What is bulimia?

Eating disorder
A person with bulimia often feels a loss of control over their eating, in that they engage in compulsive overeating, as well as have guilt about their behavior. They are usually aware that their behavior is abnormal.
  • Bulimia, also called bulimia nervosa, is an eating disorder.
  • Someone with bulimia might binge on food and then vomit (purge) in a cycle of binging and purging.
  • Binge eating refers to quickly eating large amounts of food over short periods of time.
  • Purging involves forced vomiting or the misuse of laxatives. The bulimia sufferer might induce vomiting by putting their finger down their throat or by consuming a substance that causes vomiting, like syrup of ipecac.
  • Patients with eating disorders also might use diet pills, diuretics (which control blood pressure by increasing urination), or other medications due to a fear of gaining weight.
  • They might utilize excessive exercise, dieting, or fasting in an attempt to lose weight that might be gained from eating food or binging. 
  • Affecting nearly 1% of people in the United States at some time in their lifetime, bulimia affects millions of people, women more often than men. Other statistics about bulimia include its tendency to affect more than 3% of women and that its frequency of occurrence has doubled since the 1960s.
  • The risks associated with bulimia are many. People with this or other eating disorders also often suffer from a personality disorder, substance abuse problem, or a mood problem, like depression or anxiety.
  • The strict medical definition of bulimia used by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) requires an average of at least one binge-purge episode a week for at least three months to make the diagnosis, but it's likely that some people with symptoms of bulimia may not fit these exact criteria.

A person with bulimia often feels a loss of control over their eating, in that they engage in compulsive overeating, as well as have guilt about their behavior. They are usually aware that their behavior is abnormal. Bulimia is most common in adolescent and young adult women. Despite the repeated binge-purge cycles, people with bulimia are often of normal or near-normal weight, which makes them different from people with anorexia nervosa (an eating disorder in which the person severely limits how much they eat). Bulimia is also different from binge eating disorder, an eating disorder in which the sufferer engages in recurring episodes of binge eating without engaging in purging behaviors to try to control his or her weight.

Bulimia Causes and Risk Factors

Though the exact cause of bulimia is not known, a number of risk factors appear to influence its development.

  • Studies have shown eating disorders occur more frequently in relatives of people with bulimia than in others. This frequency appears to be related to genetics, but family influences may also be important.
  • Researchers have suggested that altered levels of the chemical serotonin in the brain play a role. Serotonin levels can also be related to the development of clinical depression.
  • Experts agree that cultural factors are very important in the development of eating disorders. Many societies' emphasis on health, in particular thinness, can greatly influence those who seek the acceptance of others to maintain a good body image.
  • There seems to be increasing evidence that people who tend to ruminate, meaning focus repetitively on feeling distressed and the possible causes or consequences of these feelings without using active problem-solving strategies, have a greater likelihood to become bulimic or develop another eating disorder.

Bulimia Symptoms and Signs

Probably the earliest and most obvious warning sign of bulimia is an extreme preoccupation with obesity, weight, and body shape. People with bulimia will try to hide their bingeing and purging behavior from others. This secrecy often makes it difficult to identify the actual problem until serious complications from the physical self-abuse occur. People with bulimia may complain of generalized weakness, fatigue, abdominal pain, loss of menstrual cycles, or other physical effects of this disorder. They may even complain of vomiting or diarrhea without revealing that it is self-induced.

  • A physical exam may reveal signs of chronic bingeing and purging.
    • Dental cavities, loss of tooth enamel, enlarged salivary glands, and scars on the knuckles may be present as a result of chronic self-induced vomiting.
    • Signs of malnutrition or dehydration may be present including dry skin, changes in the hair and nails, swelling of the lower legs and feet, or loss of sensation in the hands or feet.

When to Seek Medical Care for Bulimia

Any sign that a person may be suffering from an eating disorder is reason for that person to be evaluated by a doctor. People with bulimia generally have feelings of guilt about their behavior and are less likely than those with anorexia to deny that a problem exists when interviewed by an understanding professional. Your doctor would be a good first contact. The initial evaluation can help determine if a serious medical complication exists. Referrals to therapists experienced in the treatment of eating disorders can then be made.

Bulimia often has a number of health risks associated with it.

  • Repeated vomiting can cause scratched knuckles, chronic sore throat, and eroding teeth. The excessive secretion of salivary glands during vomiting can cause swollen cheeks.
  • Frequent binging can result in bloating.

Bulimia can cause a number of serious medical conditions that could require urgent treatment.

