What is Bulimia Nervosa (BN)?

Bulimia nervosa (BN) is a specific type of eating disorder revolving around cycles of binging and purging.

Affecting people of all genders, BN has a prevalence of approximately 0.5-1.5%. The disorder can have grave effects on someone’s health, but thankfully, a majority of people who seek treatment for bulimia nervosa are able to recover. (1)

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What Is Bulimia Nervosa?

Like all eating disorders, bulimia nervosa is actually a mental health disorder, which manifests as specific disordered eating behaviors.

As one of the most widely identified causes of an eating disorder, Bulimia has come to be defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), or the record of all officially recognized mental health disorders.

To meet the official criteria for BN, a patient must engage in recurring episodes of binge eating, which are defined as the consumption of a larger-than-normal amount of food within a 2-hour period. These episodes are also marked by the sense of a loss of control over how much food is eaten, often followed by a sense of guilt.

People struggling with bulimia nervosa will also experience purging episodes, or the equal-and-opposite compensatory behavior to make up for their binging. These episodes can either be “purging,” involving the expulsion of food through self-induced vomiting or the use of laxatives, or “non-purging,” which include the use of diet pills or excessive exercise to undo the effects of a binge.

To be considered part of an official BN diagnosis, these cycles must occur at least once a week over the course of three months. (2) Bulimia is also defined by an excessive concern over body weight, shape, and size when considering their self-image.

Who’s at Risk for Developing Bulimia Nervosa?

Bulimia nervosa can impact people of all ages, genders, races, body shape and size. Some people may be exposed to certain factors that put them at a higher risk of developing the disorder.

Other studies looking into traditionally less-represented groups have found that Black and Hispanic teenagers are more likely than their white peers to engage in binging and purging behaviors. (6) Individuals in the LGBTQI+ community, women with physical disabilities, and athletes of all genders were also found to experience eating disorders at higher rates. (6)

Across the board, bulimia nervosa is also commonly linked to certain mental health conditions, with depression and a number of anxiety disorders occurring in as many as 60% of people with bulimia. (7)Traumatic histories are also widely shared among this group, with at least 25% of people struggling with bulimia showcasing symptoms of post-traumatic stress disorder and as much as 95% having gone through a potentially traumatic experience. (8)

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Bulimia Nervosa Signs and Symptoms

Bulimia nervosa is marked by a number of recognizable signs and symptoms, which represent the measurable impact the disorder has on a person, and those effects only the person can feel, respectively.

Some of the most common signs and symptoms of bulimia nervosa include: (11)

Many people who struggle with bulimia also show social indications of the disorder, including:

  • Being secretive with their eating behaviors.
    • Finding hidden food wrappers is not uncommon.
  • Feeling uncomfortable about social gatherings that include eating.
  • Wearing baggy clothes to hide the size of their body.
  • Using the bathroom frequently after a meal.

Still, it’s possible for someone to struggle with BN without presenting any of these common indicators of the disorder.

What Causes Bulimia Nervosa?

There’s no officially attributed cause of BN, and, likely, there is no one true cause of the disorder. In fact, research is increasingly uncovering a number of factors that play a role in bulimia’s development.

Biological Factors

Biological factors like genetics play a much bigger role than once thought. Aside from being born with a predisposition to develop the disorder, people can also be born with certain traits—such as the way they handle stress—that make them more likely to exhibit binging and purging behaviors. (3)

Hormones

Hormones and hormonal changes also likely have a lot to do with the development of bulimia nervosa. Puberty, in particular, has been found to kick off a number of alterations that put certain people at higher risk. (5) And some people may also struggle with a dysregulated brain chemistry, receiving irregular messages from their “reward system” that can more easily lead to binging episodes. (9)

Environmental Factors

Environmental factors also have a big impact. Aside from the presence of trauma, which is a big indicator for many types of eating disorders, the eating behaviors modeled by parents can play an outsized role in not only the development of disordered eating patterns but the negative self-image that underlies many cases of bulimia nervosa. (10)

Combination of Factors

Yet, many scientists agree that a combination of these factors is likely the most common cause of bulimia. People are often born with a higher risk factor for developing the disorder, then go through a “triggering” experience, which sets their predisposed biology into motion.

Health Complications Caused by Bulimia

While it’s entirely possible to recover from bulimia nervosa, the disorder can have a number of unfortunate, dangerous, or even deadly effects on those who don’t seek treatment.

Unfortunately, if left entirely unchecked and untreated, bulimia nervosa can also lead to death. One study recently put the death rate of the disorder at 3.9%, due to a number of potential complications, including cardiac arrest. (12)

Still, this is hardly a foregone fate. With a number of effective treatments available, bulimia nervosa actually has one of the highest recovery rates of any eating disorder. (14)

Best Bulimia Nervosa Treatment Options

There are several therapeutic methods that have been found to help people struggling with bulimia nervosa, including:

Cognitive Behavioral Therapy (CBT) being the most widely-recommended technique for those in recovery from the disorder.

The aim of this method is to help people better understand and recognize their unhelpful thought and behavioral patterns, then supply them with different and healthier coping mechanisms to deal with their troubling thoughts and feelings.

Following a pre-set course of treatment, CBT has the advantage of being easily administered in a variety of settings, including through individual therapy, group therapy, or self-help programs. And it’s a major reason why the recovery rate for bulimia nervosa is as high as 74%. (13)

A number of other programs have also shown to make a positive impact, including Dialectical Behavior Therapy (DBT), which focuses on the concepts of change and acceptance.

A number of different art therapies, which help patients express their feelings through mediums like drawing, sculpting, dance, and music.

Regardless, thanks to these treatments and more, perhaps the best answer to the question of “what is bulimia,” may be a potentially dangerous disorder that anyone has the capability to heal from.

Last Update | 11 - 14 - 2022

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