Bulimia Nervosa Symptoms & Causes


Our culture's obsession with achieving lower weight conveys an unavoidable message to maturing adolescents. According to the 2009 Youth Risk Behavior Survey, 33 percent of adolescent girls believed that they were overweight and 56 percent were attempting to lose weight 6 percent of girls and 2 percent of boys stated that they had taken laxatives or intentionally vomited to lose weight or keep from gaining weight.

Adolescents with unrealistic expectations about weight may end up suffering from bulimia. Read on to learn more about the causes and signs of bulimia nervosa, as well as how Children’s Hospital Boston can help young adults struggling with an eating disorder.


What causes bulimia?

It’s hard to pinpoint the cause of bulimia nervosa. The condition usually begins with dieting, but gradually progresses to extreme and unhealthy weight control methods. There are several factors thought to be associated:

  • Social attitudes toward body appearance — often unrealistic — are believed to play a large role.
  • Adolescents who develop bulimia are more likely to come from families with a history of weight problems, physical illness and mental health problems, such as depression or substance abuse. Genetics may also play a role.
  • Often teens with bulimia come from families with high levels of stress, poor patterns of communication, unrealistically high expectations and underdeveloped problem-solving skills.
  • Sports or activities in which leanness is emphasized (e.g., ballet, running or wrestling) and sports in which scoring is partly subjective (e.g., skating or gymnastics) are associated with a higher incidence of eating disorders.
  • Teens with bulimia often have other mental health problems, such as anxiety disorders, obsessive-compulsive disorder (OCD), affective (or mood) disorders and problems with substance abuse. They may also be dependent, immature in their emotional development and likely to isolate themselves from others.

How can I tell if my child is “bingeing”?
Bingeing is defined as eating much larger amounts of food than would normally be consumed within a short period of time (usually less than two hours). In bulimia eating binges occur at least twice a week for three months and may occur as often as several times a day.

Signs and symptoms

If your child has bulimia, some of the symptoms you may notice include:

  • normal, high or low body weight (but sees self as overweight)
  • recurrent episodes of binge eating (rapid consumption of excessive amounts of food in a relatively short period of time; often secretive), coupled with fearful feelings of not being able to stop eating during the bingeing episodes
  • self-induced vomiting (usually secretive)
  • excessive exercise or fasting after eating
  • peculiar eating habits or rituals
  • inappropriate use of laxatives, diuretics or other cathartics
  • irregular or absence of menstruation
  • anxiety
  • discouraged feelings related to dissatisfaction with themselves and their bodily appearance
  • depression
  • preoccupation with food, weight and body shape
  • scarring on the back of the fingers from the process of self-induced vomiting

Other signs you may notice include:

  • dehydration
  • swollen face
  • sore throat
  • tooth decay or cavities
  • dry, flaky skin
  • constant upset stomach
  • heartburn
  • constipation
  • weight fluctuations

What are the warning signs

Eating disorders are illnesses of denial and secrecy; they're often very difficult to track down. So family members and friends shouldn't feel badly about not figuring out right away if their loved one has a problem.

That being said, there are some signs you can look for:

  • unexplained weight fluctuations
  • dizziness
  • fainting
  • fatigue
  • irritability or moodiness
  • going to the bathroom often, especially after meals
  • food disappearance from the kitchen

Also be on the lookout for major change in eating or exercise behavior.

What are the possible complications of bulimia?

Bulimia is a serious disease. Here are some of the complications a young adult with bulimia may develop:

  • serious electrolyte problems
  • irregular menstrual periods
  • dehydration
  • swollen face
  • sore throat
  • tooth decay
  • dry, flaky skin
  • constant upset stomach
  • heartburn
  • constipation
  • depression
  • weight fluctuations

In addition, electrolyte abnormalities such as low potassium levels, from the body losing potassium after vomiting, can lead to serious heart problems and even death.


Researchers are actively exploring the question of whether bulimia nervosa can be prevented.

Awareness increases the chance of early detection and intervention — which in turn can reduce the severity of symptoms, enhance your child's normal growth and development and improve her quality of life.

Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.

