Self-help Articles

People with bulimia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all these forms of purging. Because many individuals with bulimia "binge and purge" in secret and maintain normal or above normal body weight, they can often successfully hide their problem from others for years.

Lisa developed bulimia nervosa at 18. Like Deborah, her strange eating behavior began when she started to diet. She too dieted and exercised to lose weight, but unlike Deborah, she regularly ate huge amounts of food and maintained her normal weight by forcing herself to vomit. Lisa often felt like an emotional powder keg -- angry, frightened, and depressed.

Unable to understand her own behavior, she thought no one else would either. She felt isolated and lonely. Typically, when things were not going well, she would be overcome with an uncontrollable desire for sweets. She would eat pounds of candy and cake at a time, and often not stop until she was exhausted or in severe pain. Then, overwhelmed with guilt and disgust, she would make herself vomit.

Her eating habits so embarrassed her that she kept them secret until, depressed by her mounting problems, she attempted suicide. Fortunately, she didn't succeed. While recuperating in the hospital, she was referred to an eating disorders clinic where she became involved in group therapy. There she received medications to treat the illness and the understanding and help she so desperately needed from others who had the same problem.

Family, friends, and physicians may have difficulty detecting bulimia in someone they know. Many individuals with the disorder remain at normal body weight or above because of their frequent binges and purges, which can range from once or twice a week to several times a day. Dieting heavily between episodes of binging and purging is also common. Eventually, half of those with anorexia will develop bulimia.

As with anorexia, bulimia typically begins during adolescence. The condition occurs most often in women but is also found in men. Many individuals with bulimia, ashamed of their strange habits, do not seek help until they reach their thirties or forties. By this time, their eating behavior is deeply ingrained and more difficult to change.

Written by Lee Hoffman, Office of Scientific Information (OSI), National Institute of Mental Health (NIMH). An earlier version was prepared by OSI staff member Marilyn Sargent.

Scientific review was provided by NIMH staff Susan J. Blumenthal, M.D.; Harold Goldstein, Ph.D.; Harry E. Gwirtsman, M.D.; and Susan Z. Yanovski, M.D.

U.S. Department of Health and Human Services
Public Health Service

National Institutes of Health
National Institute of Mental Health