What Causes Bulimia Nervosa?

There is no one cause of bulimia. A number of different biological, psychological and sociocultural factors contribute to the development of this condition.

Learn more about a few different factors of bulimia below.

Biological Factors

While genetic risk plays an important role in the development of bulimia, not all individuals with a family history of this disorder will develop the illness. And, many individuals with no known genetic link to eating disorders develop bulimia.


More than 50 percent of the risk of developing an eating disorder is based on your genetics, underscoring a strong familial component to these illnesses. In fact, a woman with a mother or sister who has bulimia is four times more likely to develop bulimia as well.

Personality Traits

Personality traits are believed to be inherited, and a distinct set of traits has been found to be common among those at highest risk for bulimia. Traits like the following tend to characterize those struggling with bulimia:

  • High impulsivity
  • Unstable moods
  • Emotional intensity
  • Difficulty seeing the “big picture”
  • Cognitive rigidity

Psychological Factors

Psychological factors, in conjunction with biological and social influences, can play an important role in the development of bulimia nervosa. We have learned that there are certain characteristics and experiences that are common to individuals with bulimia (including perfectionism, low self-esteem and traumatic events), that may place a person at greater risk for the illness. These factors are often considered to be maintaining features that contribute to the perpetuation of the illness and can be directly targeted during treatment.

Low Self-Esteem

When one is experiencing low self-esteem, it can cause feelings of depression which can contribute to the development of eating disorder behaviors. Sources of low self-esteem are varied and can include childhood experiences, temperament styles, and other mental health conditions.


Perfectionism refers to a personality style where an individual strives for flawlessness, is highly concerned with approval, and may be extremely self-critical regarding performance. Mistakes are often viewed as personal failures – and something to be avoided at all cost. For individuals with bulimia nervosa, high levels of perfectionism can be seen within the illness (e.g., strict rules around eating and food) as well as outside of the illness (e.g., extremely high standards and expectations for themselves in academics, work, etc.).

Sociocultural Factors

The sociocultural context (social networks, media influence and cultural norms relating to eating and appearance) during the development of bulimia nervosa requires important consideration. In fact, there are certain aspects of western society values that have been linked to bulimia including the pursuit of the “ideal body” and the overvaluation of appearance as a measure of success and worth.

Messages promoting unrealistic beauty standards that place high value on achieving a certain look (thinness, muscularity) can create pressure to engage in behaviors, like dieting, that place certain persons at greater risk. Other social influences include involvement in specific activities, groups or occupations that emphasize weight and appearance.

Traumatic Events

Research shows that many patients who are struggling with an eating disorder have experienced a traumatic event in their lifetime [1]. This is particularly true for patients who have bulimia-spectrum eating disorders [2]. Traumatic experiences, with or without a PTSD diagnosis, can lead to disordered eating behaviors as the person attempts to cope with the distressing effects of the traumatic event.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966425/
[2] Brewerton, T. D. (2007). Eating Disorders, Trauma, and Comorbidity: Focus on PTSD. Eating Disorders,15(4), 285-304. https://doi.org/10.1080/10640260701454311

The Thin Beauty Ideal

Western societies equate thinness with female beauty and success, a condition known as the “thin beauty ideal.” [3] Studies have demonstrated that cultural pressures to achieve the thin beauty ideal can lead to increased body dissatisfaction and weight concerns, which may then contribute to the development of bulimia nervosa. Western norms for male bodies emphasize extreme muscularity in an equally unrealistic standard. With modern developments like social media, western ideals and values have been disseminated globally. Recent studies have demonstrated increases in eating disorders in non-western cultures as well as minority groups.

[3] Morrissey, R. A., Gondoli, D. M., & Corning, A. F. (2019). Reexamining the restraint pathway as a conditional process among adolescent girls: When does dieting link body dissatisfaction to bulimia? Development and Psychopathology, 32(3), 1031–1043. https://doi.org/10.1017/s0954579419001287

Pressure from Social Media

With social media being a major influence on culture today, there are many negative effects that can lead to disordered eating and bulimia nervosa [4]. Being bombarded with media images of extremely thin models, for example, promotes the internalization of anti-fat attitudes and the need to control weight. On social media, there are many images of "perfection", diet talk and before-and-after images that can influence eating disorder development and maintenance.

[4] Rounsefell, K., Gibson, S., McLean, S., Blair, M., Molenaar, A., Brennan, L., Truby, H., & McCaffrey, T. A. (2019). Social media, body image and food choices in healthy young adults: A mixed methods systematic review. Nutrition & Dietetics, 77(1), 19–40. https://doi.org/10.1111/1747-0080.12581

Get Specialized Treatment for Bulimia Nervosa Today

If you are interested in learning more about treatment for eating disorders, including bulimia, we can help. Our eating disorder treatment centers across the nation provide specialized bulimia treatment for diverse patients of all ages and at all levels of care.

We encourage you to call us at 877-825-8584 so we can help you or your loved one begin the healing process.

Learn More About Bulimia Nervosa

What is bulimia?

Although research about bulimia is ongoing, there is a lot you can learn about this eating disorder to understand how to get help or help a loved one. Learn more about bulimia, including the causes, symptoms and available treatment options.

What causes bulimia?

As with other eating disorders, bulimia has no singular cause. However, the evolving scientific literature suggests that this pattern of disordered eating develops from a complex interplay between genetic, psychological and sociocultural factors.

What are the health risks associated with bulimia?

There are many health risks associated with bulimia. Learn about the short-term and long-term risks to understand the effects of this disorder.

How is bulimia treated?

Bulimia treatment is unique to each patient’s needs. Medical stabilization, psychiatric stabilization, nutritional rehabilitation and weight restoration (when appropriate) are considered when determining a patient’s treatment plan.

Learn about bulimia facts and statistics.

There are many misconceptions about bulimia, including the fact that it is simply vomiting after meals.

Do I have Bulimia? Take our Bulimia Quiz.

If you or a loved one struggle with some of the symptoms described here, it may be worth speaking with a clinician and considering treatment options.

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