Bulimia Nervosa and Binge-Eating Disorder

Learning Objectives

  • Describe the characteristics, complications, and health outcomes of bulimia nervosa
  • Explain binge eating disorder

People suffering from bulimia nervosa engage in binge eating behavior that is followed by an attempt to compensate for a large amount of consumed food. Purging the food by inducing vomiting or through the use of laxatives are two common compensatory behaviors. Some affected individuals engage in excessive amounts of exercise to compensate for their binges.

People with bulimia nervosa may be slightly underweight, normal weight, or overweight.

Symptoms include the following:

  • chronically inflamed and sore throat
  • swollen salivary glands in the neck and jaw area
  • worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
  • acid reflux disorder and other gastrointestinal problems
  • intestinal distress and irritation from laxative abuse
  • severe dehydration from purging of fluids
  • electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals), which can lead to stroke or heart attack

Bulimia is associated with many adverse health consequences that can include kidney failure, heart failure, and tooth decay. In addition, these individuals often suffer from anxiety and depression, and they are at an increased risk for substance abuse (Mayo Clinic, 2012b).

The lifetime prevalence rate for bulimia nervosa is estimated at around 1% for women and less than 0.5% for men (Smink, van Hoeken, & Hoek, 2012). The rates of bulimia increased during the 1980s and early 1990s and have remained stable since then. Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors.

Dig Deeper: Bulimia

Princess Diana dancing with John Travolta in an elegant black dress.

Figure 1. Princess Diana spoke openly about her struggles with bulimia.


An iconic fashion figure and celebrity, Princess Diana was a prominent public figure that was open about how bulimia affected her life. Read this article about how Princess Diana struggled and how she attempted to use bulimia as a coping mechanism to deal with some of her life stressors.

Watch It

Watch this video to review the basics about anorexia and bulimia, and contrast those with the obsessive-compulsive related body dysmorphic disorder.

You can view the transcript for “Eating and Body Dysmorphic Disorders: Crash Course Psychology #33” here (opens in new window).

Key Takeaways: Bulimia Nervosa

Binge-Eating Disorder

Binge-eating disorder (BED) is the most prevalent eating disorder, affecting approximately 2.8% of females and 1% of males.[1] Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating that are not combined with compensatory methods to avoid weight gain. Thus, the majority of binge-eating disorder (BED) cases are overweight or obese. Unlike bulimia, BED binges are not followed by purging.[2]. Of those patients affected, research estimates that 28.4% of people with current BED are receiving treatment and 43.6% of people with BED will receive treatment at some point in their lives.[3]

Binge eating is the core symptom of BED; however, not everyone who binge eats has BED. An individual may occasionally binge eat without experiencing many of the negative physical, psychological, or social effects of BED. This example may be considered an eating problem (or not), rather than a disorder. Precisely defining binge eating can be problematic; however, binge eating episodes in BED are generally described as having the following potential features:

  • eating much faster than normal, perhaps in a short space of time
  • eating until feeling uncomfortably full
    A dirty plate and utensils after a meal.

    Figure 2. Binge-eating is characterized by over-consuming large amounts of food in a short amount of time. Unlike bulimia, it is not followed by purging, but it does often result in feelings of shame or frustration.

  • eating a large amount when not hungry
  • subjective loss of control over how much or what is eaten
  • binges may be planned in advance, involving the purchase of special binge foods, and the allocation of a specific time for binging, sometimes at night
  • eating alone or secretly due to embarrassment over the amount of food consumed
  • there may be a dazed mental state during the binge
  • not being able to remember what was eaten after the binge
  • feelings of guilt, shame, or disgust following a food binge

In contrast to bulimia nervosa, binge-eating episodes are not regularly followed by activities intended to prevent weight gain, such as self-induced vomiting, laxative or enema misuse, or strenuous exercise. BED is characterized more by overeating than dietary restriction and over concern about body shape. Obesity is common in persons with BED, as are depressive features, low self-esteem, stress, and boredom.

Treatments for Bulimia and Binge-Eating Disorder

There are several supported psychosocial treatments for bulimia. CBT, which involves teaching a person to challenge automatic thoughts and engage in behavioral experiments (for example, in session eating of “forbidden foods”), has a small amount of evidence supporting its use.

