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Are you or a loved one struggling with bulimia? Explore the warning signs, symptoms, and treatment options for this eating disorder—along with the causes, side effects, and health risks.

Many of us turn to food when we’re feeling lonely, bored, or stressed. But if you have the eating disorder bulimia nervosa, overeating is more like a compulsion. Bulimia is characterized by frequent episodes of binge eating followed by extreme efforts to avoid gaining weight, often by vomiting, using laxatives, or exercising to excess.

This vicious cycle of bingeing and purging can take a toll on your body and emotional well-being. It can cause damage to your digestive system and create chemical imbalances in the body that harm the functioning of major organs, including the heart. It can even be fatal.

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While it is most common among young women, bulimia can affect women and men of all ages. When you’re struggling with the eating disorder, life is a constant battle between the desire to lose weight and the overwhelming compulsion to binge eat. You don’t want to binge—you know you’ll feel guilty and ashamed afterwards—but time and again you give in. After the binge ends, panic sets in and you turn to drastic measures to “undo” your overeating, such as taking laxatives, vomiting, or going for an intense run.

No matter how trapped in this vicious cycle you feel, though, there is hope. With treatment and support, you can break the cycle, learn to manage unpleasant emotions in a healthier way, and regain control of your life.

It's important to note that bulimia doesn't necessarily involve purging: physically eliminating the food from your body by throwing up or using laxatives, enemas, or diuretics. If you make up for your binges by fasting, exercising to excess, or going on crash diets, this also qualifies as bulimia.

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If you've been living with bulimia for a while, you've probably “done it all” to conceal your bingeing and purging habits. It's only human to feel ashamed about having a hard time controlling yourself with food, so you most likely binge alone. If you eat a box of doughnuts, then you'll replace them so your friends or family won't notice. When buying food for a binge, you might shop at four separate markets so the checker won't guess.

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Secrecy surrounding eating. Going to the kitchen after everyone else has gone to bed. Going out alone on unexpected food runs. Wanting to eat in privacy.

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Smell of vomit. The bathroom (or even the person) may smell like vomit. May try to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.

Not underweight. Men and women with bulimia are usually normal weight or slightly overweight. Being underweight while purging might indicate a purging type of bulimia.

There is no single cause of bulimia. While low self-esteem and concerns about weight and body image play major roles, there are many other contributing factors. You may have trouble managing your emotions in a healthy way and use eating as an emotional release, bingeing and purging when you feel angry, depressed, stressed, or anxious.

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When you are living with bulimia, you are putting your body—and even your life—at risk. The most dangerous side effect of bulimia is dehydration due to purging. Vomiting, laxatives, and diuretics can cause electrolyte imbalances in the body, most commonly in the form of low potassium levels. Low potassium levels trigger a wide range of symptoms ranging from lethargy and cloudy thinking to irregular heartbeat and death. Chronically low levels of potassium can also result in kidney failure.

If you are living with bulimia, you know how scary it feels to be so out of control. Knowing that you are harming your body just adds to the fear. But take heart: change

Possible. Regardless of how long you've struggled with bulimia, you can learn to break the binge and purge cycle and develop a healthier attitude toward food and your body.

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Acknowledge you have a problem.The first step on the road to bulimia recovery is to admit that you have a problem. It’s not losing weight or controlling what you eat that will help you to feel better, but rather, changing your relationship to food.

Reach out for support.It can be hard to talk to someone about what your experiences with bulimia, especially if you’ve kept your issues a secret for a long time. While you may feel embarrassed, ashamed, or scared of what others will think, you need to understand that you're not alone. Talk to someone who will listen without judging you and offer you support as you work towards recovery.

Avoid people, places, and situations that trigger your urge to binge or purge.Stay away from weight-loss websites and “pro-mia” sites that promote bulimia, for example. Avoid fashion or fitness magazines, and find new friends who don’t constantly diet or talk about losing weight. You may also need to be careful when it comes to meal planning and cooking magazines and shows.

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Address any underlying mood disorder. It's common for people with bulimia to also suffer from depression or anxiety. Getting help for co-existing conditions is vital to your bulimia recovery.

To stop the cycle of bingeing and purging, it’s important to seek professional help early, follow through with treatment, and resolve the underlying emotional issues that caused your bulimia in the first place.

The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.

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Because poor body image and low self-esteem lie at the heart of bulimia, therapy is an important part of recovery. It’s common to feel isolated and shamed by your bingeing and purging, and therapists can help with these feelings.

The treatment of choice for bulimia is cognitive-behavioral therapy. Cognitive-behavioral therapy targets the unhealthy eating behaviors of bulimia and the unrealistic, negative thoughts that fuel them.

The first step in bulimia recovery is stopping the vicious cycle of bingeing and purging. In order to do this, it's essential that you quit trying to diet. Dieting triggers bulimia's destructive cycle of bingeing and purging. The irony is that the stricter the diet, the more likely it is that you'll become preoccupied, even obsessed, with food. When you starve yourself, your body responds with powerful cravings—its way of asking for needed nutrition.

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As the tension, hunger, and feelings of deprivation build, the compulsion to eat becomes too powerful to resist: a “forbidden” food is eaten; a dietary rule is broken. With an all-or-nothing mindset, you feel any diet slip-up is a total failure. After having a bite of ice cream, you might think, “I've already blown It, so I might as well go all out.”

Unfortunately, the relief that bingeing brings is extremely short-lived. Soon after, guilt and self-loathing set in. And so you purge to make up for bingeing to regain control. But purging only reinforces binge eating. Though you may tell yourself this is the last time, in the back of your mind there's a voice saying you can always throw up or use laxatives if you lose control again. However, purging doesn't come close to wiping the slate clean after a binge.

Purging isn't effective at getting rid of calories, which is why most people suffering with bulimia end up gaining weight over time. Vomiting immediately after eating won't eliminate more than 50% of the calories consumed— usually much less. This is because calorie absorption begins the moment you put food in the mouth. Laxatives and diuretics are even less effective. Laxatives get rid of only 10% of the calories eaten, and diuretics none at all. You may weigh less after taking them, but that lower number on the scale is due to water loss, not true weight loss.

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Once you stop trying to restrict calories and follow strict dietary rules, you will no longer be overwhelmed with cravings and thoughts of food. By eating normally, you can break the binge-and-purge cycle and still reach a healthy, attractive weight.

Pay attention to your hunger. Don't wait until you're starving. This only leads to overeating! Eat as soon as you notice you're feeling moderately hungry.

Don't restrict foods. When something is off limits, it becomes more tempting. Instead of saying “I can never eat ice cream, ” say “I will eat ice cream as an occasional treat.”

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Focus on what you're eating. How often have you binged in an almost trance-like state, not even enjoying what you're consuming? Instead of eating mindlessly, be a mindful eater. Slow down and savor the textures and flavors. Not only will you eat less, you'll enjoy it more.

While bingeing is often triggered by overly strict dieting that backfires, it can also be a way to control or numb unpleasant moods or feelings.

The next time you feel the urge to binge, ask yourself if there's something else going on. Is there an intense feeling you're trying to avoid? Are you eating to calm down, comfort yourself, or to relieve boredom? If so, instead

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