DefinitionBulimia nervosa is an eating disorder. People who have bulimia are overly concerned with weight and body image. They eat very large amounts of food (called binging) and use inappropriate means to rid their bodies of the food (called purging). Purging may be done through vomiting, laxatives, or water pills. Excessive exercise or fasting may replace or be used along with purging. This cycle of binging and purging is used to prevent weight gain.
CausesThe exact cause of bulimia is unknown. Factors that may contribute to this condition include:
- Cultural bias toward thinness
- Changes in the level of brain chemicals
- Emotional stress
- Disturbed self-image
Risk FactorsBulimia is more young women, especially between 11-20 years old. Other factors that increase your chance of developing bulimia include:
- History of obesity
- Mood disorders
- Family members who have had an eating disorder or mood disorder
- Low self-esteem
- Unhappiness with weight and size
- Career in which physical appearance is important
- Substance abuse
SymptomsBehavioral symptoms include:
- Eating unusually large amounts of food at one time
- Feeling like eating is out of control
- Making yourself throw up
- Taking laxatives, enemas, water pills, or diet pills
- Exercising excessively
- Having dramatic changes in mood
- Having symptoms of depression
- Having difficulty controlling your impulses
- Abusing alcohol or drugs
- Abdominal pain and heartburn
- Menstrual problems
- Swollen cheeks and jaw
- Sore throat
- Swollen salivary glands (in the mouth and throat)
- Stained or chipped teeth (due to contact with stomach acid)
- Cuts or scars on back of hands (from scraping skin on teeth during forced vomiting)
- Dental and throat problems from stomach acid that rises during vomiting
- Changes in body chemistry and fluids due to vomiting and abuse of laxatives or water pills
- Lightheadedness, which can lead to feeling faint or fainting
- Muscle cramps
- Irregular heartbeat
- Heart problems, including sudden cardiac arrest , which can be fatal
DiagnosisThe doctor will ask about:
- Your medical and psychological history
- The amount of food you eat
- The ways you to try to rid your body of food
- Blood tests—to look for chemical imbalances
- Electrocardiogram (EKG)—to check your heart's electrical activity
- Drug screening—to check for drug use
|Bulimia can lead to severe heart problems.|
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TreatmentThe goals of treatment are:
- To stop binging and purging
- Restore body chemistry and adequate nutrition
- To focus self-esteem away from body weight and shape
Nutritional SupportYou may be referred to a registered dietitian. A dietitian can teach you how to follow a healthy diet and create reasonable weight and calorie goals.
PsychotherapyCognitive behavioral therapy (CBT) can be very effective, especially when combined with medication. Other therapies may be less effective, but can help you to:
- Gain insight into the problem
- Recognize what triggers binging and purging
- Develop new coping skills
- Learn and practice stress-management techniques
- Talk about feelings
- Develop a more appropriate idea of thinness
- Develop healthier attitudes about eating
- Learn to eat regularly to reduce the urge to binge
MedicationsAntidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), have proven effective in helping to reduce binging and purging.
PreventionHealthy attitudes about food and your body help prevent bulimia nervosa. Suggestions include:
- Maintain a rational approach to dieting and food.
- Accept a realistic body image.
- Take pride in what you do well.
- Set realistic goals.
- Talk to your doctor or a mental health professional if you think:
- Your desire to be thin is getting out of control
- You may be developing an eating disorder
- If you have a friend/family member who may have bulimia, encourage this person to get help.
Bulimia Nervosa Resource Guide for Family and Friends
National Association of Anorexia Nervosa and Associated Disorders
Bulimia Anorexia Nervosa Association
Canadian Mental Health Association
Bulimia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 17, 2012. Accessed August 28, 2012.
Bulimia nervosa fact sheet. Women's Health.gov website. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/bulimia-nervosa.html. Updated June 15, 2009. Accessed August 28, 2012.
Eating disorders. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml. Accessed August 28, 2012.
- Reviewer: Michael Woods, MD
- Review Date: 05/2014
- Update Date: 05/23/2014