Bulimia Nervosa

Written by Amber Erickson Gabbey | Published on January 13, 2014
Medically Reviewed by George Krucik, MD, MBA on January 13, 2014

What Is Bulimia Nervosa?

Bulimia is an eating disorder characterized by binge eating followed by purging, often through forced vomiting. Some people with bulimia purge through excessive exercise or by taking laxatives or diuretics. Bulimia is a serious condition that can be life threatening.

Bulimia can be broken into two categories: purging and non-purging. Purging bulimia follows the binge-and-purge cycle. People with non-purging bulimia use other strict methods to maintain weight, such as fasting, exercise, or extreme dieting.

People with bulimia often have an unrealistic image of themselves, specifically their body image. They are obsessed with their weight and are intensely self-critical. Many people with bulimia are of normal weight or even overweight. This makes bulimia hard to initially notice and diagnose.

Bulimia nervosa is most common in females, especially during the teenage and early adult years. Performers are also at greater risk for eating disorders, as are athletes, whose weight and body are closely monitored. Dancers, models, and actors may also be at a higher risk.

What Causes Bulimia Nervosa?

Bulimia nervosa has no known cause, but there are a couple factors that can influence its development. People with mental health conditions or a distorted view of reality are at high risk. The same is true for people with a strong need to fit into social expectations and norms, and those who are highly influenced by the media. Other factors include anger issues, depression, perfectionism, impulsiveness, and a past traumatic event.

Some research suggests that bulimia is hereditary. Bulimia could also be caused by a serotonin deficiency in the brain.

What Are the Symptoms of Bulimia Nervosa?

The most common symptoms of bulimia nervosa include:

  • long-term fear of gaining weight
  • comments about being fat
  • preoccupation with weight and body
  • a strongly negative self-image
  • binge eating
  • forceful vomiting
  • overuse of laxatives or diuretics
  • use of supplements or herbs for weight loss
  • excessive exercise
  • stained teeth (from stomach acid)
  • calluses on the back of the hands
  • going to the bathroom immediately after meals
  • not eating in front of others
  • withdrawal from normal social activities

Complications from bulimia can include kidney failure, heart problems, gum disease, or tooth decay. There may be digestive issues or constipation. Dehydration, nutrient deficiencies, and electrolyte or chemical imbalances can also occur. Women may experience the absence of a menstrual period. Anxiety and depression, as well as drug or alcohol abuse, are also common.

How Is Bulimia Nervosa Diagnosed?

To diagnose bulimia nervosa, a physical examination is needed, perhaps with blood or urine tests. A psychological evaluation can determine a patient’s relationship with food and body image.

If bulimia nervosa is advanced, further tests can check for heart or organ problems, which are potential complications of this disorder.

The Diagnostic and Statistical Manual of Mental Disorders has criteria for diagnosing bulimia nervosa. These include:

  • repeated binging
  • purging through vomiting
  • exercising
  • taking pills
  • binging and purging at least twice per week for three months
  • deriving self-worth from weight

A positive answer on at least three of the six criteria determines a bulimia diagnosis.

How Is Bulimia Nervosa Treated?

The goal of bulimia treatment focuses not just on food, but on self-esteem. This includes the development of a healthy view of the self and a healthy relationship with food. Treatment usually involves a team approach. It may include antidepressants, psychotherapy, behavior therapy, family therapy, dietician support, nutrition education, and treatment for complications from the illness.

Some eating disorder treatment facilities offer live-in or day treatment programs. Patients take classes, attend therapy, practice gentle yoga to increase body awareness, eat nutritious meals, and receive around-the-clock support and care.

What Is the Outlook for Bulimia Nervosa?

If left untreated or if treatment fails, bulimia nervosa can be life threatening. Bulimia is both a physical as well as psychological condition.

With successful treatment, bulimia can be overcome. The earlier bulimia is detected, the easier treatment will be. Effective treatments focus on food, self-esteem, problem solving, coping skills and mental health. These help patients maintain healthy behaviors in the long-term. Bulimia often doesn’t go away entirely and becomes a life-long challenge.

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