Seeking treatment early for eating disorders is essential as people with eating disorders are at higher risk for suicide and medical complications. People with eating disorders can often have other mental disorders (such as depression or anxiety) or problems with substance use. Complete recovery is possible. Treatment plans are tailored to individual needs and may include one or more of the following:

  • individual, group, and/or family psychotherapy
  • medical care and monitoring
  • nutritional counseling
  • medications


A notebook with time stamps, meals eaten and cravings recorded.

Figure 3. Keeping track of what you eat and how you feel throughout the day can be helpful and insightful.

Psychotherapies such as a family-based therapy called the Maudsley approach, where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appear to be very effective in helping people gain weight and improve eating habits and moods. This and other types of family-based treatments (FBT) are particularly helpful for younger adolescents to gradually take more control of their eating habits after learning more about the consequences of their eating choices.

To reduce or eliminate binge-eating and purging behaviors, people may undergo CBT, which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs. By using CBT, people record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis. People undergoing CBT who exhibit early behavioral changes are most likely to achieve the best treatment outcomes in the long run. Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy.


Antidepressants of the selective serotonin reuptake inhibitors (SSRI) class may have a modest benefit in treating bulimia. This includes fluoxetine, which is FDA approved, for the treatment of bulimia. Other antidepressants such as sertraline may also be effective against bulimia. Topiramate may also be useful, but has greater side effects. Compared to placebo, the use of a single antidepressant has been shown to be effective.

Combining medication with counseling can improve outcomes in some circumstances. Some positive outcomes of treatments can include abstinence from binge eating, a decrease in obsessive behaviors to lose weight and in-shape preoccupation, less severe psychiatric symptoms, and a desire to counter the effects of binge eating as well as an improvement in social functioning and reduced relapse rates.

Case Study: Reeya

Reeya is a young Indian woman in her early 20s born in Britain. She was diagnosed with bulimia nervosa in her late teens and later came into contact with an urban eating disorder specialist in the hospital as an outpatient.

Reeya’s mother passed away when she was a toddler. Thereafter, she moved in with her grandparents. Her father remarried a short time later and she moved back in with her father and step-mother. She did not get along with her step-mother. She described her relationship with her parents (father and step-mother) as “hostile” and recounted pervasive family pressure in terms of high expectations around education, marriage, and career.

Reeya attended an all-girls grammar school and described it as being quite competitive. She could not recall having had any difficulties with body image or eating prior to the age of 16. When she was in year 12, she recalled feeling quite large and began to weigh herself. At that time, Reeya and her friend began a Weightwatchers diet plan to lose weight for a big ball at the school. Reeya went from being 55 kg (121 lbs) to 47 kg (103 lbs) and felt a sense of happiness, pride, and achievement, even though her BMI measured slightly underweight. She regained the weight when going to college.

Reeya went to university at age 18 and described her living circumstances there as stressful and lonely. She pursued a course that was dominated by young women and she did not get along with her flatmates. She recounted her first year of university as being the hardest year of her life. Reeya discussed feeling quite self-conscious about her appearance when she started university. She described developing an increasing pre-occupation with weight, concerns over body image, daily intake restriction, and then overeating/binges in the evenings, followed by occasional purging.

Reeya sought help through her supportive boyfriend who accompanied her to the doctor as a first point of access.[4]

Try It

Watch It

This video provides an overview of binge-eating disorder.

You can view the transcript for “Understanding Binge Eating Disorder” here (opens in new window).

Key Takeaways: Binge Eating Disorder

Try It


binge eating disorder: type of eating disorder characterized by binge eating and associated distress

bulimia nervosa: type of eating disorder characterized by binge eating followed by purging

  1. Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. American Journal of Clinical Nutrition (2019) 109:1402–13. doi: 10.1093/ajcn/nqy342
  2. Cury MEG, Berberian A, Scarpato BS, Kerr-Gaffney J, Santos FH and Claudino AM (2020) Scrutinizing Domains of Executive Function in Binge Eating Disorder: A Systematic Review and Meta-Analysis. Frontiers in Psychiatry 11:288. doi: 10.3389/fpsyt.2020.00288
  3. Statistics & Research on Eating Disorders. National Eating Disorders Association. (2020, May 8). https://www.nationaleatingdisorders.org/statistics-research-eating-disorders.
  4. Channa, S., Lavis, A., Connor, C. et al. Overlaps and Disjunctures: A Cultural Case Study of a British Indian Young Woman’s Experiences of Bulimia Nervosa. Cult Med Psychiatry 43, 361–386 (2019). https://doi.org/10.1007/s11013-019-09625-w