Throwing up weight loss


Bulimia 101: What You Need to Know About This Common Eating Disorder

People with bulimia obsess over food, binge and purge, and try to hide their eating habits.

Many people with bulimia use self-induced vomiting as a way to purge calories. iStock

Bulimia is a serious eating disorder that involves both bingeing and purging.

“Bingeing” means you eat a large amount of food in a short period of time. “Purging” is an unhealthy way to rid your body of those extra calories. (1) People with bulimia sometimes make themselves vomit to eliminate the calories they consume.

But that isn’t the only way to purge. They may also follow a strict diet, fast, exercise excessively, or use laxatives, pills, or enemas. The harmful cycle of bingeing and purging can affect both your physical and mental health. (2)

Ironically, the bingeing and purging cycle isn’t an effective way to lose weight. In fact, many people with bulimia actually gain weight over time.

Your body starts absorbing calories from the moment you put food in your mouth. If you vomit right after a very large meal, you typically eliminate less than 50 percent of the calories you consumed. Laxatives only get rid of 10 percent of the calories you eat.

While purging may make you weigh less temporarily, it’s most likely merely water loss and not true weight loss. (2)

Bulimia May Overlap With Other Eating Disorders

Sometimes people with bulimia have other eating disorders. Many people suffer from both bulimia and anorexia, for instance. Anorexia involves extreme calorie restriction.

Exercising excessively and compulsively to purge the body of extra calories is another form of the disorder that’s known as “exercise bulimia.” People with this condition use physical activity along with other means, such as vomiting and diarrhea, to “pay” for overeating. (3)

What Causes Someone to Become Bulimic?

Doctors aren’t sure exactly what causes bulimia. Your genes, family history, mental health status, life experiences, self-esteem, and other factors may all play a role. (4)

Scientists are also studying whether certain chemical changes in the brain, such as changing levels of serotonin, may affect a person’s risk of developing eating disorders like bulimia. (4)

What Are the Risk Factors for Bulimia?

Anyone can suffer from bulimia. It affects every race and ethnicity. It does, however, tend to affect more women than men. Up to 2 percent of women have this eating disorder. (4)

Girls and younger women are more likely to have bulimia than older women. Women usually develop bulimia around age 18 or 19. Still, researchers are finding that eating disorders are beginning to affect more older members of the population. According to a 2012 study cited by the U.S. Department of Health and Human Services, 13 percent of women over age 50 had some disordered eating pattern. (4)

Some factors may make you more likely to develop bulimia. These include: (2,1)

  • Having a poor body image or low self-esteem
  • Experiencing stressful life changes
  • Having a history of substance abuse
  • Being diagnosed with depression, anxiety, or another mental health disorder
  • Experiencing trauma or abuse or suffering from post-traumatic stress disorder (PTSD)

What Are the Signs and Symptoms of Bulimia?

Signs and symptoms of bulimia can vary from person to person. Some common red flags include: (2,1)

  • Eating large amounts of food in isolation
  • Being unable to control how much you eat
  • Vomiting after meals
  • Using laxatives, diuretics, enemas, or other pills after eating when they’re not needed
  • Exercising or dieting excessively
  • Experiencing frequent weight changes
  • Suffering from fainting or dizziness spells
  • Displaying physical changes caused by vomiting, such as bad breath, damaged teeth, swelling around the cheeks, broken blood vessels in the eyes, or calluses on the knuckles (from gagging)
  • Feeling constipated or bloated
  • Feeling tired
  • Experiencing menstrual period changes
  • Engaging in repetitive, secretive, or antisocial behaviors related to food
  • Being intensely concerned with body weight
  • Using dietary supplements incorrectly

How Is Bulimia Diagnosed?

Your physician will likely use the criteria listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose your condition. Among the criteria in the DSM-5 are: (5)

  • Recurrent episodes of binge eating.
  • Recurrent inappropriate behavior designed to prevent weight gain, including using vomiting, laxatives, diuretics, or other medication.
  • The behavior occurs, on average, at least once a week for three months.

Health Complications Caused by Bulimia

Bulimia can have dangerous effects on your body. In certain cases, the eating disorder can even lead to death.

Some risks that can develop from bulimia include: (1,6)

  • Severe dehydration
  • Electrolyte imbalances, which can lead to heart or kidney failure
  • Stomach damage or ulcers
  • Irregular periods (in women)
  • Tooth decay
  • Chronic sore throat
  • Indigestion, heartburn, or acid reflux
  • Constipation, diarrhea, or other problems with bowel movements
  • Osteoporosis
  • Infertility in men and women

When to See a Doctor About Your Condition

If you think you have bulimia, it’s important to be honest with your doctor about your eating habits and weight loss methods. The eating disorder can cause dangerous effects on your body if it’s not treated.

Your healthcare provider may want to perform a physical exam; a blood or urine test; and a psychological evaluation. (4)

You may also need to have a blood test (including a particular blood test called a basic metabolic panel) or an electrocardiogram (ECG) to see if the repeated bingeing and purging episodes have affected certain organs in your body. (4)

A good first step is to consult your primary care physician. He or she can then refer you to a more specialized doctor.

Additionally, the National Eating Disorders Association offers a toll-free hotline at 800-931-2237. (2)

How Is Bulimia Treated?

Several options are available to help people with bulimia. Sometimes these approaches are used together for better results. Common treatments include: (1,4)

  • Psychotherapy Different forms of therapy and counseling can improve symptoms of bulimia. Talking to a mental health professional may help you identify your unhealthy behaviors and come up with ways to eliminate them. Sometimes family members are encouraged to participate in therapy sessions.
  • Drugs Antidepressant medications can be used along with therapy. The U.S. Food and Drug Administration (FDA) has approved Prozac (fluoxetine), which is a selective serotonin reuptake inhibitor (SSRI), to treat bulimia in adults.
  • Nutritional counseling A dietitian can help you develop a healthy eating plan.
  • Hospitalization If your condition is severe, you may need to be hospitalized until you get better.

You may relapse after treatment, but the good news is you can recover from bulimia. After proper treatment, most girls and women are able to eat and exercise in healthy ways. (4)

10 Facts About Bulimia

Bulimia is an eating disorder that stems from a loss of control over eating habits and a longing to stay thin. Many people associate the condition with throwing up after eating. But there is much more to know about bulimia than this one symptom.

Here are 10 facts about bulimia to change misconceptions you may have about this dangerous eating disorder.

1. It’s rooted in compulsive habits.

If you have bulimia or another eating disorder, you may be obsessed with your body image and go to severe measures to alter your weight. Anorexia nervosa causes people to restrict their calorie intake. Bulimia causes binge eating and purging.

Bingeing is consuming a large portion of food in a short period of time. People with bulimia tend to binge in secret and then feel immense guilt. These are also symptoms of binge eating disorder. The difference is that bulimia includes purging by behaviors such as forced vomiting, excessive use of laxatives or diuretics, or fasting. People with bulimia may continue to binge and purge for a while, and then go through periods of not eating.

If you have bulimia, you may also exercise compulsively. Regular exercise is a normal part of a healthy lifestyle. But people with bulimia may take this to the extreme by exercising for several hours a day. This can lead to other health problems, such as:

  • body injuries
  • dehydration
  • heatstroke

2. Bulimia is a mental disorder.

Bulimia is an eating disorder, but it can also be referred to as a mental disorder. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), eating disorders such as bulimia are the most fatal mental conditions in the United States. This fact is attributed to long-term health problems, as well as suicide. Some patients with bulimia also have depression. Bulimia can cause people to feel shame and guilt about their inability to control compulsive behaviors. This can worsen preexisting depression.

3. Societal pressure can be a cause.

There is no proven cause of bulimia. However, many believe there’s a direct correlation between the American obsession with thinness and eating disorders. Wanting to adapt to beauty standards can cause people to engage in unhealthy eating habits.

4. Bulimia may be genetic.

Societal pressures and mental disorders such as depression are just two of the possible causes of bulimia. Some scientists believe that the disorder may be genetic. You may be more prone to developing bulimia if your parent has a related eating disorder. Still, it’s not clear whether this is due to genes or environmental factors at home.

