Millions more people around the world are living with bulimia nervosa than three decades ago, and the sharpest rise is falling on teenagers and young adults who already face intense pressure over body image, food and achievement. The condition, marked by cycles of binge eating and compensatory behaviours such as vomiting or laxative use, damages physical health, mental wellbeing and daily life. Families, schools and health services are seeing the effects of a problem that has grown steadily rather than faded.
A new analysis of Global Burden of Disease 2021 figures, published in Current Psychology, tracks incidence and disability-adjusted life years from 1990–2021 across 204 countries and five levels of the Social Development Index. Researchers found new cases rose from 5,595,034 to 8,227,657, an increase of 47.24%. The age-standardised incidence rate climbed from 91.95 to 107.81 per 100,000 people. Age-standardised disability-adjusted life years, calculated from years lived with disability because death data were unavailable, rose from 27.52 to 33.05 per 100,000.
Peak incidence occurs among people aged 15–24 years, the period often called emerging adulthood when independence, identity and academic or social demands collide. Incidence was higher in males than females in most regions, yet prevalence stayed higher among females. High Social Development Index countries recorded the highest rates, while middle-index regions showed the fastest growth in standardised incidence. Low-index regions saw the largest jump in raw case numbers, up 161.75%, driven by population size and weaker mental health systems.
Bayesian modelling suggests the rise will continue, especially among those aged 15–19 and 20–24. Researchers link the trend to the global spread of thin-ideal images through social media, greater access to ultra-processed foods, weight stigma and the collision of traditional and Western beauty standards in rapidly urbanising societies. Shame still stops many from seeking help, and diagnostic tools have historically been geared more towards female presentations, which may hide some of the male burden.
The findings point to a growing public health challenge that cannot be treated as a matter of willpower. Early recognition in families and schools, better mental health education, and culturally sensitive support could limit long-term harm. Health systems in lower-resource settings will need extra attention if the rise in case numbers is not to outpace care.
