There is no simple answer to the question of what causes bulimia. Although the condition is linked to a fear of getting fat, more complex emotions usually contribute.

The act of binging and purging is often a way of dealing with these intense emotions.

Common emotional causes

Common problems that may lead to bulimia include:

• low self-esteem – if you have an eating disorder, you may have a low opinion of yourself and see losing weight as a way of gaining self-worth
• depression – you may use binging as a way of coping with unhappiness, but purging does not relieve this depression and the cycle continues
• stress – for example, you may develop the condition after dealing with a traumatic experience, such as a death or divorce, or during the course of important life-changing events, such as getting married or leaving home

Bulimia can also occur in people who have experienced physical illness, and in people who have been sexually abused. Some people with bulimia have experienced a difficult childhood, with family problems, arguments and criticism.

Other mental health problems

Bulimia is often linked to other psychological problems. Research shows that bulimia is more common in people who have:

• anxiety disorders
• obsessive compulsive disorder (OCD)
• post-traumatic stress disorder (PTSD)
• personality disorders

Cultural and social pressure

Some people believe that the media and fashion industries create pressure for people to aspire to low body weights.

Puberty

Many young people become affected by eating disorders around the time of puberty, when hormonal changes can make them more aware of their body.

If teenagers feel they have no say in their lives, bulimia can seem like the only way to take control.

Genetics

There may be a genetic factor related to developing bulimia. Research suggests that people who have a close relative who has or has had bulimia are four times more likely to develop it than those who do not have a relative with the condition.

Men and bulimia

The causes of bulimia in men can be slightly different. In many cases, bulimia develops because of bodybuilding or specific occupations like athletics, dancing or horse racing.

However, like many women, younger men are increasingly becoming more vulnerable to disliking their bodies and being bullied or teased as children for being overweight.