Bulimia 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.
The exact cause of bulimia is unknown. Factors that may contribute to this condition include: Cultural bias toward thinnessChanges in the level of brain chemicalsEmotional stressDisturbed self-image
Bulimia is more young women, especially between 11-20 years old. Other factors that increase your chance of developing 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 controlMaking yourself throw upTaking laxatives, enemas, water pills, or diet pillsExercising excessivelyHaving dramatic changes in mood
Having symptoms of
depressionHaving difficulty controlling your impulses
Physical symptoms 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 heartbeatHeart problems, including sudden cardiac arrest, 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
The doctor will ask about: Your medical and psychological historyThe amount of food you eatThe ways you to try to rid your body of food
The doctor will also do a physical exam. Your teeth will be checked for signs of erosion.
Tests may include: Blood tests—to look for chemical imbalancesElectrocardiogram (EKG)—to check your heart's electrical activityDrug 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.
The goals of treatment are: To stop binging and purgingRestore body chemistry and adequate nutritionTo focus self-esteem away from body weight and shape
You 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.
Cognitive 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 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
Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), have proven effective in helping to reduce binging and purging.
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. 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.
Last reviewed May 2014 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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