5. It affects men, too.

While women are the most prone to eating disorders, especially bulimia, the disorder is not gender specific. According to ANAD, up to 15 percent of people being treated for bulimia and anorexia are male. Men are often less likely to exhibit noticeable symptoms or seek appropriate treatments. This can put them at risk for health problems.

6. People with bulimia can have normal body weights.

Not everyone with bulimia is ultra-thin. Anorexia causes a large calorie deficit, leading to extreme weight loss. People with bulimia can experience episodes of anorexia, but they still tend to consume more calories overall through bingeing and purging. This explains why many people with bulimia still retain normal body weights. This can be deceptive to loved ones, and can even cause a doctor to miss the diagnosis.

7. Bulimia can have serious health consequences.

This eating disorder causes more than just unhealthy weight loss. Every system in your body is dependent on nutrition and healthy eating habits to function properly. When you disrupt your natural metabolism through binging and purging, your body can be seriously affected.

Bulimia can also cause:

  • anemia
  • low blood pressure and irregular heart rate
  • dry skin
  • ulcers
  • decreased electrolyte levels and dehydration
  • esophageal ruptures from excessive vomiting
  • gastrointestinal problems
  • irregular periods
  • kidney failure

8. Bulimia can inhibit healthy reproduction.

Women with bulimia often experience missed periods. Bulimia can have lasting effects on reproduction even when your menstrual cycle goes back to normal. The danger is even greater for women who get pregnant during episodes of “active” bulimia.

Consequences can include:

  • miscarriage
  • stillbirth
  • gestational diabetes
  • high blood pressure during pregnancy
  • breech baby and subsequent cesarean delivery
  • birth defects

9. Antidepressants may help.

Antidepressants have the potential to improve bulimic symptoms in people who also have depression. According to the Office on Women’s Health in the U.S. Department of Health and Human Services, Prozac (fluoxetine) is the only FDA-approved medication for bulimia. It has been found to help prevent binges and purges.

10. It’s a lifelong battle.

Bulimia is treatable, but symptoms often come back without warning. According to ANAD, only 1 out of 10 people seek treatment for eating disorders. For the best chance at recovery, identify your underlying cues and warning signs. For example, if depression is your trigger, then pursue regular mental health treatments. Seeking treatment can help prevent relapses in bulimia.


The real solution for long-term weight maintenance is a sensible diet and exercise plan. Bulimia ultimately disrupts normal weight maintenance, which sets up the body for greater challenges as the eating disorder progresses. Working to develop a healthy body image and lifestyle is a must. See a doctor right away if you or a loved one needs help treating bulimia.

What is Bulimia?

Bulimia Nervosa is a psychological and severe life-threatening eating disorder described by the ingestion of an abnormally large amount of food in short time period, followed by an attempt to avoid gaining weight by purging what was consumed.

Methods of purging include forced vomiting, excessive use of laxatives or diuretics, and extreme or prolonged periods of exercising. Often, in these binge/purge episodes, a woman or man suffering from this disorder will experience a loss of control and engage in frantic efforts to undo these feelings.

Jane Fonda discusses her recovery from bulimia. As posted by Amanda de Cadenet

Since he or she may have bingeing and purging episodes in secret, they are often able to conceal their disorder from others for extended periods of time. Those suffering from bulimia nervosa often utilize these behaviors in an attempt to prevent weight gain, to establish a sense of control, and/or as a means of coping with difficult circumstances or situations.

Described and classified by the British psychiatrist Gerald Russell in 1979, Bulimia Nervosa comes from a Greek word meaning ravenous hunger. If you or a loved one are suffering from this eating disorder, seek professional treatment for eating disorders.

Major Types of Bulimia

There are two common types of bulimia nervosa, which are as follows:

  • Purging type – This type accounts for the majority of cases of those suffering from this eating disorder. In this form, individuals will regularly engage in self-induced vomiting or abuse of laxatives, diuretics, or enemas after a period of bingeing.
  • Non-Purging type – In this form the individual will use other inappropriate methods of compensation for binge episodes, such as excessive exercising or fasting. In these cases, the typical forms of purging, such as self-induced vomiting, are not regularly utilized.

Causes of Bulimia

The exact cause of bulimia nervosa is currently unknown; though it is thought that multiple factors contribute to the development of this eating disorder, including genetic, environmental, psychological, and cultural influences. Some of the main causes include:

  • Stressful transitions or life changes
  • History of abuse or trauma
  • Negative body image
  • Poor self-esteem
  • Professions or activities that focus on appearance/performance

Bulimia Signs & Symptoms

An individual suffering from bulimia nervosa may reveal several signs and symptoms, many which are the direct result of self-induced vomiting or other forms of purging, especially if the binge/purge cycle is repeated several times a week and/or day.

Physical signs and symptoms of this eating disorder are:

  • Constant weight fluctuations
  • Electrolyte imbalances, which can result in cardiac arrhythmia, cardiac arrest, or ultimately death
  • Broken blood vessels within the eyes
  • Enlarged glands in the neck and under the jaw line
  • Oral trauma, such as lacerations in the lining of the mouth or throat from repetitive vomiting
  • Chronic dehydration
  • Inflammation of the esophagus
  • Chronic gastric reflux after eating or peptic ulcers
  • Infertility

Signs and symptoms of binge eating and purging are:

  • Disappearance of large amounts of food
  • Eating in secrecy
  • Lack of control when eating
  • Switching between periods of overeating and fasting
  • Frequent use of the bathroom after meals
  • Having the smell of vomit

It can also create problematic strains between the sufferer and family and friends, particularly as the individual has abnormal eating behaviors and/or the avoidance of social activities to engage in binge/purge episodes.

Bulimia Treatment

Since negative body image and poor self-esteem are often the underlying factors at the root of the problem, it is important that therapy is integrated into the recovery process. Bulimia Treatment usually includes:

  • Discontinuing the binge-purge cycle: The initial phase of bulimia treatment for involves breaking this harmful cycle and restoring normal eating behaviors.
  • Improving negative thoughts: The next phase of bulimia treatment concentrates on recognizing and changing irrational beliefs about weight, body shape, and dieting.
  • Resolving emotional issues: The final phase of bulimia treatment focuses on healing from emotional issues that may have caused the eating disorder. Treatment may address interpersonal relationships and can include cognitive behavior therapy, dialectic behavior therapy, and other related therapies.

Don’t delay and risk serious medical complications. Seek out an eating disorder treatment facility in your area.

