Causes and Risk Factors of Bulimia

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Bulimia is an eating disorder that involves binge eating followed by methods to avoid weight gain.. It is also characterized by an intense obsession with body weight and appearance.

To achieve or maintain a desired figure, people with bulimia will often experience uncontrolled eating, followed by extreme actions to counteract possible weight gain. This may be through vomiting, fasting, abusing laxatives, or following an excessive fitness regimen. 

Someone with bulimia may also become overly critical of body shape and weight. This eating disorder commonly affects adolescent girls—it will often manifest around the age of 12. About 0.5%-1% of young women live with the condition. 

Bulimia can produce dangerous complications like esophageal tears, stomach challenges, fertility issues, tooth decay, and even death. This article covers risk factors and treatment.

Brain and Body Risk Factors

While the exact factors responsible for bulimia remain unclear, there is a chance certain brain abnormalities may be at play. 

Alterations in white matter could contribute to its development. Likewise, the appetite-regulating, plus taste-reward pathways in the brain could be altered, increasing the risk of bulimia.

Sociocultural Risk Factors

Bulimia may be caused by a range of factors that span social to genetic influences. In societies where slim body types are widely accepted, people may feel a certain pressure to meet that standard.

Growing up watching people with slimmer body types on television, in commercials, etc, can create a warped necessity in members of society to achieve that look. This pressure can prompt measures like throwing up after meals and keeping a strict watch over body weight changes.

The presence of diet culture can also create unattainable expectations when it comes to eating and physical appearance. People who have a history of diety are at a higher risk of developing bulimia. Many people with bulimia nervosa restrict calories between binge episodes. Such restrictions can then later trigger an urge to binge and then purge. 

Genetic Factors

There is a high risk that bulimia is transferred across generations. A review placed the odds at between 28% and 83%.

There is a possible genetic link since people with first-degree relatives with an eating disorder are at a higher risk of developing an eating disorder. While there is no bulimia gene to speak of, the specific eating and purging behavior may travel through inherited traits of instability and impulsivity. 

Personal and Environmental Factors

A study on people with bulimia found that different internal and external elements can contribute to the condition. 

People that struggle with low self-esteem may find that they have little self-compassion, and are more critical of themselves. This can push dissatisfaction with physical appearance while encouraging binge eating and purging.

Likewise, perfectionism and mood disorders can influence the formation of the eating disorder. People living with obesity are also found to engage in binging/purging behaviors to manage appearance.

Outward influences like concern over an overweight parent can cause a person to adopt unhealthy eating. This is to keep weight in check. People who have experienced physical or sexual abuse are also at risk of developing bulimia or another eating disorder. 

Another factor is substance misuse. This can increase the risk of developing this eating disorder.

Treatment of Bulimia

Bulimia causes extreme preoccupation with the body, contributing to binging/purging behaviors. A person living with this disorder can live in constant fear of gaining weight. This behavior can cause severe struggles with a loss of control when binge eating.

People who are struggling with bulimia are not always at a low body weight. Instead, there weights are typically within a normal, or even overweight, category. It is important to recognize that people who have larger bodies can also struggle with eating disorders. It is important not to dismiss this just because of body weight, shape, or appearance.

Bulimia can lead to damaging mental and physical consequences. However, it’s possible to get this condition under control. This can often involve several types of treatment and/or a combination of treatments. A team approach that includes the individual, their family, their primary care provider, a mental health professional, and a dietitian is often best.


Selective serotonin reuptake inhibitors—popularly used to manage depression—are an effective treatment for bulimia. Citalopram and sertraline are common choices, while fluoxetine is the only FDA-approved medication for bulimia. These drugs help to reduce the frequency of binge-eating episodes.

Likewise, another antidepressant—Trazadone has helped to reduce compulsive eating. Monoamine oxidase inhibitors and tricyclic antidepressants are recommended for cases of treatment-resistance bulimia. This is because both options can produce potentially lethal side effects. 

Antiepileptic medication, particularly topiramate, can reduce incidents of binge eating.


There are different types of talk therapy that can be helpful for treating bulimia, including cognitive-behavioral therapy (CBT), interpersonal therapy, and family therapy. Talk therapy can help to trace the source and patterns that prompt bingeing and purging. 

Cognitive Behavioral Therapy

CBT can help you identify unhelpful thoughts related to food, body weight, and size. It helps you challenge those thoughts and assists with improving eating behaviors.

CBT is the leading treatment for bulimia and other eating disorders. A therapist can help patients alter their core beliefs and negative views around body image and weight. Therapy can help target emotions and triggers that prompt damaging thoughts and eating behaviors.

Interpersonal Therapy

Interpersonal therapy is an important treatment measure for bulimia. This disorder may result from interpersonal conflicts, making relations with others a direct concern for bulimia. A professional can help identify a central relational problem that may be linked to bulimia. 

These central challenges may be caused by a lack of intimacy, major life transitions, grief, or problems with plans. Improving interpersonal connections can help to reduce bulimia symptoms.

Bulimia often exists with other mental health disorders. In some cases, this condition can spark thoughts of suicide

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

A Word From Verywell

Bulimia can have severe consequences for your physical and mental well-being. This condition may be the result of personal perceptions, societal influences, plus other external factors that affect body image. Anyone prone to episodes of binge eating, and purging can overcome their condition. To get the best treatment, it’s important to consult with a healthcare professional for advice. 

6 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Elizabeth Plumptre
Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.