To some extent, parents can help prevent eating disorders in their children:

  • Here at Children’s Hospital Boston, our doctors encourage parents to avoid using food as a behavioral reward and to provide variety in appropriate portion sizes.
  • Parents should carefully monitor growth and development, helping their children avoid obesity through sensible eating and physical activity.
  • Parents should stress health and fitness—not “thinness.”

Long-term outlook

Treatment for bulimia nervosa is a slow process that may last years.

The vast majority of adolescents suffering from bulimia will enter a recovery phase, but there may be a life-long struggle with food and consequent weight loss or gain.

Questions to ask your doctor

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider, and that you understand your provider’s recommendations.

If you’ve made an appointment to talk to a doctor about your child’s eating and/or exercise habits, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling that you have the information you need.

You may want to suggest that your child write down what she wants to ask her health care provider, too.

Some of the questions you may want to ask include:

  • How much experience do you have treating bulimia?
  • What are the treatment options?
  • How will we know whether the treatment is working?
  • Will my child need to be hospitalized?
  • What’s therapy and how does it work?
  • How will the treatment for bulimia affect my child’s day-to-day life?
  • What is the long-term outlook for my child?
  • What can I do to help support my child’s health and help her cope with her condition?

When to seek medical advice

If you notice changing eating or exercising habits in your child, it might mean that she has an eating disorder such as bulimia. You should make an appointment with your child’s pediatrician right away.

If your child has already been diagnosed with bulimia, you should call her doctor if you see any further change in your child’s behavior relating to food or exercise.

Useful medical terms

Anorexia Nervosa (Anorexia) is an eating disorder characterized by self-starvation with or without over-exercise or purging. Anorexia is a complex disease involving psychological, sociological, and physiological elements.

Anxiety disorder is a generalized term used to describe mental health disorders relating to excess worrying, phobias and nervousness. A person suffering from an anxiety disorder may have panic attacks and may be unable to pursue normal daily routines.

Behavioral problem or disorder is a generalized term used when a child or teenager behaves—over a long period of time—in ways that are not socially acceptable for his or her age and situation or in ways that are destructive or self-destructive.

Bipolar disorder is a mood disorder characterized by severe mood swings. A person with this disorder may go from being manic, extremely elated and energetic to being depressed, sad, and sluggish. People with this disorder are sometimes known as “manic depressives.”

Bulimia Nervosa (commonly known as Bulimia) is an eating disorder characterized by extreme overeating or “binge” eating followed by self-induced vomiting, excessive exercising, inappropriate use of laxatives or enemas, or fasting.

Clinician is an individual who is trained to practice medicine or psychological counseling and who works directly with people instead of in a laboratory.

Depression (clinical) is a mental health disorder characterized by a sad mood that is both prolonged and severe. Clinical depression can be treated with medication, therapy, and hospitalization if necessary.

Diagnostic evaluation refers to a clinician assessing the symptoms presented by your child in order to come to an informed opinion about what condition is causing those symptoms.

Dietician/Nutritionist refers to professionals with specialized training in nutrition. They, along with nurses and doctors, help families design healthy eating plans and provide long-term follow-up.

Mood disorder is a generalized term referring to mental health disorders where a person’s general mood is distorted or inappropriate given the circumstances. Clinical depression and bipolar disorder are both mood disorders.

Nurse Practitioner refers to a person with an Advanced Practice Nurse (APN) degree who manages patient care and provides primary care services as well as specialty services. Unlike most nurses, nurse practitioners can diagnose patients and prescribe medications.

Psychiatrist refers to a medical doctor who has specialized training in behavioral and mental health disorders. Psychiatrists can prescribe medication to their patients.

Psychologist refers to a mental health professional who is not a medical doctor and who does not prescribe medication. Clinical psychologists have extensive training in therapy and psychological testing.

Social Worker refers to a professional who patients and their families deal with the broad range of psychosocial issues and stresses related to coping with illness and maintaining health.

Center for Young Women's Health

Explore the Center's website for in-depth information on issues affecting teen girls today, including healthy eating, nutrition and eating disorders.


Talking about eating disorders

Read our Q & A with Sara Forman, MD, Director of Children's Outpatient Eating Disorders Program.