Doctor's Notes on Bulimia
Bulimia is an eating disorder in which a person binges on food (eats large amounts of food over a short period of time) and then forces themself to vomit (purge) in a cycle of binging and purging. Purging can also involve the misuse of laxatives. The fear of gaining weight can cause patients with bulimia to misuse diet pills, diuretics (water pills), or other medications. Excessive exercise, dieting, or fasting in an attempt to lose weight may also occur.
An early symptom of bulimia is often an extreme preoccupation with obesity, weight, and body shape. Other symptoms of bulimia include hiding bingeing and purging behavior from others, generalized weakness, fatigue, abdominal pain, loss of menstrual cycles, complaints of vomiting or diarrhea (without revealing is self-induced, dental cavities, loss of tooth enamel, enlarged salivary glands, scars on the knuckles (from chronic self-induced vomiting), signs of malnutrition or dehydration 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 may be present.
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.
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.
Eating disorders are illnesses characterized by unhealthy behaviors associated with food or eating, such as starving, overeating, or binging.
Types of Eating Disorders
- Binge eating
- Anorexia nervosa
- Bulimia nervosa
- Night eating syndrome
- Rumination disorder
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.