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Bulimia Nervosa

What is bulimia?

Bulimia is an eating disorder. It is marked by uncontrolled episodes of overeating, called bingeing. This is followed by purging with methods such as vomiting or misuse of laxatives. Bingeing is eating much larger amounts of food than you would normally eat in a short period of time, often less than 2 hours. You may feel like you can’t stop or control these episodes of binge-eating.

The binge-purge cycles can happen from many times a day to several times a week.

Often people with bulimia have a normal or above normal body weight. This lets them hide their problem for years. Many people with bulimia don’t get help until they reach ages 30 to 50. By this time, their eating behavior is deeply rooted and harder to change.

There are 2 ways people with bulimia restrict calories:

  • Purging type. The person engages in self-induced vomiting or misuse of laxatives, diuretics, or enemas, or other medicines that clear the intestines.
  • Nonpurging type. The person uses other behaviors, such as fasting or excessive exercise, rather than purging behaviors.

Who is at risk for bulimia?

Bulimia most often affects females and starts during the teen years. But it can also affect males. People with bulimia are more likely to come from families with a history of eating disorders, physical illness, and other mental health problems. Other illnesses are also common in people with bulimia. These include substance abuse, anxiety disorders, and mood disorders.

What causes bulimia?

Experts don't know what causes bulimia. Society and cultural ideals that value certain body weights and shapes play a role. There is also a genetic link as eating disorders tend to run in families.

What are the symptoms of bulimia?

These are the most common symptoms of bulimia:

  • Often a normal or above average body weight
  • Repeated episodes of binge eating and fear of not being able to stop eating
  • Self-induced vomiting (often in secret)
  • Excessive exercise
  • Excessive fasting
  • Odd eating habits or rituals
  • Incorrect use of laxatives or diuretics
  • Irregular menstrual periods or no periods at all
  • Anxiety
  • Discouraged feelings linked to dissatisfaction with themselves and the way their body looks
  • Depression
  • Preoccupation with food, weight, and body shape
  • Throat is always inflamed or sore
  • Tiredness and less energy
  • Dental problems due to erosion of tooth enamel from vomiting

Most people with eating disorders also share certain traits including:

  • Low self-esteem
  • Feelings of helplessness
  • Fear of getting fat
  • Intense unhappiness with their body shape and size

If you have bulimia, you may binge to reduce stress and ease anxiety.

  • With binge eating comes guilt, disgust, and depression.
  • Purging brings only short-term relief.
  • You may be impulsive and more likely to take part in risky behaviors, such as alcohol and drug abuse.

The symptoms of bulimia may seem like other health problems or mental health conditions. Always talk with a healthcare provider for a diagnosis.

How is bulimia diagnosed?

You likely keep your bingeing and purging secret. This is so family, friends, and healthcare providers won’t know about it. If you get help from a healthcare provider for bulimia, he or she will want to get a detailed history of your behaviors from you, your family, parents, and others. Sometimes psychological testing is done.

Blood tests may be done to check overall health and nutritional status.

Early treatment can often prevent future problems. Bulimia, and the malnutrition that results, can affect nearly every organ system in the body. Bulimia can be deadly. If you suspect bulimia, talk with a healthcare provider for more information.

How is bulimia treated?

Bulimia is often treated with both individual therapy and family therapy. The focus is on changing your behavior and correcting any nutritional problems.

Therapy looks at the link between your thoughts, feelings, and behaviors. The therapist will look at the patterns of thinking that lead to self-destructive actions and help change that thinking.

Medicine (often antidepressants or anti-anxiety medicines) may help if you are also depressed or anxious.

A healthcare provider and a nutritionist will be part of your care.

Your family can play a vital supportive role in any treatment process.

In some cases, a hospital stay may be needed to treat electrolyte problems.

What are possible complications of bulimia?

Complications of bulimia include:

  • Hole forms in the stomach (stomach rupture)
  • Heart problems due to loss of vital minerals and electrolytes, such as potassium and sodium
  • Dental problems, as the acid in vomit wears down the outer layer of the teeth
  • Inflamed esophagus
  • Swollen glands near the cheeks
  • Irregular menstrual periods
  • Kidney problems
  • Reduced sex drive
  • Addictions, substance abuse, or compulsive behavior
  • Depression, anxiety, obsessive-compulsive disorder (OCD), and other mental health problems
  • Suicidal behavior

Living with bulimia

It’s important to follow your healthcare provider’s advice for treating your bulimia. Support is needed. Try to include your family and friends in your care.

When should I call my healthcare provider?

Tell your healthcare provider if:

  • Your symptoms get worse
  • You have new symptoms

Key points about bulimia

  • Bulimia is an eating disorder. It is marked by uncontrolled episodes of overeating called bingeing. This is followed by purging by self-induced vomiting, misuse of laxatives, and other methods.
  • Bulimia typically affects females and starts during the teen years. But it can also affect males. Society and cultural ideals that value certain body weights and shapes play a role in the cause. So does genetics.
  • People with bulimia keep it very private and hidden.
  • Bulimia is often treated with a mix of individual therapy and family therapy. The focus is on changing behavior and correcting any nutritional problems.
  • Complications may include heart and kidney problems, inflamed esophagus, dental problems, and others.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
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