Understanding Bulimia Nervosa

Bulimia nervosa is among the top most common eating disorders and can have several mental and physical effects including anxiety, depression, ‘bulimia face’ and poor dental hygiene.

What is Bulimia Nervosa? 

Bulimia nervosa is commonly listed as an eating disorder, however, it is also considered an emotional/mental health disorder. When it comes to eating disorders of any kind, poor mental/emotional health is always at play. 

Bulimia nervosa is diagnosed when someone has an unhealthy relationship with food and the following take(s) place:

  • Binge eating followed by purging (vomiting, excessive exercise, use of laxatives)
  • Excessive fasting 
  • Induced vomiting after eating even if no binge took place
  • Abusing the use of laxatives
  • Excessive use of weight loss aids such as supplements

As you can see, bulimia has everything to do with poor body image. The goal of someone struggling with bulimia is to stay as thin as possible or lose weight.

This becomes an obsession to the point where the individual will not care about related health concerns that can evolve.

Symptoms and Signs of Bulimia Nervosa

“Bulimia face” 

Bulimia face is one of the most recognizable characteristics of someone suffering from bulimia.

It looks like someone’s face is swollen in the cheek/jaw area. The swelling is due to irritated salivary glands from how often they are making themselves vomit.

bulimia face

It can also be due to dehydration as your body is trying to store water where it can. Unfortunately, bulimia face can further contribute to the unhealthy cycle of binging/purging as the individual will dislike the fact that their face looks fat (due to swelling). 

If you or someone you know is suffering from an eating disorder such as bulimia and would like to start online therapy with a certified therapist you can get 20% off your first full month with this special discount link! (plus a full toolbox including extra supportive activities) *linked below too

Lack of Sex Drive

When you’re not getting the nutrients your body needs in addition to struggling with mental health issues, your sex drive could very well be the first thing that fails you.

While some studies have shown that there are positives effects of having sex for your state of mental health, the desire will dwindle and eventually you will not have the desire at all.

While this does not reflect a healthy body, disorders such as anxiety and OCD can be genetically passed down. Your lack of sex drive may be a good thing for the time being, until you are able to achieve a healthy state of mind.


Anxiety is often a symptom seen with people suffering from bulimia. In this case, someone struggling with bulimia will always be anxious about their weight. The “highs” and “lows” of binging/purging can induce feelings of anxiety since the brain is being forced into extremes.

The anxiety they feel will constantly be urging them to act in a way that will prevent weight gain (purging/excessive dieting, etc.) 

bulimia face


Just as with anxiety, depression is common as well. This is also related to the forced extremes one will feel while practicing unhealthy habits such as binging and purging.

Depression may also have been pre-existing with bulimia. It’s common for those suffering with bulimia to have past experiences that lead them to depression which progressed into bulimia. 

Causes of developing Depression with Bulimia

  • Unhealthy or unloving relationships. Whether from a partner or parents, if someone experiences an unhealthy relationship that leads them to a sense of worthlessness this could lead to depression over time. It’s important to work on establishing your worth through yourself. It is easy to make the actions of others mean a certain thing which can affect the way one perceives themselves. By building a strong sense of self, you may be able to avoid extreme feelings of unworthiness. This will help you work on the lack of self esteem and unlovability you may feel.

  • Abuse. Abuse on any scale can lead to lifelong effects on the victim. In this case, if the individual suffering with bulimia has felt a lack of control of their own life due to mistreatment, it can lead to depression and continue into bulimia. It’s an unhealthy, ironic cycle as they will get a sense of control by monitoring their weight so closely. In reality, they are unable to control their behaviors while they’re stuck in the cycle of binging/purging.

Causes of Bulimia Nervosa

As is typical with disorders, particularly eating disorders such as bulimia, the cause(s) are typically unknown and varying. Here are some common underlying causes that could contribute to the development of bulimia…

  • Genetics. That’s right! Unfortunately, some of our susceptibility to the development of disorders such as bulimia could be inherited from our parents. The reasons could vary from inherited neurological dysfunction or anxiety/OCD traits. Regardless, you’re not a victim to your circumstance if you chose to be. Like any disorder, treatment is available and you can achieve a healthy state of mind. You can achieve this by being open to learning about your options and being willing to put in the work.

