Bulimia nervosa includes cycles of binging and compensating behaviors. However, not all cases include purging. Learn the types and treatments of bulimia.

Bulimia is an eating disorder that involves a cycle of binging and compensating, driven by the desire to control body weight or shape and an extreme fear of gaining weight. Bulimia is often associated with purging behaviors, like vomiting, as a way to compensate for food eaten. However, purging is not the only type of compensatory behavior involved with bulimia.

Although many cases of bulimia include purging, it’s not required for a formal diagnosis. In some cases, a person with bulimia may never purge, but might compensate in other ways, like through extreme exercise or fasting. To account for the different ways of compensating for a binge, there are two types of bulimia: purging and non-purging.

Overall, a diagnosis of bulimia nervosa involves key criteria, including:

  • Eating large amounts of food in a short amount of time
  • Feeling a lack of control surrounding the amount of food consumed
  • Compensating for a large amount of food eaten.

Both purging and non-purging types of bulimia meet the criteria for a serious eating disorder but may have different signs, symptoms and health consequences.

Purging Type

Purging behaviors are common in bulimia, with self-inflicted vomiting seen as the most frequent purging behavior. Purging behaviors are carried out to control body weight or shape, or to compensate for, or counteract, food eaten. The behaviors can include self-induced vomiting or misuse of laxatives, diuretics or enemas.

Usually, people with bulimia who purge feel a compulsive need to do so, and a sense of relief after purging. The purging type of bulimia can be very harmful to an individual’s health. The consequences of purging depend on the method of purging employed.

Purging behaviors are linked to concerning consequences, such as:

  • Tooth decay and enamel erosion
  • Problems with metabolism
  • Broken capillaries from repeated vomiting
  • Gastrointestinal problems
  • Electrolyte imbalances related to chronic dehydration from purging
  • Acid reflux

These effects can be long-lasting, and in serious cases of bulimia, may continue after purging behaviors have stopped.

Non-Purging Type

Non-purging type bulimia is sometimes confused or compared with binge eating disorder. However, what makes these disorders different is what the person with bulimia will do to compensate for a binge.

People with non-purging bulimia use other behaviors, like exercise or fasting, to compensate for food consumed. These behaviors are considered excessive or extreme and can be disruptive to a person’s daily life. As an example, someone with non-purging bulimia may binge eat and follow the binge with hours of exercise, days of fasting or very restricted eating.

Which is Worse?

Both purging and non-purging bulimia carry serious side effects and risks to health. The consequences of each type of bulimia differ but can be severe and long-lasting.

In some ways, the health risks of purging behaviors can carry more immediate risks than non-purging, like severe dehydration or electrolyte imbalance. People who purge may also have higher levels of dissatisfaction about their appearance, more symptoms of anxiety and depression, and higher alcohol consumption. On the other hand, people with non-purging bulimia who exercise or fast still experience significant distress, guilt and impaired functioning.

Despite these differences, experts caution against calling one version of bulimia worse than another. Both types of bulimia are linked with short and long-term consequences, and people who suffer from either type experience significant distress. Although the symptoms and outcomes might look different depending on the type, both kinds of bulimia should be taken seriously and treated accordingly.

Risks Involved with Bulimia

Although bulimia carries a lower risk of mortality than anorexia nervosa, there are still many dangers and health risks.

Both purging and non-purging behaviors can impact psychological, social and mental health. The thoughts and feelings that cause compensatory behaviors can be damaging to a person’s self-worth, and in many cases, people with bulimia experience other mental health conditions. Additionally, eating disorders are associated with increased risk of suicide.

From a physical health perspective, chronic compensatory behaviors (whether they include purging) can impact an individual’s risk of illness. Purging and non-purging behaviors may increase the risk of chronic health conditions that may require lifelong care or can increase the risk of death.

Finding Bulimia Treatment

The treatment approach for each type of bulimia nervosa may be different. As a starting point, it’s important to address thoughts and feelings of body dissatisfaction and the fear of weight gain in all cases of bulimia, as well as any co-occurring mental health conditions.

In addition to addressing underlying thought patterns, bulimia treatment also includes developing strategies to stop compensatory behaviors, addressing any existing health problems resulting from bulimia and re-establishing a healthy relationship with food.

Some of these treatment options for bulimia can include a combination of:

  • Cognitive behavioral therapy
  • Interpersonal psychotherapy
  • Guided self-help
  • Nutritional management

Seeking treatment for both types of bulimia nervosa can improve quality of life and reduce the risk of long-lasting effects from compensatory behaviors. If you or someone you care has bulimia and a co-occurring substance use disorder, contact The Recovery Village today to discuss treatment options.

a man with a beard wearing glasses and a hoodie.
Editor – Thomas Christiansen
With over a decade of content experience, Tom produces and edits research articles, news and blog posts produced for Advanced Recovery Systems. Read more
a woman standing in front of a clock on a building.
Medically Reviewed By – Dr. Sarah Dash, PHD
Dr. Sarah Dash is a postdoctoral research fellow based in Toronto. Sarah completed her PhD in Nutritional Psychiatry at the Food and Mood Centre at Deakin University in 2017. Read more

Steinhausen, Hans-Christoph; Weber, Sandy. “The Outcome of Bulimia Nervosa: Findings From One-Quarter Century of Research.” The American Journal of Psychiatry, December 1, 2009. Accessed June 7, 2019.

Substance Abuse and Mental Health Services Administration. “DSM-5 Changes: Implications for Child Se[…]otional Disturbance.” Center for Behavioral Health Statistics and Quality, June 2016. Accessed June 7, 2019.

Pearson, Carolyn; Wonderlich, Stephen; Smith, Gregory. “A risk and maintenance model for bulimia[…]compulsive behavior.” Psychological Review, May 11, 2015. Accessed June 7, 2019.

Westmoreland, Patricia; Krantz, Mori; Mehler, Philip. “Medical Complications of Anorexia Nervosa and Bulimia.” The American Journal of Medicine, January 2016. Accessed June 7, 2019.

Mond, Jonathan. “Classification of bulimic-type eating di[…]rom DSM-IV to DSM-5.” Journal of Eating Disorders, August 20, 2013. Accessed June 7, 2019.

Abebe, Dawit; et al. “Binge eating, purging and non-purging co[…] longitudinal study.” BMC Public Health, January 13, 2012. Accessed June 7, 2019.

Slade, Keeney; et al. “Treatments for bulimia nervosa: a network meta-analysis.” Psychological Medicine, 2018. Accessed June 7, 2019.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.