Articles on Bulimia Nervosa

  • Recovery from an eating disorder is difficult and there are many opportunities to backslide into old habits. There are tools available that will help in the continued journey of recovery after the completion of treatment. Dr. Jantz has composed five essentials that will aid in the continued success of recovering.
  • One of the more detrimental and common side effects involves dental damage. The negative ways in which teeth are impacted is often overshadowed by other major health consequences, such as cardiovascular complications, electrolyte imbalances, gastrointestinal distress, and bone loss.
  • Trying to getting insurance coverage for bulimia is a confusing and frustrating experience for many patients, families and treatment providers. Several factors play into the difficulties.
  • Interpersonal Therapy is based on a simple idea: how you relate to others impacts your emotional and mental health. This idea grew out of the work of a psychiatrist named Harry Stack Sullivan who believed that an individual’s personality was significantly influenced by his/her interpersonal relationships.
  • Bulimia Nervosa is an eating disorder that is characterized by “a cycle of bingeing, self-induced vomiting and other compensatory behaviors such as starving designed to undo or compensate for the effects of binge eating.”
  • Do you believe your child has an eating disorder? Let’s define what bulimia nervosa is, and why it can be difficult to detect –– even among a family member.
  • Weight fluctuations can be a common occurrence within a healthy individual. One’s body weight can fluctuate on average 2 to 4 pounds per day. However, individuals who consistently engage in chronic dieting behavior, as well as individuals suffering from bulimia nervosa, experience weight fluctuations beyond the normal day to day variance.
  • Bulimia Nervosa is a psychological disorder resulting in devastating health consequences if left untreated. New research findings are creating more effective methods and approaches for treatment, which can improve outcomes for individuals seeking recovery from this eating disorder. Addressing the underlying issues related to bulimia along with the use of effective psychotherapy methods can dramatically improve the chances for recovery. Learn more about these new research findings for bulimia treatment in this article.
  • Often times, men and women with eating disorders may not appear as though they are struggling. Part of this is due to the fact that eating disordered behaviors are hidden and may not be as obvious to concerned family and friends. This is especially true where binge and purge cycles are usually done in secret. This secrecy can allow individuals suffering from Bulimia to do so for several years before seeking help. If you are concerned that someone you care about may be struggling with this issue, read this article to learn more about identifying signs and tips for approaching your loved one.
  • Add the chaos and pressure from the transition to college life and the lifestyle changes this involves, and the perfect storm may be created for college students struggling with this eating disorder.
  • Is it possible to be compelled to lose weight for reasons other than aesthetics? Last but not least to ask is, whether there are external forces that reinforce weight loss in order to achieve success in an occupation or avocation?
  • I would like to examine some of those differences to illustrate how an obvious, general similarity can obscure a telling difference. Exercise, body image, and the effects of media among males are prime examples where apparent similarities with females can obscure crucial differences.
  • One behavior that differentiates non-athletes with bulimia from athletes with bulimia is the athlete’s use of exercise as the predominant purging method. Because excessive exercise is a normative behavior in competitive athletes, exercising as a compensatory behavior may go unrecognized, thus putting the athlete at physical and psychological risk.
  • While it has devastating effects on an individual’s mental and physical health, it also affects the entire family. When a loved one is struggling tension is often created within the family unit.
  • Eating disorders are often said to be both compulsive and impulsive. Compulsive means to act repeatedly on an irresistible urge. Impulsive means to act without thought, to act on a whim. So, eating disorders are repeated behavior, often taken without thought. Now, I’m no doctor, but that sounds right to me. What about the link between specific manifestations of an eating disorder and impulsivity, though? How does bulimia intersect with impulsive behavior? Let’s find out.
  • When a bulimic individual purges their body, they are inadvertently robbing their body of insulin. This is the same with a diabetic who purges or limits their insulin injections. For this reason, diabetics have a higher chance of becoming bulimic, compared to individuals who are not. Young women with Type One diabetes are shown to be 2.4 times more likely to develop some form of eating disorder.
  • The National Center on Addiction and Substance Abuse has shown that approximately 35 percent of all women who suffer from alcoholism also suffer from an eating disorder. Eating disorder sufferers also have an increased risk of abusing alcohol or illicit drugs, with studies revealing that up to 50 percent of individuals with eating disorders simultaneously struggling with substance abuse.
  • For a mother who is trying to raise a family while also dealing with an eating disorder, the struggles encountered are much more intense and forceful. The effects of a severe psychiatric illness are wearisome for any individual who may be suffering from this disorder.
  • Unless we have lived it ourselves, it may seem clouded in mystery. Without the facts, misinformation circulates. If we want to be part of the solution, we do well to become more informed about this troubling psychological disorder. Here are a few common misunderstandings.
  • Weight suppression (WS) is defined as highest ever historical weight minus current weight. It represents a measure of the level of weight lost since being at the highest ever weight achieved over a lifetime. Although the psychological and behavioral symptoms are undoubtedly the major focus in this eating disorder, it has been argued that the magnitude of weight suppression may play an important role.
  • Researchers have discovered a link between women who suffer from post-traumatic stress disorder (PTSD) and bulimia, finding that the chances of developing eating disorders are increased significantly when an individual is diagnosed with PTSD.
  • Some family members, teachers, coaches, and trusted friends may mistake this eating disorder for a “fad” that teenagers will “grow out of”, but the reality is that it can result in detrimental physical and emotional consequences, including death.
  • While headway has been made to moderate the impact of the thin-ideal in the sports and dance industries, similar pressure is yet to be applied to the beauty and fashion industries. There is little doubt that the pressure to be thin has seen an increase in eating disorders in recent years and there is much evidence that social norms and ideals can be changed. In a similar way that the public health discourse of smoking has changed radically in the last 100 years, so too, can discourse around thinness transform to occupy a new and better-informed space in the health debate.
  • As you come alongside your loved one (whether it’s your child, your spouse, or a close family member) on their road to recovery, you will find things that are in your power and things that are not. You can’t wave a magic wand and “fix” the eating disorder, but you can certainly play a vital role in the recovery process by helping to create the best possible atmosphere for healing. Here are some helpful things you can do.
  • While no single factor can be pinpointed as the cause of bulimia nervosa, the role of genetics in eating disorder development has been increasingly understood. Because the heritability factor is not as readily discussed, it seems more straightforward to base our insight on these disorders on what we know, namely what is seen in our environment.
  • For those who have struggled with Bulimia, it is easy to identify and recognized the heightened anxiety that often comes hand-in-hand with this mental illness. Whether severe anxiety is a co-occurring condition with Bulimia, if anxiety is induced by the eating disorder, or if it is used to help cope with anxiety, these two conditions are often intertwined.

Page Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on February 11, 2018
Published on, Eating Disorders Information & Resources

A single in-lab assessment of caloric consumption, loss, and retention during binge-purge episodes in individuals with bulimia nervosa (BN) is frequently cited as evidence that purging via self-induced vomiting is an ineffective strategy for calorie disposal and weight control (Kaye, Weltzin, Hsu, McConaha, & Bolton, 1993). These findings have been widely interpreted to mean that, on average, purging rids the body of only about half of the calories consumed, regardless of total quantity.

However, a closer examination of the study does NOT support the notion that purging is an ineffective compensatory behavior. Indeed, the findings of Kaye et al. (1993) would appear to have been both misunderstood and overgeneralized in the subsequent decades. This has important implications for therapeutic alliance in clinical practice as well as for understanding the nature of symptoms, metabolic processes, and physiological alterations in EDs.


The study included 17 individuals, all of whom had the diagnosis of BN and were of “normal weight” (i.e., >85% of average body weight for their age and height). Three patients were inpatients, two were outpatients (OP), and twelve were going to be starting OP.

After an overnight fast, the participants were instructed to pick items out of a vending machine and “binge in the laboratory as they would binge at home.” There were no restrictions on time or amount of calories they could eat. They were given a plastic bucket into which they could vomit. The authors used “proximate analysis” to measure the amount of calories in the vomit.


The figure below shows the relationship between calories consumed during a binge and calories vomited in 17 subjects. As you can see, 12 of the 17 subjects consumed 2,110 or fewer calories during their binge (this is the number Kaye et al. cite). Only 5 of the 17 subjects had binges of over 2,600 calories.

This figure shows the relationship between calories consumed during a binge and calories retained after self-induced vomiting.


While whether a 50% loss of calories is deemed effective or non-effective comes down to individual goals and the definition of “effective,” Kaye et al. (1993) do not conclude that their results demonstrate that purging gets rid of half of the calories in a given binge. Rather, the “50%” likely results from the fact that the average number calories retained after purging (approx. 1,200) were about half of the calories of the average binge (around 2, 200 calories) among the study participants.

The authors refer to the number retained as a “ceiling” and not as representing a proportion of the total binge as the “1,200 calories” appears to have been misunderstood.

Even without taking into account considerable individual differences in physiology (e.g., the rate at which one’s stomach empties ), and purging motivation, ability and techniques), the 50% retention rate may only hold true for those whose binges are comparable to the mean binge amount for the group in the study. Indeed, the authors mention that a linear relationship between calories consumed and purged only held true for those whose binges contained fewer than 2,110 calories (mean (M) = 1,549, standard deviation (SD) = 505). They did not find a linear relationship between intake and calories retained for binges that contained more than 2,626 calories (M = 3,530, SD = 438). Importantly, only five participants had binges that were more than 2,626 calories.

From their abstract:

Contrary to the assertion that purging is ineffective, Kaye et al. in fact draw the exact opposite conclusion from their findings, reporting in their discussion that:

Bulimic patients retain similar amounts of calories when they consume more than 2,600 kcal and when they consume fewer than 2,100 kcal. Thus, it appears that vomiting is a fairly efficient means of ridding the body of caloric intake, particularly for large binges. (p. 971)


“Purging only gets rid of 50% of calories, you know – it’s not worth it.”

