Do I Have Bulimia?

Not everyone will experience all the signs and symptoms of bulimia nervosa (BN), and you don’t need to have all the criteria for BN to be suffering from the eating disorder. Individuals can experience bulimia differently. 

Self-Assessment Eating Disorder Quiz

If you feel like you might have bulimia, ask yourself the following question (5):

• Do you force yourself to vomit, exercise excessively, or use laxatives or diuretics to compensate for your eating?

While the above behaviors are characteristic of bulimia specifically, there are also other behaviors that bulimia has in common with other eating disorders. Ask the following questions:

If you answer yes to one or more these questions, you may be demonstrating disordered eating thoughts, or are suffering from bulimia. Of course, this self-assessment should not be taken as a diagnosis for bulimia nervosa. Rather, it may be an indicator that it’s time to talk to someone about what you’re feeling, whether a trusted family member or healthcare professional.

If you struggle with binging, purging behaviors, and negative self-image, you might be wondering if you have bulimia nervosa. Keep reading to learn more about the signs and symptoms of bulimia nervosa, the consequences of not addressing the disorder, as well as a self-assessment quiz to help you determine if you should seek help immediately.

Diagnostic Criteria for Bulimia Nervosa

If you don’t know much about bulimia, you might think the only criteria to meet a positive diagnosis for the disorder are binging and purging, but there is more to it than that. According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), the official diagnostic criteria for bulimia nervosa is as follows (2):

• Recurrent episodes of binge eating are characterized by eating a large amount of food in a short time and feeling a lack of control over eating during the episode.
• Recurrent purging or compensating behaviors to prevent weight gain, such as self-induced vomiting, excessive exercise, fasting, or use of laxatives and/or diuretics.
• The binging and purging behaviors both occur, on average, at least once a week over three months.
• How you perceive yourself is heavily influenced by your body shape, size, and weight.
• The disordered eating behaviors don’t occur only when you’re experiencing the symptoms of anorexia nervosa.

What are the Signs and Symptoms of Bulimia Nervosa?

Different eating disorders have many of the same signs and symptoms. Bulimia and binge eating disorder (BED) share many characteristics. What distinguishes bulimia from BED is engaging in what are called “compensatory behaviors” after binging on a large quantity of food to purge the calories consumed. These behaviors can present as vomiting, exercising excessively, or using laxatives or diuretics. People who have anorexia or bulimia may avoid certain foods, severely limit the amount of calories or food eaten. But, unlike people who have anorexia, those who have bulimia are usually not of lower weight. 

The signs and symptoms of bulimia nervosa fall into three primary categories: Behavioral, psychological, and physical.

What are the Long-Term Consequences of Bulimia Nervosa?

The short-term consequences of bulimia nervosa are often fairly subtle, but they by no means should be ignored. The short-term effects of bulimia nervosa typically include dental issues, electrolyte imbalances, fatigue, and heartburn/acid reflux.

However, if BN goes on unaddressed and the cycle of food restriction, binging, and purging continues in the long term there can be more serious impacts. The long-term consequences of bulimia nervosa include (3,4):

• Irritated, torn, or ruptured esophagus that can lead to blood in vomit
• Difficulty in having a bowel movement without laxatives, due to overuse
• Kidney damage from misdirected use of diuretics
• Severe dehydration, which can cause electrolyte imbalances that can lead to potentially life-threatening heart or kidney problems, and/or seizures
• Cardiovascular problems including low blood pressure, an irregular heartbeat, weakened heart muscle, and in severe cases, heart failure
• Loss in bone density and muscle mass
• Reduced immune function
• Hormonal imbalances that can affect the reproductive system, such as reduced sex drive, menstrual cycle abnormalities, infertility, and pregnancy complications
• Increased risk of substance use, self-harm, and suicide

The consequences of untreated bulimia nervosa can seem frightening, but there is always hope. Research shows that almost 75% of people diagnosed with BN who see treatment, fully recover from the condition (1).

In Summary

Bulimia nervosa (BN) is a serious eating disorder that’s characterized by a cycle of binging and purging or compensating. Put simply, a person regularly eats a large amount of food (more than usual) in a single sitting and then attempts to compensate by self-induced vomiting, excessively exercising, fasting, and/or using diuretics and laxatives.

This eating disorder typically manifests in late childhood and early adulthood and is believed to affect 0.5% to 1.5% of the population. However, the prevalence may be higher due to the secrecy and shame accompanying the condition (1).

If you’ve noticed that your attitudes and behaviors towards food and yourself have changed, and not in a positive way, it can be a worrying experience. 

If you’re becoming secretive over your eating habits, eating large quantities of food in a single sitting, purging after meals, and finding your self-worth is increasingly linked to how you see or feel about your body, you may be suffering from bulimia nervosa.

We know that there is a lot of shame and guilt that can accompany the disordered eating behaviors associated with BN and this can make it difficult to admit that there is a problem. However, if you ignore or downplay the seriousness of an eating disorder your physical and mental health could suffer in the long run.

If you think you have a problem with bulimia nervosa or any other eating disorder, it’s important that you try to speak up to someone you know or to your healthcare provider. This is the first important step on the journey to getting the help and support you need.