Bulimia Nervosa

Bulimia nervosa - often called simply “bulimia” - is a serious, potentially life-threatening eating disorder characterized by regular cycles of overeating (bingeing) and purging. A person feels a loss of control after bingeing and then uses different ways, such as vomiting or laxatives, to purge and prevent weight gain. People with bulimia may have an intense fear of gaining weight and a distorted perception of body weight. People with bulimia usually appear to have a normal body weight.

Bulimia can cause serious complications including dehydration, heart problems, severe tooth decay and gum disease, absent or irregular periods in females, digestive problems, anxiety and depression, misuse of alcohol or drugs, and suicide.

Approximately 80% of people with bulimia are girls and women. Bulimia is an unhealthy way to try to cope with emotional problems, and it can be very difficult to overcome. Treatment is available to help people with bulimia gain a better self-image and return to healthier eating habits.

Signs and symptoms of bulimia may include:

• Being preoccupied with body shape and weight
• Living in fear of gaining weight
• Feeling that you cannot control your eating behavior
• Eating until the point of discomfort or pain
• Eating much more food in a binge episode than in a normal meal or snack
• Forcing yourself to vomit or exercise too much to keep from gaining weight after binge eating
• Misusing laxatives, diuretics or enemas after eating
• Restricting calories or avoiding certain foods between binges
• Using dietary supplements or herbal products excessively for weight loss
• Compulsive exercise
• Suddenly eating large amounts of food or buying large amounts of food that disappear right away
• Regularly going to the bathroom right after meals
• Throwing away packages of laxatives, diet pills, emetics (drugs that cause vomiting), or diuretics
• Broken blood vessels in the eyes (from the strain of vomiting)
• Dry mouth
• Pouch-like look to the cheeks
• Rashes and pimples
• Staining or discoloration of the teeth
• Cuts and calluses on the hands and fingers from inducing vomiting

The exact causes of bulimia nervosa are not known. Many factors may be involved, including biological, psychological, and environmental factors.

Risk factors for bulimia include:

• Being female
• Being worried about, or paying more attention to, body weight and shape
• Having anxiety disorders
• Having a negative self-image
• Having certain social or cultural ideas about health and beauty

To be diagnosed with bulimia nervosa, you must meet criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

DSM-5 diagnostic criteria for bulimia include:

• Recurrent episodes of eating an abnormally large amount of food ― more than most people would eat in a similar amount of time and under similar circumstances
• Lack of control during bingeing, such as how much you are eating and whether you can stop eating
• Getting rid of extra calories from bingeing to avoid weight gain by vomiting, excessive exercise, fasting, or misuse of laxatives, diuretics or other medications
• Bingeing and purging at least once a week for at least 3 months
• Self-worth that is influenced by body shape and weight

The severity of bulimia is determined by the number of times a week that you purge.

Bulimia nervosa is a serious condition that can be life-threatening.

Bulimia can have numerous complications, including:

• Dehydration, which can lead to major medical problems, such as kidney failure
• Heart problems, such as an irregular heartbeat or heart failure
• Severe tooth decay and gum disease
• Absent or irregular periods in females
• Digestive problems, and possibly a dependence on laxatives to have bowel movements
• Anxiety and depression
• Misuse of alcohol or drugs
• Suicide

Support groups are available to ease the stress of bulimia for the patient and the family. If you are receiving treatment for bulimia and managing your disorder, stick to your treatment plan. Do not skip therapy sessions and try not to stray from meal plans, even if they make you uncomfortable. Talk to your doctor about appropriate vitamin and mineral supplements to make sure your body is getting all of the nutrients it needs. Do not isolate yourself from family members and friends who want to see you get healthy. Resist urges to weigh yourself or check yourself in the mirror frequently. These fuel your drive to maintain unhealthy habits.

Bulimia nervosa is a serious health condition that can be both physically and emotionally destructive. It can become chronic, debilitating, and even life-threatening, but early diagnosis and intervention enhance recovery.

Treatment generally involves a team approach that includes medical providers, mental health providers, and dietitians. The most effective and long-lasting treatment for bulimia is usually psychological counseling coupled with medical and nutritional care. Any treatment should be tailored to the person with bulimia and will vary according to both the severities of the disorder and the patient’s particular problems, needs, strengths, as well as the support systems available for the patient and family.

The goals of treatment for bulimia are improve eating habits. Treatment may include psychotherapy and medication therapy, along with nutrition education. The antidepressant fluoxetine (Prozac) is approved to treat bulimia.