Bulimia Nervosa

Bulimia nervosa, commonly known as bulimia, is a serious eating disorder that can become life-threatening. People with bulimia often binge on large amounts of food during a short time (within 2 hours), then purge in some way, eliminating the unwanted calories. Purging is a compensatory behavior that can take several forms such as induced vomiting, excessive exercise, or laxative, diuretic, or enema use.^1,2

Most people with bulimia feel like they can’t control the amount of food they eat during a binge. And some become so accustomed to purging after they eat that they may even purge after normal-sized meals and small snacks.¹

Like people with anorexia nervosa, those with bulimia are abnormally preoccupied with body image. They are extremely critical of their self-perceived flaws, including their body shape, and have an intense fear of gaining weight. They also spend inordinate amounts of time thinking about both food and weight loss.¹ However, unlike anorexia, people with bulimia are usually a normal to above-normal body weight, which can make the problem more difficult for friends and family members to spot. ²

While bulimia can affect anyone, it is most common among females, affecting 1% to 2% of all adolescent and young adult women.² Bulimia typically begins in adolescence, between the ages of 14 and 22.³ But it is rarely diagnosed in childhood or early adolescence because girls often struggle for many years before seeking treatment.³

Researchers believe that the male-to-female ratio of bulimia is 1:10, but some estimates are as high as 1:3.³ Males with bulimia are more likely than females to present with over-exercise and steroid use as their compensatory behavior.³

Anorexia is one of the deadliest psychological conditions, and recent research suggests that bulimia may be just as deadly.

Among all behavioral health issues, eating disorders are notoriously the most dangerous. Anorexia is one of the deadliest psychological conditions in the United States, and recent research suggests that bulimia may be just as deadly as anorexia, with an approximate 4% mortality rate.⁴

Most adolescents with bulimia have a co-occurring mental health or addiction problem. One study shows that 88% of adolescents with bulimia will have at least 1 other psychiatric illness during their lifetimes.³ Such comorbidity increases the risk of suicide in adolescents with bulimia. Studies show that as many as 53% of adolescent bulimics experience suicidal ideation, 26% make plans, and 35% attempt suicide.³

How Does It Develop?

No one knows exactly what causes eating disorders like bulimia, but researchers believe that there are several potentially influencing elements, including psychological, biological, and sociological factors.³ Bulimia has also shown to be more common among people who have a first-degree relative (parent, sibling) with an eating disorder.³

Certain people are at greater risk than others of developing bulimia. Personality traits such as perfectionism, impulsivity, and anxiety put people at greater risk. A history of abuse or post-traumatic stress disorder (PTSD) and having a family history of mental illness or addiction also increases the risk of developing an eating disorder.¹ People with depression, anxiety, and low self-esteem are at increased risk too, particularly if they were overweight as children.¹

Although girls and women are at a much higher risk of developing bulimia than their male peers, certain males are at higher risk than others. For instance, males who participate in sports in which weight can affect performance, such as gymnastics, wrestling, and long-distance running.³ Additionally, researchers estimate that homosexual males may be at greater risk than their heterosexual peers.³

Signs and Symptoms

People with bulimia often try to deal with stress by out-of-control binging. They then try to reassert control with purging behaviors, which creates a vicious cycle of deprivation, binging, and purging. An intense fear of gaining weight coupled with feelings of shame and guilt fuels this cycle.³

Certain signs and symptoms become telltale indicators of bulimia, including:^1,2,5

• Binge eating high-carbohydrate or high-fat foods, usually in secret.
• Being preoccupied with your body shape and weight.
• Developing an intense fear of gaining weight.
• Forcing yourself to vomit after eating.
• Feeling out of control when binging.
• Forcing yourself to exercise despite weather, fatigue, or injury.
• Eating until the point of discomfort.
• Eating much more food in a binge episode than in a normal meal or snack.
• Misusing laxatives, diuretics, or enemas after eating.
• Restricting calories between binges.
• Using dietary supplements for weight loss.
• Feeling guilt and shame about eating.
• Weight that goes up and down.
• Constipation, diarrhea, nausea, gas, abdominal pain.
• Dehydration.
• Missed periods or lack of menstrual periods.

Other warning signs of bulimia that parents or loved ones can look for include:^1,2,5

• Bad breath.
• Mouth sores.
• Depression.
• Swollen jaw or cheek area.
• Going to the bathroom during or after meals.
• Sounds or smells of vomit.
• Evidence of binge eating (empty wrappers, missing food).
• Empty packages of laxatives or diuretics.
• Rigid exercise regime.
• Discoloration of teeth.
• Calluses on the back of hands from induced vomiting.
• Preoccupation with weight, food, or dieting.

Consequences and Side Effects

Behavioral health disorders like bulimia do serious damage to the body. The constant cycle of deprivation, binging, and purging is punishing to the entire digestive system, and frequent vomiting can cause inflammation—even rupture—of the esophagus. The stomach acid in vomit often causes severe tooth decay and may permanently stain or discolor teeth. Gum disease is also a common side effect.⁵

Purging behaviors may also lead to severe dehydration and electrolyte imbalance, which can affect organ function.

Acid reflux disorder and other gastrointestinal problems, such as ulcers, are common. Excessive laxative use can interfere with normal GI functioning, and some people become completely dependent on laxatives to have any bowel movement at all—raising their risk of intestinal blockage and bowel perforation. For those who excessively use diuretics, kidney damage is a serious concern.⁵

Purging behaviors may also lead to severe dehydration and electrolyte imbalance, which can affect organ function—perhaps the most serious of bulimia’s consequences. Electrolyte imbalances may be implicated in the development of an irregular heartbeat and, eventually, heart failure, making bulimia fatal in some cases.¹

Treatment Options

• Hospitalization: In severe cases where someone is suffering from malnutrition or refuses to eat without purging, they may need emergency medical treatment. Doctors monitor vitals, look for medical complications, and provide IV fluids for dehydration and electrolyte imbalances.³
• Inpatient Residential Treatment: Patients live at the facility and receive 24/7 medical care, psychotherapy, and nutritional support. This works well for patients who are medically stable but psychiatrically impaired and not ready for or responding to outpatient treatment.³
• Outpatient Treatment: There are many different types of outpatient bulimia treatment programs ranging from intensive full-time outpatient programs to weekly therapy in a private office environment. This works well for patients who no longer require daily medical monitoring and are psychologically stable enough to make independent progress toward recovery.³
• Luxury Treatment Programs: These are residential inpatient programs that offer high-end amenities in addition to conventional treatment. Amenities can include upscale lodging, swimming pools, spas, massage, yoga, acupuncture, and other alternative treatments.
• Executive Treatment Programs: Often with program features similar to their luxury treatment counterparts, these residential programs are designed for working adults suffering from bulimia. They may offer flexible work/treatment schedules to allow professionals time for recovery.
• 12-Step Programs: People with bulimia and their families organize these peer-to-peer support groups to support one another’s recovery. They follow the same 12-step recovery protocol as Alcoholics Anonymous and include Overeaters Anonymous and Anorexics and Bulimics Anonymous.

Sources

1. Mayo Clinic. (n.d.). Bulimia nervosa.
2. National Eating Disorders Association. (n.d.). Bulimia nervosa.
3. Lock, J. & La Via, M. C. (2015). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 54(5), 412–425.
4. Kaye, W. (n.d.). Mortality and eating disorders.
5. U.S. Department of Health and Human Services. (2012). Bulimia nervosa fact sheet.