Bulimia Nervosa | Symptoms & Causes

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.

What are the signs and symptoms of bulimia?

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.


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.