First, the 50% statistic is frequently offered up during psychoeducation and nutritional therapy with the hope that this knowledge will disincentivize individuals to binge and purge. While many quote this number in an attempt to reduce the appeal of and belief in utility of purging, there is little, if any, evidence beyond anecdotes for this “fact” to produce behavioral change, for one.

Second, the 50% is too often applied transdiagnostically, taken to hold true for all individuals who experience binge and purge. However, both Kaye et al. (1993) and a similar study in Brazilian patients by Alvarenga, Negrão, and Philippi (2003), which found a similar number of calories retained after purging (around 1, 300), purposefully included only BN participants, meaning that neither of the (only) two studies on the topic examined this process in the binge/purge subtype of anorexia nervosa (AN-BP).

In the study by Kaye et al. (1993), participation was limited to individuals meeting DSM-III-R criteria for BN who were >85% of “average body weight” (ABW; now “ideal body weight” or IBW) in order to avoid the potential confound of low body weight. There were only 17 participants and they had a mean weight of 106% ABW (SD=12%), with individual ABW ranging 85% to 126%. This would seem to indicate that their results might be specific to cases where binge-purge behavior leads to weight gain or maintenance of normal body weight or overweight. Thus, these findings may not be generalizable to individuals for whom binging and purging results in weight loss or maintenance of low weight.

While individuals with AN-BP in general tend to have a marginally higher BMI than those with solely restrictive anorexia (AN-R), and while it is true that hypermetabolism is present far more often in AN than BN (de Zwaan, Aslam, & Mitchell, 2002), the notion that purging is ineffective as a compensatory behavior is incongruous with the fact that individuals with AN-BP can be markedly underweight (in some cases to a severe degree) while engaging in objective binges followed by purges.

Individuals with AN-BP frequently binge multiple times per day, every day, and while this presentation of symptoms along with severe weight loss is certainly extreme, it is not exceptional, and the crossover rate from AN-R of 58-62% (Eddy, Keel, Dorer, Delinsky, Franko, & Herzog, 2002; also see this post), makes the AN-BP subtype itself far from uncommon among those with EDs.

Even assuming considerable individual variation in purging motivation, thoroughness and effectiveness, hypermetabolism in AN versus hypometabolism in BN is not sufficient to explain why the 50% average is applicable to two groups with divergent physiological outcomes.

Repeated objective binges in highly symptomatic individuals can amount from 10,000 to even 30,000 calories or more during a single day. If 5,000 to 15,000 calories are being digested on a daily basis, it is implausible that this does not result in weight gain or higher body weight. Delayed gastric transit is also commonly seen in AN, and could therefore reduce the number of calories the body is able to absorb from a binge, as well as increase the length of time before digestion of a binge occurs.


Even research-savvy clinicians may quote the 50% statistic to all of their patients, regardless of diagnosis and symptom presentation, figuring that at the very least, it can’t hurt. However, this may not be an accurate assumption.

Firstly, when the information told by clinicians conflicts with lived experience, it may be interpreted by the patient as indicative of the clinician not being knowledgeable about EDs, not believing the patient’s account of their own symptoms, trying to deceive them, or thinking that the patient is stupid. All of these have potential to contribute to difficulty in creating therapeutic alliance, which is one major factor found to be predictive of a positive outcome from therapy. Further, it can provide a rationale for reluctant or ambivalent individuals to disengage, quit, or avoid seeking treatment.

Secondly, employing the 50% statistic to instill motivation to curtail purging may be a beneficial part of psychoeducation, but clinicians should consider the context of the patient’s description of their symptoms (type, severity and frequency) or at least maintain flexibility in their belief in this “fact” when confronted with evidence that makes this an unlikely phenomenon.

Finally, using this tactic obscures the fact that EDs are problematic and conflict with myriad other personal values irrespective of what happens with weight.


How a small, in-lab study of 17 BN subjects came to be so widely misinterpreted is unclear. It would be great if self-induced vomiting was ineffective at getting rid of calories and that this knowledge alone was sufficient to prevent or stop this habit, but, for many people, this is not the case. Self-induced vomiting is terribly damaging to the body and carries significant health risks (Tetyana blogged about it here), but spreading misinformation or overgeneralizing findings–particularly when those findings directly contradict patients’ lived experiences–benefits no one.

Indeed, when clinicians discount or disbelieve their patients’ lived experiences, they might not only by damaging therapeutic alliance, but, more worryingly, inadequately assessing the severity of their patients’ illnesses and minimizing potential medical risks.

And before we are accused of promoting self-induced vomiting, an egregious claim in its own right, please remember: We are not saying anything Walter Kaye and colleagues did not already say back in 1993.

Note: This post was written jointly by Saren and Tetyana.

This may be particularly true for those for whom purging is an chronic behavior which has become entrenched via malnutrition, low body weight, and/or repetition or when purging (with or without a preceding binge) serves an anxiolytic function, negatively reinforcing this as an emotion regulation strategy in response to stressors, rather than or despite of the primary weight loss objective.

Are You Considering How To Make Yourself Throw Up?

By Michael Puskar

Updated November 07, 2019

Reviewer Wendy Boring-Bray, DBH, LPC

Vomiting is an uncomfortable topic for most people. Nobody likes to do it-or think about it. But because forcing yourself to throw up can indicate an eating disorder, it’s important to talk about. There are specific circumstances where vomiting may be necessary, but those who struggle with eating disorders and controlling their weight require careful attention from mental health professionals. If you are worried about a medical emergency, such as poison or too much medicine ingested, you should call your doctor or a poison control center right away. They can give you some ideas on what to try to rid your body of a potential toxin without the anxiety of having to solve this problem on your own.

You’re Concerned About Something You Ate And You Need To Throw Up Let’s Talk. Get Matched With A Licensed Therapist Today

What Causes a Person to Want to Throw Up?

It’s doubtful that anyone enjoys the act of vomiting, however, certain thought processes compel some people to do so. One of the most common reasons a person may feel the need to vomit is the desire to control how they look. This is a primary cause of many eating disorders. For example, if a person feels they’re overweight and has a negative self-image, they may attempt to rectify this by purging their food.

Along with being a chronic mental health concern, eating disorders can cause severe physical health problems, and in many cases, it can cause a person to, ironically, gain weight. We’ll discuss why later. Sometimes, eating disorders can even be fatal, but fortunately, with the right support and treatment, this outcome is entirely preventable.

Is It Ever Healthy to Force Yourself to Throw Up?

There are certain instances where it may be wise to induce vomiting, like if you’ve eaten something toxic, or maybe if you drank too much. In these cases, your body may vomit automatically. Some people will overeat to the point of making themselves sick but not as far as vomiting. Maybe you accidentally took the wrong medication. Whatever the reason, making yourself throw up without an order from a doctor or poison control is not usually a good idea. You should contact your doctor immediately if you’re trying to induce vomiting due to something you ate. They will walk you through the proper, medically safe steps.


Questions Your Doctor May Ask

If you are on the phone with your doctor in one of these instances, or if you have called about someone else, the physician may ask:

  • What did you eat or drink?
  • How much did you eat or drink?
  • When did it happen?
  • How are you feeling right now?
  • Why did you eat or drink?
  • Has this happened before?
  • What do you expect vomiting to do for you?
  • Are you trying to throw up to lose weight?

How to Safely Throw Up

If your doctor recommends inducing vomiting, there are several safe methods:

  • Emetics – You can try an ipecac to make you throw up. Follow the instructions on the bottle, but be exact because too much can be fatal. Your doctor may suggest some other substances that can induce vomiting.
  • Toothbrush – Use your toothbrush to push on the back of your tongue until you feel the gag reflex.
  • Finger – Rather than a toothbrush, you can use your finger, but be careful not to scratch yourself with your fingernails.
  • Mustard Mix – You can mix one tablespoon of plain yellow mustard with six to eight ounces of warm water, and drink it down in one big gulp. This may take up to 30 minutes to work, and it doesn’t work for everyone.
  • Rotten Odors – Sometimes just smelling something awful such as rotten food or a smelly trash can will make you throw up.
  • Visual Help – Watch a video of someone else throwing up. Some people are able to vomit just by watching someone else do it.

