Bulimia is a serious eating disorder. Though the exact causes of bulimia aren’t known, several factors can contribute to its development.

Appearances aren’t everything, despite what the media might proclaim. But many people with eating disorders like bulimia nervosa find themselves consumed with thoughts of body weight and shape.

Someone with bulimia nervosa — aka bulimia — will typically binge (eat a lot of food) and then do purging or non-purging behaviors to get rid of the food.

If you or someone you know has bulimia, you’re not alone. In fact, at least 1% of U.S. adults will have bulimia at some point in their life.

But how does bulimia begin? While there’s not one single cause of bulimia, there are several factors that may contribute.

Bulimia is a type of eating disorder that might start when someone becomes fixated on their body image, shape, and weight. Though most people associate bulimia with throwing up after eating, it’s so much more than that — and some people with bulimia don’t vomit.

If you have bulimia, these fixations or obsessions with your body lead you to take extreme measures which often involve bingeing and purging.

Many people with bulimia cycle between binge eating (eating a lot) and purging (getting rid of the food), though some people with bulimia use non-purging behaviors such as obsessive exercising to “make up for” the binge.

Binge eating is usually done in secret, then followed by overwhelming guilt or shame, which leads to purging.

Purging isn’t just making yourself throw up — it can also mean using laxatives or diuretics. Some people may also go on crash diets, not eat for long periods of time (fasting), and exercise compulsively even when they’re sick or tired.

Symptoms of bulimia can last for many years and lead to both physical and mental health issues if left untreated.

Recovery is possible. Treatment plans typically involve addressing issues with body image, treating any underlying mental health conditions, and teaching coping strategies.

Have more questions about bulimia? You can check out our answers to frequently asked questions.

There’s no single cause of bulimia, and the exact causes aren’t known.

However, researchers believe there are several factors that can increase a person’s chances of developing this eating disorder.

Biology (genetics)

Some eating disorders like bulimia can run in families, meaning they have a genetic component.

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), people who have a family member with an eating disorder have between a 28–74% chance of also developing an eating disorder.

This means that if your parent or sibling has an eating disorder, you may be more likely to develop one, too.

Research in 2009 suggests that women with diabetes are more likely to develop an eating disorder than those who don’t have diabetes. The American Diabetes Association says that bulimia is the most common eating disorder seen in women with type 1 diabetes.

Other research in 2013 suggests that eating disorders may be linked to changing levels in serotonin and other chemicals in the brain. These chemicals play a role in appetite regulation and impulse control.

Researchers are still exploring the connection between brain activity and bulimia.

Though genetics and family traits can influence your chances of developing bulimia, it doesn’t mean you’ll definitely develop the condition. Other factors play a role.

Bullying and weight shaming

It’s not new in any way, but in recent years, the harmful effects of bullying and teasing have received a lot of attention in the media.

Weight shaming — a form of bullying — can play a big part in school-aged children developing an eating disorder.

Weight shame can lead to low self-esteem and body image issues. These are both common in bulimia. According to the National Eating Disorders Association (NEDA), 40–60% of children ages 6 to 12 say they’re concerned about their weight or becoming fat.

Many kids who have bulimia say that bullying and weight shaming were one of their first triggers. Bullying and teasing — and all other forms of physical or emotional abuse and neglect — are never OK.

If you’re experiencing any type of abuse or neglect, consider talking with a doctor, counselor, your family, or any adult you can trust.

Society and culture

Social and cultural pressures to look a certain way can play a role in eating disorders.

Endless media ads that promote a certain body type can encourage unrealistic expectations of how you should look.

NEDA reports that nearly 69% of children ages 6–12 say that pictures in the media influence what they think is the perfect body shape, and 47% say these images make them want to lose weight to look like those pictures.

These harmful attitudes about weight and body image can cause a person to take extreme measures to live up to society’s standards of the “ideal” body.

Emotional health

People with bulimia may cope with upsetting emotions or feelings by binge eating. In the moment, food helps them deal with emotions or distress.

A small 2019 study found that people with bulimia have trouble managing their emotions. Rather than venting these negative feelings, they may hold on to them, often avoiding or even denying they exist.

Suppressing negative emotions can lead to other mental health conditions, such as depression and anxiety, conditions that have also been linked with bulimia.

Psychological health

Depression and anxiety aren’t the only mental health conditions that can occur in people with bulimia. Nearly 95% of people with bulimia have a coexisting mental health condition such as:

Research in 2016 has shown that approximately 30–40% of people with eating disorders also engage in self-harming behaviors such as cutting.

These coexisting conditions are so closely linked that doctors have trouble determining which condition occurred first. Did the coexisting condition contribute to the bulimia, or did the bulimia contribute to the other condition?

But don’t worry — you don’t have to figure this out on your own. Consider talking with a mental health professional or doctor, so they can work with you to figure out if one condition is causing symptoms of another.

In your treatment plan, your doctor can explore all of your needs, looking at how factors and stressors in your life have contributed to developing your conditions.

Stressful life events

Big life changes — like a breakup, starting a new job, moving, going away to college, or puberty — can be incredibly stressful.

You may be more likely to develop an eating disorder during stressful times.

One study in 2011 suggests that even just changing schools — transitioning from junior high, for instance — played a part in some young people developing an eating disorder.

Adapting to a new environment, such as a new school or college, can be challenging. It’s common to feel lonely, depressed, or anxious. Adding a lack of support or lack of close relationships can make these times harder.

Traumatic events

Experiencing a traumatic event — even if it took place years ago — may be a trigger or cause of bulimia in some people.

A study in 2011 found that one-third (36.9%) of people with bulimia reported a history of interpersonal trauma such as sexual abuse and assault. They experienced PTSD from these traumas.

Other forms of emotional and physical abuse and neglect, including food deprivation and physical assault, may also increase your chances of having bulimia.

Dealing with any type of trauma can be challenging and feel overwhelming. For some people, bingeing and purging offers them an escape from dealing with the trauma and feelings surrounding it, as well as any symptoms of PTSD that occur.

Now that you understand more about the causes of bulimia, consider learning more about bulimia, its symptoms, and the treatment options.

Knowing as much as you can about bulimia, including when to seek help, is important if you believe you or someone you know may have it.

Bulimia can often feel like a lonely condition. You may feel like you’re the only one thinking or feeling the way you do, but you’re not alone.

If you want to connect with others who are going through similar things, NEDA has several resources such as their community forums and local treatment centers for professional support.