

50% of those with eating disorders use alcohol or illicit drugs.

Some studies have found as many as 50% of people who struggle with eating disorders use alcohol or illicit drugs, a rate which is more than five times that of the general population.

In other reports, up to 35% of people with alcohol use disorders or substance use disorders had a comorbid eating disorder diagnosis—more than 11 times the rate of the general population. [1]

And as many people with psychiatric disorders or common eating disorders such as bulimia nervosa, binge eating disorder, or anorexia nervosa don’t seek out professional help, it’s likely the reality of that overlap rate is even higher.

Overlapping Factors of Bulimia and Alcohol Addiction

There are several potential explanations for the common combination of alcohol and eating disorders.

Both drinking and disordered eating behaviors are often used as maladaptive coping mechanisms. Someone may exert strict control over what they eat to make up for the lack of control they feel they have over the rest of their life. And others may choose to drink to help them forget about traumatic or hurtful experiences.

In some cases, one disorder may work to trigger the other. Someone who feels their alcohol consumption is spiraling out of control, for example, may try to compensate by adhering more strictly to their disordered eating behavior. Alcohol can also cause weight gain, which can trigger someone with bulimia nervosa to fall back on purging methods, like excessive exercise.

Other studies have uncovered genetic factors potentially linking substance use disorders and eating disorders. Both types of conditions have been found to run in families, and some experts believe they may derive from the same genetic source. [2]

What is Bulimia Nervosa?

Bulimia nervosa is an eating disorder marked by a number of distinctive qualities, including: [3]

  • Repeated episodes of binge eating
  • The repeated use of inappropriate compensatory behavior
  • An inability to properly self-evaluate body shape and weight

Binge eating is considered an event when someone eats, over a two-hour period, significantly more food than the average person would during that time. The episodes are often colored by the loss of a sense of control, including an inability to stop eating or control the amount they are eating. [3]

Someone’s preferred compensatory behaviors may vary, but they are all intended to prevent weight gain or promote weight loss. Some of the most common compensatory behaviors associated with BN include: [3]

  • Self-inducing vomiting
  • Laxative and diuretic misuse
  • Excessive exercise

What Are Alcohol Use Disorders?

Alcohol use disorder (AUD) is characterized as a problematic pattern of alcohol use, in which someone exhibits at least 2 of 11 following criteria within a 12-month period: [4]

  1. Drinking more or for a longer period than intended
  2. A persistent desire to cut down on or control alcohol use, but an inability to do so
  3. Significant time dedicated to obtaining alcohol, using alcohol, or recovering from alcohol use
  4. Strong cravings to use alcohol
  5. An inability to meet major obligations at work, school, or home due to recurrent alcohol use
  6. Continued alcohol use despite significant interpersonal or social consequences
  7. Giving up or cutting back on important activities because of alcohol use
  8. Using alcohol in scenarios where it may be physically dangerous, such as drunk driving
  9. Continuing to use alcohol despite knowing its use is resulting in notable physical or psychological problems
  10. A notable tolerance to alcohol
  11. Experiencing withdrawal related to alcohol use

While experts use the 12-month period as a marker for gauging alcohol use, AUD can have significant consequences before that time, especially if someone also struggles with an eating disorder.

Dangers of Co-Occurring Bulimia and Alcohol Use Disorders

While eating disorders and alcohol addiction are both connected to a number of physical and mental health ailments, the combination of the two can create further complications and concerns.

Esophageal Cancer

Both BN and alcohol use disorder are associated with an increased risk for esophageal cancer. Both conditions can be highly taxing on the throat, leaving the sensitive tissues there more vulnerable to the type of abnormal development that can lead to cancer.

One study found that patients who were previously hospitalized for bulimia nervosa were at a higher risk of developing esophageal cancer, and named alcohol use as a potential aggravating factor. [5]

Heart Complications

Both bulimia nervosa and alcohol use disorder are also noted dangers for heart health.

BN frequently causes electrolyte imbalances in the body, which can wreak havoc on a number of internal systems, but has a particularly bad effect on the heart. It can lead to arrhythmia, blood pressure issues, and major cardiac events, including cardiac arrest.

Heavy alcohol use also is associated with a number of heart health complications, including:

  • High blood pressure
  • Cardiomyopathy (disease of the heart muscle)
  • Heart failure

Types of Treatment for Bulimia Nervosa and Alcohol Addiction

Co-occurring mental health disorders tend to complicate treatment programs.

It’s generally believed that these conditions should be treated simultaneously in order to achieve sustainable recovery. But professionals have yet to develop a screening system that can help them identify someone struggling with AUD in an eating disorder treatment program, or vice versa. [6]

While co-occurring bulimia nervosa and alcohol addiction present a number of potential dangers to physical and mental health, it’s important to remember that full recovery is possible.

With comprehensive care that addresses these co-occurring conditions, you can learn how to leave disordered eating and drinking behaviors behind, and start making your way toward a better, happier, and healthier future.

Still, there are some types of therapy that may be suitable for people struggling with both of these conditions.

Cognitive behavioral therapy (CBT) is one of the most highly-recommended therapeutic treatments for people struggling with both BN and AUD. The school of therapy dictates that disordered behaviors are the result of disordered thoughts, and works to help people first recognize, then understand, and ultimately change these unhelpful thoughts and behavioral patterns.

Many people also rely on alcohol or disordered eating behaviors as maladaptive coping mechanisms. Their shared origin as attempts to manage emotions after experiencing trauma can make certain therapies developed for post-traumatic stress disorder particularly helpful for treatment.

Group therapy and support group meetings are also helpful places for many people with BN or AUD to find camaraderie and community and help build a strong support system that lends itself to sustained recovery.

The National Eating Disorders Association (NEDA) offers a helpline where you can talk to trained volunteers about available resources and get answers to questions you have about BN and the recovery process. If you have trouble finding treatment, this can be a good place to start.

Similarly, the Substance Abuse and Mental Health Services Administration also offers a national helpline. The helpline is designed to provide people with information on the mental health and substance use treatment options that fit their needs. This government resource is free, confidential, and available 24/7.


  1. Substance Use and Eating Disorders. National Eating Disorders Association. 2022. Accessed February 2023. 
  2. Lilenfeld, L. R., & Kaye, W. H. (1996). The Link Between Alcoholism and Eating Disorders. Alcohol health and research world; 20(2):94–99.
  3. Diagnostic Criteria for Bulimia Nervosa (DSM-5). (2020, April 24). Retrieved September 2022.
  4. Alcohol Use Disorder. (2016, March). Veterans Affairs Canada. Retrieved September 2022.
  5. Brewster, D. H., Nowell, S. L., & Clark, D. N. (2015). Risk of oesophageal cancer among patients previously hospitalised with eating disorder. Cancer epidemiology; 39(3):313–320.
  6. Clients With Substance Use and Eating Disorders. (2011). Substance Abuse and Mental Health Services Administration. Retrieved September 2022.

Last Update | 02 - 6 - 2023

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