The safest thing to do is to follow your doctor’s orders, including when to seek help if your efforts fail.

Vomiting to Lose Weight: A Different Issue

There are medical reasons a professional might suggest induced vomiting, but there are psychological reasons why some feel the need to do so. Some doctors will assess for this when asking someone about their motivations for wanting to vomit.

You may be considering, or have considered, making yourself vomit because you’re hoping it will help control your weight after eating a quantity of food you regret.

If you’re trying to make yourself throw up to lose weight, it’s recommended you speak to your doctor or a mental health professional. Many people who induce vomiting develop a pattern of compulsive behavior called bulimia nervosa. People with this condition engage in episodes of overeating called binging, and then afterward engage in purging behavior. Unfortunately, over time, the stress of these actions on the body can cause adverse physical and emotional effects, and it won’t lead to any long-term weight loss.

Your body will only get rid of half of the calories you consume, so if you’re purging and vomiting, you’ll end up gaining weight in the long run. Bulimia nervosa also slows your metabolism, causing your body to store the calories, leading to weight gain. In addition, stomach acid can cause damage to your teeth. It could even lead to an electrolyte imbalance and cause a heart attack or stroke. There can be other negative health consequences, such as damage to your esophagus, sores on your hands, and other digestive issues.

You’re Concerned About Something You Ate And You Need To Throw Up Let’s Talk. Get Matched With A Licensed Therapist Today


The DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders) lists the symptoms of bulimia nervosa as follows:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g., within a two hour period), an amount of food that is definitely larger than what most people would eat during a similar period of time and under similar circumstances.
    • Lack of control over eating during the episode (e.g., a feeling that you cannot stop eating, or control what or how much you are eating).
  • Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • Binging or purging does not occur exclusively during episodes of behavior that would be common in those with anorexia nervosa.

If you often feel you have to make yourself throw up after eating, or if you engage in episodes of binge-eating with other types of purging, talking to a mental health professional can help you get to the root of this behavior and change it. Working with someone who understands that this behavior is more than about food can help you create a healthier relationship with eating, increased body positivity, and a long-term solution to your troubles. It can be hard at first to think about reaching out about this struggle, but mental health professionals will listen without judgment or bias.

How BetterHelp Can Help

If you don’t know where to start looking for a licensed therapist, or if you’re concerned about seeing someone face-to-face, consider an online counseling platform such as


BetterHelp has therapists that specialize in eating disorders such as bulimia, and they’re ready to speak to you, or chat with you in the comfort of your own home. The counseling services are confidential and affordable. Counseling can help you find that you have the power to change this cycle and feel more in control of your weight, your decisions, and your emotions. Read some of the reviews in the next section to see how others found relief for similar issues with BetterHelp’s online services.

Counselor Reviews

“Ingrid has been incredible! She is so supportive and encouraging of my healthy behaviors and really helps me problem solve when I have a particular problem. I never feel judged, it’s always a safe space to talk about how I’m feeling. Thanks, Ingrid, it’s fantastic to have the extra support I need right now.”

“In the short time that I’ve talked with her, I’ve found Sirena to be warm, receptive, and understanding of my needs and goals with therapy. She listens with attention and care to my issues of the moment and always seeks the best path to resolve those issues for me in a prompt, healthy and meaningful way.”


There are times when self-induced vomiting is understandable and may even help you (only in the case that you’ve spoken with a medical professional), but in other situations it can point to an eating disorder. If you have one, it doesn’t need to be permanent. Hopefully, by reading this article, you’ve learned how you can find help and put an end to throwing up or having thoughts of doing so. Take the first step to a truly healthy and fulfilling life today.

Bulimia Weight Loss – Fact or Fiction?

There is a commonly held belief that bulimia, or more specifically the compensatory behavior of purging, helps with weight loss. However, beliefs are not necessarily true. So, is bulimia weight loss Fact or Fiction? Read on to discover the truth.

Now I know from my own experience that it can seem like bulimia weight loss is Fact: It seems the strategies of throwing up, exercising frantically, using laxatives etc and or restricting your food intake in some way, does compensate for overeating, breaking dietary rules or bingeing.

And maybe they do…


And therein lies the trap: Initially they can work and because of this, the idea ‘you can lose weight with bulimia’ is validated.

And besides it makes sense – right?

  • If you throw up the food you’ve recently eaten, all things being equal you should at the very least counteract the binge and possibly loose weight.
  • If you exercise like crazy, you should burn off the calories you’ve eaten.
  • If you reduce your calorie intake; miss meals, or perhaps fast or ‘detox’ you should be able to counteract any effect of over-eating or bingeing.

I remember watching the downward trend of the scales and receiving the compliments with joy.


The downward trend of the scales stops or gets erratic, you often feel fat and any happiness gets quickly replaced with confusion, frustration and fear.

So How Come Bulimia Weight Loss Strategies Work Initially And Then Stop?

The thing is you can’t fool Mother Nature, or not for too long! Whilst the compensating behaviours that follow bingeing may seem like effective weight loss strategies, Mother Nature soon bites back. And when you look at the Science, you’ll understand why.

So let’s look at the science and research behind the 7 Most Common Bulimia Weight Loss Strategies and you can draw your own conclusion as to whether Bulimia Weight Loss is Fact or Fiction.

Maybe it will settle some doubt in your mind, if you believe there is something wrong with you that you can’t be bulimic and loose weight and maybe if you’re looking for some bulimia tips to loose weight, you’ll realise that loosing weight with bulimia simply won’t work.


Self induced vomiting is perhaps the most common method of purging. However research shows that even if you throw up immediately after a binge your body has already absorbed 40% to 70% of the calories eaten! This means that realistically the number of calories you absorb from a binge, even after vomiting, is probably going to be greater than the number of calories you would have absorbed, if you’d eaten sensible-sized portions on a binge-free day.

Now for you mathematicians out there…

You may think you can calculate this and stay well within a calorie deficit and therefore loose weight but this becomes increasing harder to calculate because…

  • Bingeing has a tendency to become an increasingly frenzied, out of control behaviour and keeping track of what goes in and comes back up, even with ‘markers’ becomes harder.
  • Overtime the binges become more frequent and larger as your body tries to compensate for the restriction.
  • Sometimes no matter how hard you try, you cannot get all the food back up.

And that’s not all…

Self Induced Vomiting Plays Havoc With Your Blood Sugar Levels and Encourages More Bingeing.

Because of the tendency to binge on large amounts of sugary food, blood sugar levels in the body rocket. This is not a healthy state for your body and so it responds by releasing Insulin to bring your blood sugar level back down. However, when you ‘throw up’ the food, the elevated levels of insulin still in your body, cause your blood sugar levels to crash which can leave you feeling…

  • Shaky, nervous or anxious
  • Tired (fatigued)
  • Dizzy

Your pulse may quicken, you may experience palpitations and sweating is common.

LOW BLOOD SUGAR LEVELS ARE DANGEROUS. Therefore this rapid and extreme drop in blood sugar needs further adjustment; more food, high in sugar and starch is required to ‘sweep’ up the insulin. For this reason, it’s common to actually have stronger cravings and urges to binge than it was before that cycle of bingeing and purging started! And so bingeing can become more frequent and out of your control.


Exercising may seem a more pleasant and less harmful way to to compensate for overeating or bingeing, than throwing up. On top of which we are told exercise is good for us: We are designed to move and we actually need to move, so exercise is a great thing for the body and has many health benefits. So more exercise should be better – right?

Errr… Wrong.

Logic would say that by exercising enough you should be able to burn off the calories eaten. A notion validated by the plethora of machines and gadgets available, that tell you how many calories you are burning.

Again, all is not what it seems: Whilst you can possibly manage or lose weight for a time through exercise – Mother Nature has her eye on you.

Science now shows that weight loss through exercise is a myth. And over-exercising, especially when used to compensate for eating, over-eating or bingeing, and or to create a calorie deficit, in an attempt to lose weight, can pose serious physical and mental health risks.

The truth is whilst exercise makes your body more efficient at burning calories, due to your metabolism being raised, it also has a tendency to INCREASE your appetite**.

