Bulimia Nervosa: The Binge-Purge Eating Disorder

What is Bulimia?

Jennifer Huddy, MS, RD, LD

Registered Dietitian and Nutrition Writer

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Bulimia nervosa is an eating disorder that can lead to serious health risks if left undiagnosed and untreated. It is important to understand what bulimia is in order to identify possible cases in loved ones or yourself.

What is Bulimia Nervosa?

Bulimia nervosa is an eating disorder involving routine binge eating and subsequent compensatory behaviors, most commonly purging. It typically involves negative body image and internalized fat phobia. People with bulimia view their self-worth as being tied to body weight and size.

Like many eating disorders, people with bulimia can be very secretive about their problematic eating habits. Shame and guilt due to binge eating and purging habits often lead people with bulimia to hide their eating disorder from their friends, family, and doctors. Also, bulimia can go undetected for long periods because people with bulimia are often a normal weight or overweight.

Binge eating

Binge eating is defined as eating more food than an average person would eat in a similar amount of time, usually defined as a period of fewer than two hours. It is accompanied by feeling out of control while eating and excessive guilt afterward.

A binge generally involves eating “unhealthy” or high-calorie foods. It can often stem from a history of restrictive dieting and labeling certain foods as “off limits.” Binge eating tends to occur in private settings to avoid the judgment of family and peers.

With bulimia, due to the purging component, individuals will binge eat foods that are not as painful or uncomfortable to throw up, such as ice cream.

Purging

There used to be two subtypes of bulimia nervosa: purging type and non purging type. However, these were removed in the 5th edition of the Diagnostic and Statistical Manual (DSM-5). The subtypes are no longer used to classify bulimia. Instead, the diagnostic terminology used is “inappropriate compensatory behaviors.”

The inappropriate compensatory behaviors that follow binge eating episodes in bulimia can mean several things. The most common type of compensatory behavior is purging, which includes self-induced vomiting, diuretics, laxatives, weight loss pills, enemas, suppositories, or other supplements and medications used to avoid weight gain. Excessive exercise or fasting are examples of non-purging compensatory behaviors.

Purging is often done directly following a binge eating episode with the intention of “getting rid of” the calories consumed with the goal of avoiding weight gain. The purging methods used by people with bulimia can be classified as mild, moderate, or severe and put them at a particularly high risk of complications.

Top warning signs

The following signs and symptoms are the most common things that loved ones or medical professionals may notice in people with bulimia. These include large amounts of food disappearing, frequent bathroom trips after eating, yo-yo dieting, skin breakdown on the knuckles (a result of self-induced vomiting), dental issues, and electrolyte imbalance.

Bulimia is often associated with other psychiatric conditions, most commonly anxiety and mood disorders such as depression. Alcohol or substance abuse occurs in at least 30% of people with bulimia. Self-harm is another common co-occurring problem in bulimia.

How is Bulimia Different From Other Eating Disorders?

Bulimia vs. binge eating disorder

Bulimia is often confused with binge eating disorder because both disorders involve routine binge eating. However, binge eating disorder does not include the purging component that is present in bulimia. A person who regularly binge eats but does not purge would be diagnosed with binge eating disorder and not bulimia.

Bulimia vs. anorexia

Bulimia can also be confused with anorexia nervosa, particularly the binge eating purging subtype of anorexia. This anorexia subtype occurs when a person oscillates between intense food restriction and binging purging behaviors. It also includes people with anorexia who purge without binge eating. Low body weight is more common in the anorexia binge eating purging subtype than in bulimia.

Bulimia vs. purging disorder

Purging disorder is classified under the Other Specified Feeding or Eating Disorders (OSFED) category in the DSM-5. It includes individuals who purge but do not binge eat or restrict food. It is more common for adolescents to purge in the absence of binge eating than in the adult population.

Diabulimia

Diabulimia, though not its own diagnosis in the DSM-5, is a type of eating disorder that involves people with type 1 diabetes restricting their insulin dosage with the goal of losing weight. It is also known as Eating Disorder-Diabetes Mellitus Type 1, or ED-DMT1.

Since insulin restriction is considered a form of purging, a person experiencing diabulimia can be diagnosed with bulimia if they restrict their insulin following binge eating episodes. However, depending on its presentation and the specific eating behaviors of the individual, diabulimia can also be classified as purging disorder, anorexia nervosa, or OSFED (Other Specified Feeding and Eating Disorders).

Prevalence and Statistics

The prevalence of a person having bulimia nervosa in their lifetime is somewhere between 1% and 3%. It is known to be more common in females, with 1% of young women and 0.1% of young men experiencing bulimia at any given time.

Recent studies have found that the onset of eating disorder symptoms occurs at younger ages, emphasizing the importance of early screening.

Nourish

Finding treatment for bulimia nervosa can feel overwhelming. At Nourish, we match you with registered dietitians who are experts at treating bulimia. Our dietitians work with you to provide compassionate, evidence-based care to lead you on the path to recovery.

All visits are done remotely and are covered by insurance, making it easy to access the care you need. Get started with Nourish today.