Bulimia nervosa affects roughly 12.4 million people worldwide, with a lifetime prevalence of about 1% in the United States. That makes it one of the more common eating disorders, though the true number is likely higher because many cases go undiagnosed. The condition disproportionately affects women, typically begins in adolescence, and has become more widely recognized in recent decades as diagnostic criteria have broadened.
Prevalence in the U.S. and Globally
The National Institute of Mental Health puts the lifetime prevalence of bulimia nervosa at 1.0% for U.S. adults. Among American women specifically, that figure rises to about 1.5%, while for men it sits around 0.5%. In any given year, roughly 0.32% of women and 0.05% of men in the U.S. meet the diagnostic criteria.
Globally, the number of people living with bulimia grew by 67% between 1990 and 2021, from about 7.4 million to 12.4 million cases. Wealthier nations carry a larger share of that burden. High-income countries report around 311 cases per 100,000 people, while low-income countries report closer to 97 per 100,000. Australasia has the highest regional rate at roughly 812 per 100,000. Part of this gap reflects genuine differences in prevalence, but part of it comes down to access to healthcare and the likelihood of being diagnosed in the first place.
Lifetime prevalence estimates vary depending on which diagnostic criteria researchers use. Under older, stricter criteria, pooled estimates come in around 0.6%. When studies apply the current DSM-5 criteria, which lowered the threshold for how frequently binge-purge episodes need to occur (from twice a week to once a week over three months), the pooled lifetime prevalence jumps to about 1.4%. Among women specifically, studies using these updated criteria consistently find lifetime rates around 2.3%.
Who Is Most Affected
Women are diagnosed with bulimia far more often than men, at a ratio of roughly 6 to 1 based on annual prevalence data. The median age of onset is around 12.4 years, meaning half of all cases begin before a person’s 13th birthday. Among U.S. adolescents, the prevalence is about 0.9%.
Certain populations face elevated risk. Gay and bisexual men show significantly higher rates of bulimia compared to heterosexual men. One study found a lifetime prevalence of full-syndrome bulimia of 6.2% among gay and bisexual men, while heterosexual men in the comparison group had a rate of essentially zero. For women, sexual orientation did not create a meaningful difference in prevalence, with rates of 4.6% among lesbian and bisexual women compared to 3.2% among heterosexual women.
Athletes in sports that emphasize leanness or weight classes, such as gymnastics, wrestling, and distance running, are also known to be at higher risk, though precise prevalence figures vary widely across studies.
Co-occurring Mental Health Conditions
Bulimia rarely exists in isolation. Approximately 61% of people with bulimia experience major depression at some point in their lives. Anxiety disorders are even more common, affecting between 41% and 75% of people with the condition. This overlap means that someone with bulimia is frequently managing more than one mental health challenge at the same time, which can complicate both recognition and treatment.
Is Bulimia Becoming More Common?
The short answer is: it depends on how you measure it. The raw number of cases worldwide has risen sharply since 1990, but much of that increase tracks with population growth and improved detection. The shift to DSM-5 diagnostic criteria in 2013 also played a role. By lowering the required frequency of binge-purge episodes from twice weekly to once weekly, the updated criteria captured people who would previously have fallen just below the diagnostic threshold. Studies using DSM-5 criteria consistently report higher prevalence than those using older standards, which makes direct comparisons across decades tricky.
That said, there is evidence of a genuine increase in prevalence among women in Western countries, independent of diagnostic changes. Researchers have found that lifetime rates among women converge around 2.1% to 2.6% in recent studies, a figure higher than what earlier generations of research produced even after accounting for methodology differences.
Health Risks and Mortality
Bulimia carries serious physical consequences. Repeated purging damages tooth enamel, irritates the esophagus, and disrupts the body’s balance of electrolytes like potassium and sodium, which are essential for heart function. Chronic cases can lead to heart rhythm abnormalities, kidney problems, and gastrointestinal damage.
The mortality risk is significant. One large analysis found a crude mortality rate of 3.9% among people with bulimia, comparable to the 4.0% rate seen in anorexia nervosa. The death rate from all causes was significantly elevated compared to the general population, and suicide rates were also higher. These numbers reflect the combined toll of the physical damage from purging behaviors and the mental health burden of the disorder itself.
Recovery Rates Over Time
The outlook for recovery is cautiously optimistic, especially with treatment. In a long-term study that followed patients over 22 years, about 68% of people initially diagnosed with bulimia had recovered by the 9-year mark. At the 22-year follow-up, roughly two-thirds remained recovered. That means a meaningful majority of people do get better, but recovery often takes years rather than months, and a substantial minority continues to struggle with symptoms long-term.
Recovery does not always follow a straight line. Relapse is common, particularly during the first few years. The high rate of co-occurring depression and anxiety can slow progress if those conditions are not addressed alongside the eating disorder. Evidence-based therapy, particularly cognitive behavioral approaches tailored to eating disorders, remains the most effective treatment path and significantly improves the odds of lasting recovery.