And when you exercise and are not eating correctly to compensate for the energy expended and satisfy your hunger you are far more likely to…

  • Have food and eating in the fore front of your mind.
  • Over-eat or binge
  • Feel tired and experience mood swings

Rather than burning fat, muscle fiber is broken down for energy: When you use muscle fiber, you lose muscle mass, the very thing that helps you burn calories and keeps your body toned and in good shape!

And if most of your energy intake (calories) is being used for exercise, the body will start lowering it’s basic metabolic rate. Fewer calories are then required for the effective functioning of your body, making it harder for you to lose weight.

A slowed metabolism compromises digestion and reduces the speed at which food moves through the gut. This can cause weight gain, bloating, gas and constipation; conditions that make you feel fat, and are common triggers for bingeing.

If your basic metabolic rate goes too low, your health will be seriously compromised.

If you still think over-exercising works to help you lose or control your weight or you HAVE TO EXERCISE, that is you have an overwhelming desire to exercise and burn calories or you must burn the calories you’ve eaten, please click HERE to check out the serious health risks posed by this behaviour.

** INCREASED Appetite: You may not necessarily experience an increase in appetite immediately after exercise, particularly intense exercise, due to the suppression of the hormone ghrelin. However, ghrelin levels go back to normal after about half an hour, so you may incorrectly assume that your hunger is down to something other than the exercise you’ve just done.

Lastly, exercise can increase your weight as you build muscle, although you may be loosing inches from various parts of your body, so the number on the scales is not a reliable indicator of what is going on.


Many people believe that they will be able to control their weight or counter the effects of a binge by taking laxatives. However, because laxatives ONLY work in the lower part of the digestive tract, by which point most of the food that’s been eaten has been absorbed, they do not mitigate the consequences of a binge.

Any ‘weight loss’ is a temporary loss caused by the loss of water and returns once the body is re-hydrated.

Now you might be tempted to avoid re-hydrating yourself so you can avoid the water weight but correct hydration is vital for your health and well being. Not re-hydrating can lead to serious health complications and even death. If you are using laxatives or have become dependant on them please read the dangers of laxative abuse.


Similar to laxatives, any weight loss from diuretics is due to water loss and will return once you have a drink. Diuretics have NO EFFECT on calorie consumption whatsoever.

A common side effect of the overuse of diuretics is dehydration. And when you’re dehydrated it can cause your body to hold onto water. This doesn’t just increase your weight, but it makes you feel uncomfortable, bloated and constipated and for many people, ‘feeling fat’ can trigger bingeing.

BULIMIA WEIGHT LOSS STRATEGY#5 Controlling Your Food Intake.

Possibly even before bulimia fully develops, especially if you’d been following a restrictive diet, the body ADAPTS to the restricted food intake and erratic eating patterns by LOWERING the body’s Basal Metabolic Rate** and INCREASING Fat Conversion. This reverses the trend of weight loss and increases the chances of weight gain, even though you maybe eating less!

** The Basal Metabolic Rate (BMR) is an estimate of how many calories you’d burn doing nothing but rest for 24 hours. It represents the minimum amount of energy needed to keep your body functioning effectively, including breathing, digestion, brain function and keeping your heart beating. As an example the average BMR for a 28 year old woman is approximately 1586 calories, which is higher than the calories recommend in many diets and is why so many people struggle sticking to them.

This adaptation to food restriction is hard-wired into our brains and is triggered whenever the brain perceives a famine – which is exactly how the brain perceives dieting – regardless of your conscious desire to diet and loose weight.

After the initial Honeymoon period where there is some weight loss, RESTRICTIVE DIETING in any form (calorie counting, avoiding or missing out certain food groups, missing meals etc) is generally the MAIN TRIGGER for bingeing and the start of the cycle of binging and purging behaviours that ultimately lead to weight gain.

Restrictive dieting or controlling your food intake in some way that doesn’t meet your body’s requirements, is seen as a threat to your survival and is extremely stressful for the body. To get an understanding of the impact of this stress on your body please read “The Side Effects of Under Eating”. The side effects may not just surprise you but you may finally understand why you feel so awful (if you’re dieting and or struggling with bulimia)

Your Body Demands Fuel.

The demand for fuel is first experienced as an increase in appetite or hunger. If that hunger isn’t satisfied you will begin to obsess about food and eating and experience overwhelming cravings and urges to eat. Not just that, you will find yourself compelled to seek out food and when you find it, eat as much as possible. .

These demands and compulsions are automatic, that is they are outside your conscious control and can be quite frightening. And as they run counter to your desire to lose weight, you find yourself at war with your body and mind: Food becomes the enemy and consequently there is a lot of anxiety and agitation experienced around food and eating.

The inner conflict becomes increasing stressful physically, mentally and emotionally. Stress is further increased with the physical, mental and emotional stress brought on by any compensatory behaviors of purging.

This chronic level of stress raises the levels of the cortisol level, which is linked to weight gain. For more information read Low Calorie Dieting Increases Cortisol.

An important thing to know is that many bulimics actually lose weight when they replace bingeing and purging with healthy patterns of eating.

BULIMIA WEIGHT LOSS STRATEGY #6 Weight Loss Pills & Potions

The old adage, “if it is too good to be true, it probably is” fits the promises made by the advertisers of diet pills and teas.

Whilst there can be an initial weight loss – perhaps due more to the placebo effect – research shows that…

  • The majority of these pills and teas, have little or no effect
  • The way results are achieved, tend to be unhealthy and unsustainable.

And because diet pills and potions are unregulated and with the possibility of buying them online, some are not just ineffective but dangerous and can kill you!

I remember resorting to drastic measures to divert my attention away from my desire to eat, curb my cravings and prevent myself from bingeing. This included a variety of slimming pills, both over the counter and prescription – ultimately none of them worked. But I didn’t come to that conclusion until after I’d become increasing dependent, for a time, on more and or stronger substances and made myself quite ill.

As with laxatives and durietics, you can come to believe that you need diet pills, especially those that have addictive qualities and make you feel better when you take them. However like anything addictive, over time you need more, or stronger, to get the same effect.

Whilst some of the side effects are short term and go when you stop taking the pills or teas, some are not; long-term use of some diet pills can have serious consequences, especially for those with underlying vulnerabilities.

Despite the FDA banning many of the harmful ingredients that were added to diet / slimming pills and teas, they make their way back into the market through the internet and poor regulation of dietary supplements.

As with anything that artificially restricts your food intake and or reduces your body weight below what is a good weight for your body, Mother Nature will work to redress it. With the adverse side effects of diet pills, some of which are listed below, are ask you is it worth it?

The adverse side effects of Diet Pills.

  • Anxiety
  • Blurred vision
  • Chest pains
  • Convulsions/seizures
  • Diarrhea
  • Dizziness
  • Fatigue
  • Hallucinations
  • Headaches
  • Heart palpitations
  • Increased risk of cancer, heart attack or strokes, high blood pressure, primary pulmonary hypertension
  • Shallow breathing
  • Vomiting


There’s a very common belief that if you just had enough Will Power, you’d be able to…

  • Stick to a diet,
  • Control yourself around food
  • Resist any urge to binge.
  • Lose weight

Unfortunately this is not the case. Rather than helping you lose weight, ‘trying‘ to use will power, can actually make you gain weight.

I say ‘trying‘ to use will power because it’s likely you’ve experienced that it’s often not long, before you cave in and eat what you didn’t want to or didn’t think you should eat.

The thing is we human beings only have so much will power before it is depleted.

Resisting Repeated Temptations has a Mental Toll

You may not have thought about this but exerting Will Power USES UP ENERGY. And in one way or another your Will Power is being drained throughout the day, and I’m not just talking around food.

EVERY TIME any temptation or urge is resisted, whether that is…

  • Finishing off a task, rather than checking out your Social Media
  • ‘Biting your tongue’, rather than making a snide remark or
  • Being diplomatic with an infuriating colleague


And when you add all the times you are also trying to…

  • Resist what you want to eat,
  • Stick to dietary rules or
  • Use Will Power to manage the urges to binge,

Your Will Power store is going down and it’s going down fast.


