Bulimia Nervosa

What is bulimia?

Bulimia is a serious illness that causes severe problems with a person's eating behaviors. It is marked by uncontrolled episodes of overeating, called bingeing. This is followed by purging with methods such as vomiting or misuse of laxatives or water pills (diuretics). 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.

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

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 age 30 to 50. By this time, their eating behavior is deeply rooted and harder to change.

There are two ways people with bulimia restrict calories:

• Purging type. The person uses 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.

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 exactly 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

• Specific eating habits or rituals

• Misuse of laxatives or diuretics

• Irregular menstrual periods or no periods at all

• Anxiety

• Discouraged feelings about themselves and the way their body looks

• Depression

• Fixation on 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 such as:

• 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. It's vital to find a healthcare provider who is supportive and won't judge you. Keep looking until you find a healthcare provider you can trust. When you find a healthcare provider for bulimia, they will want to get a detailed history of your behaviors. They may ask for your permission to get more information from loved ones or other healthcare providers. Sometimes you will need psychological testing.

You may have blood tests. These are to check your 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 think you have bulimia, talk with a healthcare provider.

How is bulimia treated?

Bulimia is often treated with both individual therapy and family therapy. The focus is on changing your behavior and fixing 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. Cognitive behavior therapy (CBT) can work well for people suffering from bulimia.

Antidepressant or anti-anxiety medicine may help if you are also depressed or anxious.

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

Your trusted friends and family members can play a vital support 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 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. You will need support. Options include family and friends, professional counselors, in-person support groups, and reputable online support resources such as the National Eating Disorders Helpline (NEDA) or at 800-931-2237. NEDA also has an emergency line and chat and text support.

When should I call my healthcare provider?

Tell your healthcare provider if:

• Your symptoms get worse

• You have new symptoms

• You have constant feelings of sadness or thoughts of harming yourself

Key points about bulimia

• Bulimia is a serious medical illness. It causes severe problems in a person's eating behaviors. 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 do 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 healthcare 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 healthcare 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 healthcare provider if you have questions, especially after office hours and on weekends and holidays.