Bulimia Nervosa

Who gets Bulimia Nervosa?

Bulimia Nervosa can affect many different populations including women and men, as well as people of different racial and ethnic backgrounds. While many different types of people may have bulimia nervosa, approximately 90% of those affected are women. Most individuals with the disorder develop it in early adulthood, though onset may occur earlier or later.

Risk Factors for Bulimia Nervosa

Bulimia Nervosa is a multi-determined illness. A variety of environmental and genetic factors may play a role in increasing the risk of developing this disorder. Several of these risk factors include:

  • Temperament
    Weight concerns, low self-esteem, depressive symptoms, social anxiety disorder, and overanxious disorder of childhoods are associated with increased risk for the development of bulimia nervosa
  • Environmental
    Internalizations of a thin body ideal has been found to increase risk for developing weight concerns, which in turn increase risk for the development of bulimia nervosa. Individuals who experienced childhood sexual or physical abuse are at increased risk for developing bulimia nervosa
  • Genetic and physiological
    Childhood obesity and early pubertal maturation increase risk for bulimia nervosa. Familial transmission of bulimia nervosa may be present, as well as genetic vulnerabilities for the disorder

Diagnostic Criteria*

  • Recurrent episodes of binge eating at least once a week for three months. An episode of binge-eating is characterized by both of the following:
    • Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
    • A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
  • Recurrent inappropriate compensatory behaviors in order 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 3 months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of anorexia nervosa.

What Treatment is Available for Bulimia Nervosa?

Treatment possibilities include cognitive-behavioral therapy (CBT), supportive psychotherapy and medication, as well as inpatient treatment if needed.

Outpatient Psychotherapy

Research has found outpatient Cognitive-Behavioral Therapy (CBT) to be useful in treating Bulimia Nervosa. CBT is a structured psychotherapy aimed at helping patients develop a regular pattern of eating and providing psychoeducation about binge eating and purging. In addition, CBT focuses on increasing interpersonal functioning, targeting body image disturbances as well as issues of control and mood intolerance.

Inpatient Treatment

Inpatient treatment is most helpful for those individuals unable to reduce binge eating and purging without the help of a highly structured setting. Typically, these programs have a multidisciplinary team approach that incorporates individual, family and group psychotherapy and are geared at normalizing eating habits and addressing disturbed thoughts about body shape and weight.


Research indicates that medications are often a helpful component of treatment for Bulimia Nervosa.

* American Psychiatric Association, DSM-5

For additional information, call 646-774-8066 or e-mail: edru@nyspi.columbia.edu