Using Will power as a Bulimia Weight Loss strategy causes stress, initiating the release of Cortisol, the hormone linked to weight gain.

Persistent high levels of Cortisol not only make you feel anxious and disrupt sleep which further compromise Will Power, it can also make you eat!

Maybe It’s Time Break Free From Any Bulimia Weight Loss Strategies.

The truth is the behaviours and strategies associated with bulimia weight loss and any form of restrictive dieting, are counterproductive.

Rather than help you lose, maintain or control your weight, they only serve to make your weight more uncontrollable, more variable and ultimately weight gain.

None of which is conducive to your happiness.

So if you are toying with the idea of using any of these bulimia weight loss strategies, I’d be more than happy to speak with you to show you how you can reach your goals without resorting to these behaviours.

If you are struggling with bulimia you’ll be far more likely to lose weight if you stop purging NOW and eat healthy, nutritious meals with enough calories for your body’s requirements on a regular basis, consistently over time.

For some people this is relatively easy but for the majority of people suffering from bulimia eating in this way can be difficult because of underlying fears and beliefs. It can become even more challenging if you’ve had bulimia for sometime because of the habitual nature of the behavior and unconscious programming to binge under certain emotional conditions.

If you’d like some help please email me at [email protected]

Bulimia Recovery Coach

Julie won a 15 year battle with bulimia over 20 years ago and now mentors and coaches others to bulimia freedom. She is a compassionate, caring bulimia recovery coach who brings a unique and powerful perspective on recovery that has helped people from all walks of life, not just stop bingeing and purging but learn how to love themselves and their bodies and create a life they love.


How do you stop the urge to make yourself throw up?

As a recovered bulimic, I recognize this specific pain. When you feel the urge to make yourself throw up, ask yourself how you’re feeling. Did you have a good day? Did somebody say something that triggered you? Do you just feel uncomfortable after a meal? If you are following a meal plan by your doctor, try your hardest to trust the process and know that your recovery team does not want to make you unhealthy. If you don’t have a recovery team or meal plan, I highly suggest seeking professional help. Self-induced vomiting can lead to serious consequences if left untreated. You are doing a fantastic job by seeking new perspectives on this forum! If you really feel the urge to throw up, you can also: -Go on a long walk (ask your recovery team about this one if you feel it is necessary) -Ask a close family member or friend or one of us listeners to help distract you in a fun, healthy, and productive way by means of conversation or games that require cognitive effort! Puzzles and board games are a great help. Us listeners are also here to help you clarify what you’re truly feeling. -Personally, I put post-it notes of positive affirmations all over my bathroom and especially on the toilet seat. When you’re about to act on your eating disorder, it can be beneficial to have something positive staring right at you as a reminder that what you’re feeling does not define you as a person or physical entity. You are unique, loved, and appreciated. Your body is your vehicle, it does not define your spirit or your character.

The Bulimia Myth – Bulimia doesn’t work

People diet with one thought in mind – to lose weight. Unfortunately, for them the body does not realise this is the intention and interprets the lack of food as a period of famine. It reacts in a number of ways, but, the outcome is usually the same, they have a lapse and break one of their diet rules. Followed by ‘I’ve blown it’ followed by a binge, which is usually, followed by further restriction which leads to a binge and so the downward spiral begins.

At first sight bulimia seems to solve the problem of bingeing. People with bulimia can restrict – binge – purge (problem solved) – get back to their restricting and weight loss.

But, unfortunately as with most things nutritionally,

‘It’s a bit more complicated than that.’

Like dieting, bulimia seems to work in the short term, but the body soon responds, and the weight goes back on and more so. As a way of losing weight bulimia does not work.

‘Of course, it works’ you might say, ‘if a person vomits their food, surely they won’t get fat’.

Well you might think that, on the surface it sounds reasonable, but you would be wrong. Ask yourself this. ‘If bulimia worked, why aren’t all bulimics ‘stick thin’ in fact most bulimics normal weight or overweight.’ Just let that sink in.

In fact, bulimia actually makes weight loss much more difficult.

It goes without saying that bulimia is very dangerous and can be fatal. But let’s put the health issues on one side and see if bulimia is an effective way of losing weight?

But, Tony, you might say, ‘If it doesn’t work why do people persist in doing it for years.’ That is a very good question. Ironically, people get locked into bulimia, BECAUSE it does not work,

One of the main reasons people persist in bulimia although it does not work, is the fear that they will get fat if they stop (vomiting, laxative abuse, over exercising). At one level you can understand how people would think along these lines. It goes something like,

Stage 1

‘I am trying to lose weight, I am good at sticking to my diet, but, every now and again I break down and binge. I purge to make up for the binge. Problem solved.

But this soon changes to,

Stage 2

‘I am trying to lose weight, I am good at sticking to my diet, but, I keep breaking down and bingeing. I purge to make up for the binge. I’m not losing weight but at least I’m not gaining weight from the binges’

And finally,

Stage 3

‘I am trying to lose weight, I am good at sticking to my diet but, I keep bingeing. I purge to make up for the binges. Even though I’m purging, I’m gaining weight – just think how big/fat I would be if I didn’t purge?’

So, the less the bulimia works, the less it helps you lose weight, the more strongly it takes over your life.

Purging does NOT work

Purging in bulimia takes 3 main forms, laxative abuse, over-exercising and vomiting. Let’s, look at each of these in turn, to see if they work.


Where do I begin. Laxative abuse is extremely painful, it has long term health consequences and it DOES NOT work. Most food is digested in the small intestine, before what is left is passed to the large intestine. But laxatives only work on the large intestine by which time over 90% of what will be digested, has already been digested.

Yes, you feel thinner, but basically you have gone through considerable pain (and the pain can be agonising) to basically lose water. Water that will be reabsorbed with your next drink.

I won’t go into the numerous often long term negative effects of abusing laxatives (which are horrendous), But, as a way of compensating for a binge, it is completely useless.


This is a variation on the ‘calories in calories out myth’. ‘Oh no!’you’ve had a binge – no problem, just go for a run in the morning and work it off.

But is this realistic? If you have a small binge say 1000 calories, you will have to run around 16 miles at 5mph to burn that off – that’s well over a half marathon. Do you really have over 3 hours for that run in the morning? Face it, it’s not going to happen and a quick trot round the block won’t even scratch the surface.

Oh, by the way, the average binge is around 3000 calories. I’ll let you do the maths


You might concede that laxatives and exercising are worse that useless for getting rid of the extra calories from a binge. But surely, vomiting works. You can’t digest food that’s not in your body.

You might think that, but you would be wrong. When you binge you usually eat lots of foods that are rapidly digested (sweet fatty food). A large amount of this food is actually digested even before you’ve finished eating. So even if you purge immediately after bingeing a lot of the food is already digested. When I explain this to my clients, they often reply with some variation of:

‘Yes, but, that just the rubbish they tell you, to put you off being bulimic? I know that food stays in the stomach for 2 to 3 hours and very little if any food is absorbed by the stomach.

It’s obvious if I throw the food up while it is still in the stomach it can’t be absorbed by my body and I won’t gain weight.’

I know that there is a lot of information on very dodgy forums out there, saying that you can empty your stomach by vomiting. In extreme cases this might be just be possible, but in reality, no matter how hard you try, you will still have food in their stomach and this will be digested.

Even after vomiting, around 1200 calories of food remain in the body and this will be digested. That’s 1200 calories, even if you vomit directly after eating (and most have that zoned out period after the binge). That is the equivalent of 2 large meals, just let that sink in….

Far from a method of losing weight, bulimia is a great way of gaining weight.

A better weight control method would be to eat a really nice meal of around 600 calories rather than a round of bingeing and purging and gaining 1200 calories. I know which is more fun.

To answer the question ‘does bulimia help you lose weight’. The answer is a resounding ‘NO it doesn’t work, it doesn’t help you lose weight. In fact it makes weight loss much more difficult.

