Bulimia: When You Eat a Lot and Feel You Have to Get Rid of It
- Donald St Pierre, MSN, RN-BC
- Nov 7, 2025
- 7 min read
Bulimia (full name: bulimia nervosa) is not just “bad eating habits.”
It is a serious mental health condition.
People with bulimia:
Have times when they eat a lot of food very quickly (this is called a binge)
Then try to “get rid of it” so they don’t gain weight (this is called purging) (American Psychiatric Association, 2013)
Purging can include (American Psychiatric Association, 2013; National Eating Disorders Association [NEDA], n.d.; National Institute for Health and Care Excellence [NICE], 2017):
Making themselves throw up
Taking laxatives or water pills (diuretics) they don’t need
Not eating for a while after a binge
Doing too much exercise just to burn off food
Most people with bulimia look like they are a “normal” weight. Some may even be in a larger body.You cannot tell who has bulimia just by looking at them (NIMH, 2024; Mehler & Rylander, 2015).
What Is a Binge?
A binge is more than just “eating a lot.”
During a binge, a person may:
Eat much more than most people would in the same situation
Eat very quickly
Feel like they cannot stop, even if they want to
Often eat in secret
Feel very guilty, ashamed, or scared afterward (NIMH, 2024; NEDA, n.d.; American Psychiatric Association, 2013)
Doctors use a guide called the DSM-5. It says bulimia usually means bingeing and purging at least once a week for 3 months or more (American Psychiatric Association, 2013).
What Does “Getting Rid of It” Look Like?
After a binge, someone with bulimia may:
Throw up on purpose
Use laxatives or water pills to make food or water leave their body
Eat nothing or very little for a while
Do very hard or long exercise because they feel they “must” burn off calories
These are called compensatory behaviors, and they are dangerous, even when they happen “only sometimes” (American Psychiatric Association, 2013; NICE, 2017; Crone et al., 2023).
Signs and Symptoms of Bulimia
Here are some signs that may point to bulimia (especially if many happen together):
Going to the bathroom right after eating, a lot
Exercising all the time, even when tired, sick, or injured
Being very worried about weight, shape, or looks
Being afraid of gaining weight
Feeling out of control around food
Feeling guilty or ashamed after eating
Hiding food, eating in secret, or lying about eating
Depression or anxiety
Pulling away from friends and family (NIMH, 2024; NEDA, n.d.; Crone et al., 2023)
Bulimia can affect:
Kids
Teens
Adults
People of any gender, race, or body size (NIMH, 2024; NICE, 2017; Crone et al., 2023).
Why Does Bulimia Happen?
There is no single cause. Research shows bulimia usually comes from a mix of factors (Crone et al., 2023; NICE, 2017; NIMH, 2024).
1. Biology and Family
Some people may be born with a higher risk
Having a family member with an eating disorder, depression, anxiety, or substance use can raise the risk (Crone et al., 2023; NIMH, 2024)
2. Thoughts and Feelings
Low self-esteem
Feeling like life is out of control
Perfectionism (“I must do everything perfectly”) (Crone et al., 2023; NIMH, 2024)
3. Environment and Culture
Living in a culture that says you must be thin to be worthy
Sports or activities that focus on weight or shape (dance, gymnastics, modeling, etc.) (NICE, 2017)
Bullying or hurtful comments about body size
Trauma or big stressful life events
Bulimia is not a choice and not a character flaw.It is a medical and mental health condition that deserves real treatment (NIMH, 2024; Crone et al., 2023).
How Bulimia Hurts the Body
Bulimia can damage almost every part of the body, even if the person still looks “healthy” on the outside (Mehler & Rylander, 2015; NIMH, 2024).
Mouth and Teeth
Repeated vomiting brings up strong stomach acid. Over time, this can cause:
Tooth enamel erosion
Cavities
Tooth pain and sensitivity
Gum problems and bad breath
People with bulimia have a much higher rate of tooth erosion than people without the disorder (Mehler & Rylander, 2015; NEDA, n.d.).
Throat and Stomach
Sore, swollen, or injured throat
Heartburn and stomach pain
Possible ulcers or tears in the stomach or esophagus (Mehler & Rylander, 2015)
Heart and Blood
Low potassium and other mineral (electrolyte) problems
Irregular heartbeat
Risk of dangerous heart rhythm problems, which can be life-threatening (Mehler & Rylander, 2015; Crone et al., 2023)
Brain and Mood
Worse anxiety and depression
Trouble focusing and thinking clearly (Crone et al., 2023; NIMH, 2024)
Some damage can improve when the person stops bingeing and purging and gets help. The earlier someone gets care, the better the chances of healing (Crone et al., 2023; Mehler & Rylander, 2015; NIMH, 2024).
The Good News: Bulimia Is Treatable
Big expert groups like NIMH, NICE, and the American Psychiatric Association (APA) all say that bulimia can be treated, and many people recover (NIMH, 2024; Crone et al., 2023; NICE, 2017).
Treatment often includes a team:
A therapist
A medical provider (doctor, nurse practitioner)
Sometimes a dietitian
And family or support people
1. Therapy (Talking Treatment)
The main therapy for bulimia is usually cognitive-behavioral therapy (CBT):
Helps people notice and change unhelpful thoughts about food and body image
Teaches new ways to cope with feelings instead of bingeing or purging
Builds healthier eating patterns and routines
Treatment guidelines from APA and NICE strongly support CBT for bulimia in adults and young people (Crone et al., 2023; NICE, 2017).
