Cause

The cause of bulimia is not clear, but it probably results from a combination of family history, social values (such as admiring thinness), and certain personality traits (such as perfectionism).

Your risk for developing bulimia increases if your parent, sister, or brother has the condition. But family history may be only part of the cause.

Stressful life events such as moving, divorce, or the death of a loved one can trigger bulimia in some people.

Many young women, such as those in college or high school, have unhealthy attitudes toward eating and toward their bodies. Socially, they may accept and encourage destructive behaviors like extreme dieting or binging and purging. These beliefs and behaviors are not normal or healthy. They can play a part in developing eating disorders that need treatment. Women who begin to severely restrict their diets in order to lose weight are at risk for bulimia.

Bulimia, like all eating disorders, is a complex physical and psychological condition. Recovery requires treatment that helps you change your behavior and also deals with the deeper attitudes and feelings that cause you to binge and purge.

Symptoms

Symptoms of bulimia include:

• Repeatedly eating large amounts of food in a short period of time (less than 2 hours).
• Frequently getting rid of the calories you've eaten (purging) by making yourself vomit, fasting, exercising too much, or misusing laxatives, diuretics, ipecac syrup, or enemas. Misuse of these medicines can lead to serious health problems and even death.
• Feeling a loss of control over how much you eat.
• Having binge-purge cycles.
• Feeling ashamed of overeating and very fearful of gaining weight.
• Basing your self-esteem and value upon your body shape and weight.

Any of the above symptoms can be a sign of bulimia or another eating disorder that needs treatment. If you or someone you know has any of these symptoms, talk to a doctor, friend, or family member about your concerns right away.

Bulimia and other eating disorders can be hard to diagnose, because people often keep unhealthy thoughts and behaviors secret and may deny that they have a problem. Often a person won't get evaluation and treatment until someone else notices the signs of bulimia and encourages the person to seek the help that he or she needs.

Other signs that a person may have bulimia

Common signs that a person may have bulimia are when the person:

• Is very secretive about eating and does not eat around other people.
• Sneaks food or hides food in the house. You may notice that large amounts of food are missing.
• Has frequent weight changes. For example, the person may gain and lose large amounts of weight in short periods of time.
• Has irregular menstrual cycles.
• Seems preoccupied with exercise.
• Often talks about dieting, weight, and body shape.
• Seems to be overusing laxatives and diuretics.
• Has low levels of potassium or other blood electrolyte imbalances.
• Looks sick or has symptoms such as:
  • Tooth decay or erosion of tooth enamel.
  • Sore gums or mouth sores.
  • Dry skin.
  • Loose skin.
  • Thin or dull hair.
  • Swollen salivary glands.
  • Bloating or fullness.
  • Lack of energy.
  • Teeth marks on the backs of the hands or calluses on the knuckles from self-induced vomiting.
• Feels depressed, anxious, or guilty.
• Shoplifts food, laxatives, or diuretics.
• Drinks large amounts of alcohol or uses illegal drugs and may have a substance abuse problem.

Conditions that commonly occur with bulimia, such as depression, substance abuse, or anxiety disorders, can make treatment of bulimia harder. Recovery from bulimia can take a long time. And relapse is common. If the person feels extremely discouraged, be sure to tell the doctor immediately so that the person can get immediate help.

In some cases, people who have an eating disorder may feel suicidal.

• Warning signs of possible suicide in children and teens can include being preoccupied with death or suicide, giving away belongings, withdrawing, being angry, or having failing grades.
• Warning signs and possible triggers of suicide in adults can include alcohol or substance abuse, depression, giving away belongings, a recent job loss, or divorce.

If you or someone you know shows warning signs of suicide, seek help immediately.

Bulimia is different from anorexia. People with anorexia weigh 85% or less of their normal body weight. But most people with bulimia are in their normal weight range. Some people who have anorexia make themselves vomit, but this is a different eating disorder. For more information, see the topic Anorexia Nervosa.