Bulimia nervosa is an eating disorder. People who have bulimia are overly concerned with weight and body image. They eat large amounts of food (called binge eating) and use inappropriate means to rid their bodies of the food (called purging) or excessive calories. 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 binge eating and purging is used to prevent weight gain.
The exact cause of bulimia is unknown. Factors that may contribute to this condition include: Cultural bias toward thinnessPsychological problems due to changes in the level of brain chemicals, such as depressionEmotional stressDistorted self-image
Bulimia is more young women, especially between 11-20 years old. Other factors that may increase your chance of bulimia include:
obesityAnxietyMood disordersFamily members who have had an eating disorder or mood disorderLow self-esteemUnhappiness with weight and sizeCareer in which physical appearance is importantSubstance abuse
Behavioral symptoms include: Eating unusually large amounts of food at one timeFeeling like eating is out of controlIntentional/forced vomitingTaking laxatives, enemas, water pills, or diet pillsExercising excessivelyHaving dramatic changes in mood
Having symptoms of
depressionHaving difficulty controlling your impulses
Typically have a normal weight. Physical symptoms may include: Abdominal pain and heartburnMenstrual problemsSwollen cheeks and jawSore throatSwollen salivary glands (in the mouth and throat)BloatingStained or chipped teeth (due to contact with stomach acid)Cuts or scars on back of hands (from scraping skin on teeth during forced vomiting)
Bulimia may lead to other problems, including: Dental and throat problems from stomach acid that rises during vomitingChanges in body chemistry and fluids due to vomiting and abuse of laxatives or water pills
Symptoms of these complications include: Lightheadedness, which can lead to feeling faint or faintingThirstMuscle crampsWeaknessConstipationIrregular heartbeat
Heart problems, including sudden
, which can be fatal
People with bulimia have a high incidence of psychiatric conditions, including: Depression (often with rapid and wide swings in mood)Anxiety
Bulemia may be suspected after a physical exam and medical history. Questions about your dietary and exercise habits may be asked.
Once bulimia is suspected, other tests may be done to determine if the bulimia has caused an imbalance in the blood or heart. Tests may include: Blood tests—to look for chemical imbalancesElectrocardiogram
(EKG)—to check for abnormal heart rhythms Drug screening—to check for drug use
Bulimia can lead to severe heart problems.
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A mental health professional may also perform a psychiatric exam and/or psychological tests. Drug screening may also be done.
Immediate care may be needed to stabilize chemical imbalances in the body and manage changes to the heart.
Overall goals of treatment are to stop harmful behaviors and thought patterns.
Treatments may include:
A registered dietitian can create a healthy nutrition plan and create reasonable weight and calorie goals. The plan may also help avoid electrolyte imbalances.
Therapy can help reshape behaviors by helping to: Gain insight into the problemRecognize what triggers binging and purgingDevelop new coping skillsLearn and practice stress-management techniquesTalk about feelingsDevelop a more appropriate idea of thinnessDevelop healthier attitudes about eatingLearn to eat regularly to reduce the urge to binge
One type of behavior called cognitive behavioral therapy
(CBT) can be very effective, especially when combined with medication.
Therapy may be one on one, group, family, or a combination of therapies.
For children, the school system should also be included. The school can provide special accommodations like snack breaks in class.
Antidepressants medication may help reduce the urge to binge and purge. Medication is most effective when combined with therapy.
Healthy 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 controlYou may be developing an eating disorderIf you have a friend/family member who may have bulimia, encourage this person to get help.
Bulimia nervosa. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated November 19 2015. Accessed May 5, 2016.
Bulimia nervosa fact sheet. Office on Women's Health website. Available at:
http://www.womenshealth.gov/publications/our-publications/fact-sheet/bulimia-nervosa.html. Updated July 16, 2012. Accessed May 5, 2016.
What are eating disorders? National Institute of Mental Health website. Available at:
http://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml. Updated February, 2016 Accessed May 5, 2016.
Last reviewed June 2016 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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