  • Abuse. As previously mentioned, abuse can be the cause of depression just as it can be the cause of bulimia itself. This is simply because of the narrative that plays out when one is abused. Typically, the abuser conditions the victim into believing that they are worthless or unworthy in some way. If you have a negative body image, this could certainly lead to an eating disorder such as bulimia.

bulimia face

  • Poor body image. Bulimia is much more common in girls/women as it is with boys/men. This is attributed to the pressure we may feel to look a certain way given the media or society. It is often seen in teens as adolescent peers can be cruel and less accepting of others. This is usually out of fear of not fitting in or the need to impress their friends. Thankfully, in recent years, the promotion of body positivity is rising and people are becoming more comfortable in their own skin.

As you can see from symptoms, signs and causes of bulimia, there are several contributing factors. The behavioral cycles can be hard to break out of.

bulimia face

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Long Term Effects of Bulimia Nervosa

Poor Dental Health

It’s no surprise that the presence of self-induced vomiting will eventually lead to poor dental health including tooth decay.

When food is eaten and enters the stomach, acid proceeds to break it down to prepare it for full digestion.

When regular vomiting takes place, the presents of that stomach acid in your mouth will eventually wreak havoc on the condition of your teeth. Tooth decay is inevitable with consistent vomiting.

Throat Issues

Your esophagus is extremely delicate compared to the rest of your digestive tract. Obviously, vomiting is sometimes a typical occurrence with certain sporadic sicknesses (flu/stomach “bug” etc.).

However, just as it can cause dental health issues, your throat will suffer as well. Your throat could start bleeding from the stomach acid that comes in contact with it as vomiting occurs.

With continued vomiting, the throat could bleed severely and in some cases this could lead to death. Another severe issue that can affect the throat is swelling.

I thought the explanations in this article by eatingdisorderhope.com had interesting explanations for causes and lasting effects of bulimia.

Stomach Damage

While the stomach is much more fortified than the throat or mouth, it still experiences a large amount of stress from bulimic behaviors.

bulimia face

When someone starves themselves and then proceeds to eat large portions of food during a binge, this creates too much strain.

Severe discomfort and pain can come from this and it may take a while to recover depending on how long these unhealthy habits have been taking place.

Hair Loss

There are many negative effects to an unhealthy diet, one of which is hair loss.

Eventually, your body will be so unhealthy and malnourished that you could start to see lack of hair renewal and overall loss.

Not only is hair loss devastating for most, but those suffering with negative body image will be further pushed into self esteem issues.

The physical effects of long term bulimia practices can cause the individual suffering with this disorder to develop worse symptoms. These symptoms could include extreme anxiety and/or depression.

Heart Problems

When someone is constantly binging and purging dehydration is a common concern.

When someone is severely dehydrated, it can lead to heart issues such as irregular heart rate. With continued irregular heart rate, certain organs can be put under a lot of strain.

If the individual has preexisting health conditions or not, heart conditions could escalate to heart dysfunction or even heart failure.

Development of Personality/Anxiety Disorders

Just like any disorder, if not properly treated in the early stages, it can develop into a more extreme version of that disorder and even develop additional disorders as a result.

Typically, mental health issues such as anxiety and depression have a lot to do with the development of a personality disorder.

When someone is suffering with bulimia, they typically do suffer with both of these issues on some level. If this is not treated, the development of anxiety personality disorder OCPD could develop.

In this case, OCPD can only be developed by someone struggling with bulimia if they are so extreme in their practices that they believe that everyone else is “fat” and/or “unhealthy”.

While this may be a rare case due to the fact that OCPD is typically developed on it’s own, it is still possible depending on the severity of the symptoms and characteristics of an individual’s unique case.

bulimia face

While OCD is also a concern, personality disorders may relate more to someone suffering with bulimia because the traits with this severe disorder become much of who that individual is.

As discussed in the article we posted recently on OCPD, it’s important to note that OCPD is a personality disorder, not an anxiety disorder (like OCD).

In so many words, when someone has OCPD, they will seem like they’re uptight about their preferences. They will be extremely particular on how things are done and will appear to be a perfectionist.

In this case, the OCPD traits will not play into every area of their life. They will be extremely particular about their eating/binging/purging habits, however, they may be more laid back in most other areas.

This sounds relatively harmless, however, the extreme levels of how particular they are seriously affect multiple areas of their lives.