If you want to find out more about how to recover from bulimia or binge eating, help is available on my website

Physical Effects of Bulimia Nervosa

January 8, 2019

Bulimia Nervosa is an eating disorder characterized by bingeing and purging. People diagnosed with bulimia frequently binge on food, eating thousands of calories in a single episode. Feelings of shame and disgust often accompany these binge eating episodes, leading to purging behaviors such as vomiting, laxative abuse, over-exercising and/or fasting. This compensatory behavior is a tell-tale sign that an individual is suffering from bulimia. Despite attempts to lose weight by purging, those with bulimia generally maintain a body weight that is normal or slightly above average.

According to the DSM-5, the following criteria must be met for an individual to be diagnosed with bulimia (please note that if all of the following are not met, an individual may still have a serious eating disorder that requires treatment):

  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    1. Eating, within a two- hour window, an amount of food that is definitely larger than what most people would eat during a similar period of time and under similar circumstances.
    2. Lack of control over eating during the episode (e.g., a feeling that you cannot stop eating or control how much you are eating).
  1. Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
  2. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
  3. Self-evaluation is unduly influenced by body shape and weight.
  4. Binging or purging does not occur exclusively during episodes of behavior that would be common in those with anorexia nervosa.

Warning Signs and Symptoms

Warning signs of bulimia may include:

  • Frequently and repetitively eating large quantities of food, especially sweets
  • Uncontrolled eating, typically in response to negative events or feelings
  • Compensatory behavior: vomiting, laxatives, fasting or over-exercising
  • Bathroom use immediately after eating
  • Swollen cheeks and broken blood vessels in the eyes from vomiting
  • Yellow, painful teeth, tooth decay and receding gum lines from vomiting
  • Skin sores
  • Excessive focus on body size, weight, and shape
  • Feeling depressed, anxious and/or out of control

Physical Effects of Bulimia

Bulimia is a frequent, recurring cycle of bingeing and purging that can have serious effects on an individual’s physical health. Outward appearances of those with bulimia typically disguise the fact that they are suffering from a detrimental eating disorder. As the illness progresses, a person’s dental health may decrease along with a myriad of other serious physical symptoms. These consequences of the eating disorder vary depending on the severity and length of a person’s eating disorder, but the seriousness of the illness will progress the longer an individual is affected by it. If treated swiftly and correctly, individuals are able to experience recovery and healing, along with the reversal of most, but not all, of the physical consequences. However, without professional treatment, bulimia nervosa may be life-threatening.

Dental Effects

Dentists are often the first people to notice signs of bulimia. With repeated vomiting, teeth are permanently eroded and may begin to discolor or change in shape, size or length. They often become weaker, more translucent and brittle. The ends of teeth may become drastically thinner and chip off. Stomach acid coming into contact with veneers and fillings will eventually erode the materials. This destruction of the teeth causes sensitivity to hot and cold temperatures, making it painful to eat and drink (Burkhart, 2011).

Along with the destruction of the teeth, gums and soft tissues in the mouth are affected as well. Those who purge may develop lesions on the roof of their mouth, on the insides of their cheeks or on the back of their throat from inducing vomiting with a finger, toothbrush or another device. In numerous patients, it has been shown that immediate brushing after vomiting has negative effects on the teeth, often making decay and damage worse. This damage can be partially prevented when patients rinse their mouths following purging instead of brushing their teeth. Frequent vomiting also results in canker sores, redness and pain in the mouth and enlarged salivary glands, which may cause swollen cheeks. Bulimia behaviors may also result in dry mouth, cavities, periodontal disease and general poor oral hygiene (Lyons, 2017).

Dermatological Effects

With consistent bingeing and purging, individuals with bulimia experience severe nutritional deprivation and they may start to experience starvation. As a result of starvation and malnutrition, lanugo hair may appear on the face and body in an attempt to keep the person warm, the skin may pale and scalp hair and nails may become brittle. If an individual is vomiting, they may experience a change in their facial appearance, as vomiting may lead to swollen glands causing puffy cheeks and ruptures in the blood vessels in the eyes. In addition to these effects, frequent vomiting may cause hand dermatitis from frequent, compulsive handwashing and the knuckles and fingers may develop sores, scratches and dry skin from self-induced vomiting (Gupta, Haberman, 1987).

Gastrointestinal Effects

Those with bulimia may suffer from a variety of gastrointestinal symptoms due to frequent vomiting, laxative use and/or diuretic use. Vomiting and excessive laxative use can disrupt the digestive system, causing gastrointestinal bleeding and reflux. By repeatedly vomiting, the esophagus relaxes, “making it easy for the contents of the stomach to rise up into the throat and the mouth. When a bulimic leans over after eating, or burps, for example, may spontaneously vomit” (Herrin, Matsumoto, 2013). Many individuals experience extreme heartburn due to this regurgitation along with the inflammation of the esophagus. If irritation of the esophagus is severe and the vomiting behavior is not lessened, bulimia rarely may result in a ruptured esophagus. While this is rare, “the mortality rate from esophageal rupture is approximately 25%” (Krantz et al., 1987).

In addition to the negative results of vomiting, bingeing has serious consequences as well. Frequent episodes of bingeing may result in gastric rupture, where the stomach bursts from being too full. This happens when an individual eats so much that they unable to purge after due to the pressure in the gut. Gastric rupture may be fatal.

Those who abuse laxatives will typically have electrolyte imbalances and will often become dependent on laxatives. With bingeing and laxative use, the colon may stretch and lose strength, causing severe constipation. In severe cases of bulimia, individuals have permanently lost bowel function and have had to use a colostomy bag for the remainder of their life (Herrin, Matsumoto, 2013).

Endocrine System Effects

Diuretic or “water pill” abuse in those with bulimia often results in dehydration, causing the kidneys to “reabsorb fluid to make up for what is lost by purging. The fluid and electrolytes lost from purging cause the body to hold onto more water and electrolytes,” which causes individuals to gain more weight due to water retention (Herrin, Matsumoto, 2013). This increased weight gain often causes individuals with bulimia to increase their use of diuretics in an attempt to lose weight, which creates a cycle of use.

Bulimia with bingeing and vomiting can also cause hypoglycemia and alter glucose levels. Altered hormone states and malnutrition may cause the loss of menstruation for applicable parties and stunted growth. Those with bulimia that stop menstruating do so because their body shutting down non-essential functions in an effort to preserve itself. Going forward, this disruption in bodily cycles may lead to infertility in women.

Nervous System Effects

Bulimia negatively impacts an individual’s nervous system and has several severe impacts on day-to-day life. Due to malnutrition and starvation, individuals often find themselves unable to focus, reason well and/or process information efficiently. These functioning issues can be regained after an individual seeks treatment and begins recovery from their eating disorder.

Skeletal System Effects

When a person purges they are losing essential nutrients and, notably, calcium. This loss of nutrients makes it challenging on the body to maintain proper growth and strength. Approximately 85% of women and 26-36% of men with a form of anorexia will experience osteoporosis (loss of bone density) or osteopenia (loss of bone calcium), and are at risk for bone breakage and fractures (Brown & Mehler, 2017). It is advised that individuals struggling with bulimia avoid exercise unless they are able to properly nourish their bodies for the activity.

Cardiovascular Effects

Most purging behaviors result in dehydration. This dehydration may cause hypotension and electrolyte abnormalities, which affects the cardiovascular system (Gupta et al., 1987). In addition, if the body is not getting adequate calories to burn, it may begin to consume muscle, making the heart weaker. If an individual has a weaker heart, they are at a higher risk for heart rate abnormalities and cardiac arrest, which may be fatal (Mehler, 2017).

Treatment Options

For those experiencing bulimia, or any eating disorder, it is recommended to seek treatment as soon as possible. The sooner an individual begins treatment, the easier and shorter the duration of recovery often is. With appropriate treatment, those struggling with bulimia nervosa will be able to reverse most of the physical symptoms and lead a normal, healthy life. Unfortunately, dental issues including tooth decay, breakage and discoloring may not be reversible and may require medical intervention.

Recovery is Possible

Eating disorders don’t have to be permanent. With the professional treatment, recovering from bulimia is possible. If you or a loved one are struggling, reach out to The Emily Program at 1-888-364-5977.

Tags: Bulimia, Compulsive Overeating, Eating Disorders, ED Q&A, Education, For Providers, Physical Health, Research

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