  • Severe weakness, fainting, near fainting, or abdominal pain should be evaluated as soon as possible.
  • Vomiting blood could indicate a tear of the esophagus or stomach and is a medical emergency.
  • Many people with bulimia also suffer from clinical depression, and any behavior or statements from someone that suggests that the person may be contemplating suicide is reason to bring that person in for evaluation at once.

Diagnosis of Bulimia

A history may shed light on the seriousness of the situation, depending on the person's openness regarding the length and extent of their behavior. There is some evidence that people with bulimia and other eating disorders may draw pictures of themselves differently than people without an eating disorder.

Laboratory tests may reveal problems such as low blood sugar. Many electrolyte changes can occur. Low potassium as one of the side effects of laxative or diuretic abuse is common and can be severe. This and other electrolyte changes can cause life-threatening disturbances of the heart rhythm.

Self-Care at Home for Bulimia

Most people with eating disorders are treated by doctors and psychologists without being admitted to the hospital unless a serious physical complication requires hospitalization.

Early treatment is important, because over time this behavior pattern becomes more deeply ingrained and harder to change. People with bulimia who are treated early in the course of the disease have a better chance of full recovery than those who have the disease for years before treatment begins.

As part of a support circle for a person with bulimia, you can be of help at home by monitoring the person's behavior and helping them maintain a reasonable eating pattern. Offer support and encouragement to help the person get and stay in treatment. You can also ensure that the person keeps appointments with doctors and other therapists.

Bulimia Treatment

Treatment of bulimia usually involves behavioral therapy and nutritional counseling. Most eating disorders are not about food but about self-esteem and self-perception. Therapy is most effective when it concentrates on the issues that cause the behavior, rather than on the behavior itself. Individual therapy, combined with group therapy and family therapy, is often the most helpful. Group therapy, where people with the same disease get together and share their experiences with the guidance of a therapist, seems to work well for people with bulimia. Effective nutritional counseling for bulimia tends to focus on normalizing nutrition and eating habits. At times, healthy dieting with mild weight loss can sometimes be an effective part of treatment as well. Some people with bulimia benefit from emotional support groups or spirituality-based group therapy. Facilities and practitioners experienced in the treatment of eating disorders are recommended.

Since people with bulimia also often suffer from depression, anxiety, and obsessive compulsive disorder (OCD), treatment of those disorders, if present, with psychiatric medication may be appropriate in combination with counseling. People whose symptoms do not adequately improve with psychotherapy and education may also benefit from the addition of medications for treatment.

Any serious medical problem related to an eating disorder may require hospitalization. Electrolyte imbalances will be corrected and fluids will be given to rehydrate. IV nutrition may even be required. Even if immediate hospitalization isn't needed for medical treatment, the doctor may request an urgent referral to a psychiatric facility for evaluation.

Follow-up for Bulimia

Follow-up is a critical component in the treatment of eating disorders. Monitoring of a person's compliance with any treatment program for bulimia, whether that involves behavior modification (such as dietary restriction), psychotherapy, scheduled medication, or all three forms of treatment is vital to the success of treatment.

Bulimia Prevention

Removing the emphasis on physical appearance in our culture and in particular within the family is the best way to prevent thought processes and behavior that put people at risk of developing eating disorders. Programs that educate young people about the facts versus myths of nutrition, exercise, and weight loss while promoting self-esteem are being increasingly used to prevent bulimia and other eating disorders.

Bulimia Prognosis

If left untreated, bulimia can have a significantly negative impact on the sufferer's life. For example, bulimia increases the likelihood of infertility, the pregnancy-associated dangers of postpartum depression, and the need for C-section deliveries.

Experts suggest that the earlier bulimia is recognized and treated, the better the chances for recovery. Factors such as long duration of symptoms, older age at start of treatment, severe weight loss, or clinical depression are associated with a poorer prognosis. The rate of relapse with all eating disorders is fairly high and is usually triggered by social stress. Bulimia can have a mortality rate as high as nearly 4%.

For More Information on Bulimia

Academy for Eating Disorders
Phone: 847-498-4274

American Psychological Association
Phone: 800-374-2721

National Association of Anorexia Nervosa and Associated Disorders
Phone: 847-831-3438

National Eating Disorders Association
Phone: 800-931-2237

National Institute of Mental Health (NIMH), NIH, HHS
Phone: 866-615-6464

Medically reviewed by Marina Katz, MD; American Board of Psychiatry & Neurology


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