2. Nutrition Support
A dietitian or clinician trained in eating disorders can:
Help build regular meals and snacks
Reduce binges that come from being too hungry
Explain what balanced eating looks like (no “good” and “bad” foods, just patterns) (Crone et al., 2023; NIMH, 2024).
3. Medication
Some people also benefit from medicine, especially antidepressants called SSRIs.
A large clinical trial and later reviews show that fluoxetine (Prozac), especially at 60 mg per day, can help reduce bingeing and purging episodes in people with bulimia when added to therapy (Walsh et al., 1992; Mukai et al., 2023; Crone et al., 2023).
Medicine is usually added to therapy, not used alone.
4. Medical Care and Safety
Because bulimia can affect the heart, blood, stomach, and teeth, medical check-ups are important. Sometimes tests like:
Blood work
Heart tests (EKG)
Other exams are needed to check for hidden problems (Mehler & Rylander, 2015; Crone et al., 2023).
In very serious cases (for example, very low electrolytes, heart rhythm problems, or thoughts of self-harm), hospital or emergency care may be needed (NIMH, 2024; Crone et al., 2023).
How Do You Know If You Need Help?
You deserve help if:
You feel out of control around food
You binge and then try to get rid of the food
You live in constant fear of gaining weight
Eating feels scary, confusing, or shameful
You do not have to be underweight. You do not have to “look sick.”If you’re struggling, that is enough (NIMH, 2024; Crone et al., 2023).
What You Can Do Right Now
If This Might Be You
Talk honestly with:
A doctor, nurse, or mental health professional
A school counselor or trusted adult
You can say something like:
“I think I might have bulimia. I binge and then try to get rid of the food.I’m scared. Can you help me find treatment?”
If you have chest pain, trouble breathing, fainting, or thoughts of hurting yourself:
Call 911 (in the U.S.) or go to the closest emergency room (NIMH, 2024).
If You’re Worried About Someone Else
Pick a calm moment.
Use kind words. For example:
“I care about you. I’ve noticed you seem stressed about eating and sometimes go to the bathroom right after meals.I’m worried you might be hurting yourself. Can we talk about it?”
Offer to:
Help them find a doctor, therapist, or school counselor
Sit with them while they call for help
Share information from trusted sources like NIMH, NEDA, or national health services (NIMH, 2024; NEDA, n.d.; Crone et al., 2023)
Why Talking About Bulimia Matters
Bulimia is:
More common than many people realize
Often hidden because of shame and fear
Treatable with the right support (NIMH, 2024; Crone et al., 2023)
By learning about it and talking openly, you can:
Notice when you might need help
Notice when a friend or family member is at risk
Encourage people to get real, life-saving care
You might be the person who spots the signs, speaks up with kindness, and helps someone start getting better.
Our Bulimia Awareness Tee: Education You Can Wear
A lot of people have never heard the word bulimia, or they don’t really understand what it looks like in real life. That’s one reason we created the NurseMob Bulimia Awareness Tee—to turn everyday clothing into a simple teaching tool.
On the shirt, a colorful cartoon shows someone surrounded by food, eating quickly and alone. Above and around the image are short phrases like:
“Binge eating (usually in solitude)”
“Mood while eating” versus “Mood when stopped”
“May vomit when binge is over”
“Generally sleeps after eating”
These phrases point to real warning signs of bulimia, such as binge eating, secretive eating, and purging behaviors (American Psychiatric Association, 2013; NIMH, 2024; NEDA, n.d.).
For a person walking by, this shirt might be:
The first time they realize, “This looks like what I do when I’m alone with food.”
A prompt to look up bulimia, talk to a trusted person, or ask a nurse, doctor, or therapist for help.
A reminder that bingeing, purging, and shame are signs of a treatable illness, not a character flaw (NIMH, 2024; Crone et al., 2023).
Every time someone wears this tee, it can:
Spark conversations in classrooms, clinics, and communities
Help others recognize the signs of bulimia
Spread the message that help is available and recovery is possible
The more of these shirts we see out in the world, the more people are exposed to accurate information about bulimia—and that awareness can literally save lives.
You can find the bulimia awareness tee, along with other mental health education apparel, in the NurseMob shop.
Key References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
Crone, C., Anzia, D. J., Fochtmann, L. J., & Dahl, D. (2023). The American Psychiatric Association practice guideline for the treatment of patients with eating disorders (4th ed.). American Psychiatric Association.
Mehler, P. S., & Rylander, M. (2015). Bulimia nervosa—medical complications. Journal of Eating Disorders, 3, 12.
Mukai, T., et al. (2023). Efficacy of pharmacotherapies for bulimia nervosa: A systematic review and meta-analysis of randomized controlled trials. BMC Pharmacology and Toxicology, 24, 18.
National Eating Disorders Association. (n.d.). Bulimia nervosa: Symptoms, health consequences & treatment. National Eating Disorders Association.
National Institute for Health and Care Excellence. (2017). Eating disorders: Recognition and treatment (NICE guideline NG69).
National Institute of Mental Health. (2024). Eating disorders: What you need to know (NIH Publication No. 24-MH-4901). U.S. Department of Health and Human Services.
Walsh, B. T., et al. (1992). Fluoxetine in the treatment of bulimia nervosa: A multicenter controlled trial. Archives of General Psychiatry, 49(2), 139–147.
Comments