The difference between OCPD and just being “particular” about things is that someone with OCPD will feel an intense need to have things done their way.

Since they’re living with a personality disorder, they will not know that there is anything wrong with their behavior.

They may justify their behavior in the name of health. This is more of a rare case, but the shift from eating disorder to personality disorder is not that far off.

Similarly, an anxiety disorder can develop outside of “normal” anxiety.

While experiencing anxiety every now and then isn’t unusual, if someone is suffering on a regular basis they may have an anxiety disorder.

An anxiety disorder is characterized as intense episodes of worry, fear and or anxiety that frequently inhibit someone’s ability to do something.

This could be a certain trigger that causes a panic attack or any other instance where the individual’s life is affected by the intense anxiety.

It can come in many different forms such as anxiety or social disorders. An example of this could be if someone experiences intense stress or anxiety when they’re in public and/or large groups of people.

The anxiety they experience is not equally aligned with the situation. It’s important to know that people with an anxiety disorder are not just over reacting.

While the situation is not as dangerous or threatening  as they’re interpreting it, what is happening to them on the inside is very intense. The fear/anxiety they are feeling is debilitating and very real in that regard. 

Causes of an Anxiety Disorder

As we’ve talked about in related articles, the cause of an anxiety disorder can be a preexisting condition such as a chemical imbalance.

Many people who suffer with an anxiety disorder developed it from childhood. Certain experiences, genetic factors and repetitive situations can cause one to develop an anxiety disorder if not properly addressed.

Most of the time, those with anxiety disorders are aware of them. They are able to recognize that it is not healthy to be dealing with the things that they have to.

Some may actively seek treatment, however, many do not. It’s unclear why some people prefer to avoid treatment, but factors such as shame or even anxiety itself may be the cause. It isn’t uncommon for those suffering with bulimia to develop an anxiety disorder.

Learn more about the long term effects of bulimia in this article.

Treatment Options

Just like the other disorders we’ve been discussing lately, the use of therapy and sometimes medication is the recommended treatment approach.

Typically, medication is only used when there is a use to control/treat symptoms such as anxiety and/or depression. 

Psychodynamic psychotherapy

Psychotherapy is known as “talk therapy” and the oldest form at that. This is used for a variety of disorders and emotional support. Psychotherapy is great for working through the daily struggles that individuals with bulimia nervosa may face.

Working with a professional therapist in psychotherapy will help control the disorder’s symptoms and give the patient a better quality of life.

Depending on the severity of the individual’s disorder, psychotherapy can be a short process or can last for years.

According to research and this article the majority of people in psychotherapy typically see helpful results. The professional skills and knowledge a therapist has can help rewrite destructive patterns of behavior.

This will lead to better outcomes in every area of the patient’s life such as relationships, their job, and even their relationship with themselves.

Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) is also a form of psychotherapy (“talk therapy”), although its focus is slightly different. CBT specifically targets eliminating negative thought patterns.

This focus may be an appropriate treatment if someone has self-esteem issues that affect a variety of areas in their life.

In the case of bulimia, self-esteem and poor body image are some of the main contributors to the disorder.

By working with someone to eliminate negative thoughts/beliefs, you open a door to endless possibilities for yourself and recovery.

There are also a variety of other personality disorders that benefit from CBT. By being willing to work on destructive behavior patterns, you can eliminate the narrative in your mind and change your actions!

CBT is a great way for people to take control and change their lives.


As previously mentioned, medication may be an option of treatment for someone suffering with bulimia if they’re struggling with anxiety and/or depression. 

There are several antidepressants that are approved for treatment. If you think this is something you could benefit from, talk to your doctor about which one could help you! 

In conclusion, understanding the complexity of bulimia is a great way to connect with someone you know who may be struggling with it. As with most disorders, there are a variety of causes and symptoms that make the disorder’s experience unique to everyone.

Check our more interesting mental health topics from the blog…

Resources and Helpful Articles

healthline.com – Bulimia effects on the body


Hi, I'm Marissa! I'm passionate about mental and emotional health and want to share what I've learned over the years with others! I've seen first hand how mental health struggles can cause serious issues within relationships, work life, daily productivity, self-worth and more! I truly believe that we owe it to ourselves to bring more awareness to these life changing topics. Start your mental/emotional health journey by learning more today!

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