Bulimia is an eating disorder characterized by its cycle of binge eating and purging. But what does it mean to binge and purge?

Bulimia nervosa is a type of eating disorder where people typically binge eat and then purge.

Someone living with bulimia may feel a lack of control when eating large amounts of food in a short time. Or they may feel powerless over life’s stressors, seeing their eating habits and weight as the only things they can control. To compensate for overeating, they may purge, like vomiting or using laxatives.

To be classified as bulimia by a doctor, someone must binge eat and purge — or use other ways to prevent or control their weight — once a week for at least 3 months.

Some people living with bulimia compensate for binge eating with excessive exercise or fasting, rather than purging. Or they mix purging and non-purging behaviors.

Bulimia is associated with an intense dissatisfaction and obsession with body weight and shape. You may feel shame or feel isolated.

Binge eating and purging behaviors can have health side effects that not everyone knows of. Bulimia can also be a heavy condition to deal with on your own.

Having an eating disorder is not your fault. You can find support and treatment options that can help you manage this condition.

Binge eating is when you eat a large amount of food in a short period of time while feeling out of control.

It’s not the same as having a second helping of Thanksgiving dinner. Many people have had the experience of indulging in extra servings during a special meal. That is not binge eating.

Binge eating in bulimia happens regularly, on ordinary days as well as on special occasions.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) — the guide mental health professionals use to diagnose conditions like eating disorders — bulimia is characterized by:

  • the binge eating episode occurs within a 2-hour time frame
  • the amount of food a person eats within that 2-hour period is more than someone else in the same situation would usually eat in 2 hours
  • the person binge eating feels out of control, like they cannot stop eating or control how much they eat

You may not even be hungry when binge eating. Instead, bingeing can be used as a coping mechanism for stress or upsetting emotions. Eating helps take your mind off what’s bothering you.

People who binge eat often do so in secret, sometimes hiding food.

Because binge eating is driven by emotions rather than hunger, you might binge eat even if you feel full. You may even eat to the point where you feel uncomfortable or ill.

When you binge eat, you might be driven to continue eating by thoughts like, “I’ve already blown my diet, I might as well go all-in on bingeing and start dieting again tomorrow.”

Side effects and risks

When someone binge eats, they typically consume more calories than they need in a short amount of time. It overwhelms the body with calories which affect blood sugar levels, digestion, energy, and more.

Regular binge eating is usually connected with two eating disorders: bulimia and binge eating disorder (BED). The main difference is that people with BED don’t purge like people with bulimia do.

People with bulimia often report feelings of shame and guilt after they binge eat. This drives them to purge — to “undo” their overeating.

Side effects of binge eating include:

  • bloating, abdominal cramping, and nausea
  • acid reflux or heartburn
  • diarrhea
  • lethargy
  • gallstones
  • resistance to insulin or type 2 diabetes

Binge eating can sometimes cause medical emergencies. According to the National Eating Disorders Association (NEDA), eating too much at once can cause the stomach to rupture. Eating too quickly can also raise your chances of choking.

Purging means getting rid of something unwanted. For a person living with bulimia, purging is how someone controls or “makes up for” bingeing on food.

Purging behaviors include:

  • making yourself vomit
  • misusing laxatives, diuretics, or enemas

Some people use non-purging behaviors to compensate for binge eating, including:

  • fasting
  • excessive exercise

Some people use only one purging or non-purging method, while others use several.

In a 2018 study on adolescents with bulimia, 41.3% reported purging while the rest (58.7%) reported non-purging behaviors.

You might feel relief when you purge, believing you’re getting rid of the excess calories you ate while bingeing. When you purge, you “fix” the issue.

Many people living with bulimia vow that this purge is the last one, until the next binge eating episode starts the cycle all over again.

The DSM-5 uses the frequency of purging behaviors to determine the severity level of bulimia:

  • Mild: 1 to 3 times per week
  • Moderate: 4 to 7 times per week
  • Severe: 8 to 13 times per week
  • Extreme: 14 or more times per week

Sometimes healthcare professionals increase the severity rating based on how much the condition interferes with your life.

Side effects and risks

Purging behaviors have many side effects that can be dangerous. If left untreated, eating disorders like bulimia nervosa can be life threatening.

When you vomit, the contents of your stomach are forcefully propelled back up through your esophagus. Regular vomiting can cause problems, such as:

  • tooth decay
  • a hoarse voice and swollen throat or face
  • oral bleeding
  • chronic cough
  • digestive issues like acid reflux, diarrhea, and stomach pain
  • esophageal tears
  • low blood pressure and heart rate
  • an irregular heart rhythm
  • difficulty regulating body temperature
  • kidney failure
  • pregnancy complications

Purging can also disrupt hormone levels. A small 2013 study involving 74 females revealed hormonal changes in the 31 participants who regularly purged.

You may also develop Russell’s sign — scarring on your hands from scraping them against your teeth during induced vomiting.

The amount of dental erosion you experience can depend on your diet. For example, if your diet contains a lot of sweetened or acidic foods, purging will likely affect your teeth more.

Rare but possible complications of regular, forced vomiting include hiatal hernias and gastroesophageal intussusception, a condition where your stomach slides up into your esophagus.

Vomiting isn’t the only harmful purging method, though. If you regularly use laxatives or diuretics, you can become dependent on them and be unable to have a bowel movement naturally. Overuse of diuretics can also cause kidney damage.

Purging, fasting, and excessive exercising can result in nutritional imbalances and dehydration, which can contribute to other health issues, such as:

  • fatigue
  • electrolyte imbalances
  • seizures
  • drying and thinning hair
  • brittle nails
  • reproductive complications
  • muscle weakness

Compulsively exercising can also lead to more than nutritional imbalances and dehydration.

Pushing yourself physically to burn extra calories can also cause reduced bone density, along with chronic joint and bone pain. You may also have chronic muscle soreness and regular overuse injuries.

Over-exercising can even cause you to have upper respiratory tract infections more often, and more illnesses in general.

While some side effects of purging are serious, remember that people do recover from bulimia — and so can you.

An eating disorder is not a choice, and it’s not your fault. Many people are able to move past eating disorders to live without the guilt and shame the comes along with them.

Bulimia is a serious mental health condition. About 94.5% of people living with bulimia also have at least one other mental health condition, like depression or anxiety.

Both binge eating and purging can have negative effects on your health. To prevent unwanted health effects, you can find support through a doctor or therapist and learn more about treatment options.

If you need help now and don’t know where to start, you can call, text, or chat online with NEDA.