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Bulimia Nervosa (BN)

Prof. Yael Latzer, School of Social Work and Public Health, University of Haifa, Center for Eating Disorders, Rambam Health Care Campus
14 July 2025

The article uses feminine language because most people with the disorder are girls, but the information is accurate and relevant for boys, young people, and men and women of all ages.

Bulimia nervosa is marked by an obsession with body shape, appearance, food, and weight, along with dangerous methods of losing and controlling weight. This includes episodes of uncontrollable binge eating followed by self-induced vomiting. Sometimes, people may also use laxatives or diuretics or engage in excessive exercise.

Diagnosis

  • Recurrent episodes of an uncontrollable eating pattern (binge eating) characterized by eating a large amount of food, compared to what most people would eat in a similar period of time and under similar circumstances, and in a relatively short period of time (up to two hours). Those who struggle with the disorder may consume as much as 10,000 calories in one episode that lasts a very short time.
  • After a binge eating episode, compensatory behaviors often occur to "get rid" of the excess food and weight and to avoid weight gain. These behaviors are called "purging" and are usually characterized by self-induced vomiting, use of laxatives or diuretics that cause excessive urination and rapid elimination of body fluids, excessive exercise, or use of enemas.
  • This pattern of binge eating episodes followed by compensatory behavior has occurred on average at least once a week for the past 3 consecutive months. Self-esteem is strongly influenced by body appearance and weight, and the disorder does not occur as part of an episode of anorexia nervosa.
  • In this disorder, weight is usually within the normal range, unlike anorexia nervosa.

Severity levels

The severity of bulimia nervosa is measured by the number of episodes per week:

Number of episodes per week Severity level
1–3 Mild
4–7 Moderate
8–13 Severe
More than 14 Extreme

Statistics

Bulimia nervosa affects about 2% to 4% of the general population. Around 80% of those affected are teenage girls and young women. The disorder usually starts between the ages of 15 and 26. Most people with bulimia also have other mental health issues, most often mood disorders, anxiety disorders, substance use disorders, impulse control disorders, and attention deficit disorder (without hyperactivity).

Mortality

The mortality rate for bulimia nervosa is lower than that of anorexia nervosa, ranging from 2% to 5%. The most common causes of death include heart problems caused by:

  • Frequent vomiting and laxative use

  • Suicide attempts (3% to 7%)

  • Electrolyte imbalances (disruptions in the body's salt levels), which can affect the function of vital systems, including heart rhythm and kidney function.