Bulimia nervosa is an eating disorder. People who have it eat very large amounts of food (binging) and many also use inappropriate means to rid their bodies of the food (purging). Purging may be caused by vomiting, laxatives, or water pills. Individuals use this cycle to prevent gaining weight. These behaviors last for more than three months for at least two times a week. Individuals are overly concerned with weight and body image. In some, excessive exercise or fasting may replace or supplement purging.

The cause of bulimia is unknown. Several factors may contribute to this condition:

• Cultural bias toward thinness
• Dieting or restricted eating
• Changes in the level of brain chemicals
• Emotional stress
• Physical changes in the digestive system, including:
  • An enlarged stomach
  • A stomach that empties slowly
  • Decreased production of a digestive hormone

Factors that increases your chance of developing bulimia include:

• Sex: female
• Age: 11-20 years old
• History of obesity
• Anxiety
• Mood disorder
• Family members who have been obese
• Family members who have had a mood disorder
• Compulsive dieting
• Low self-esteem
• Unhappiness with weight and size
• Career in which physical appearance is important

Behavioral symptoms include:

• Eating unusually large amounts of food at one time
• Feeling like eating is out of control
• Making yourself throw up
• Taking laxatives, enemas, water pills, or diet pills
• Excessive exercising
• Mood swings
• Depression
• Trouble controlling impulses
• Alcohol or drug abuse

Physical symptoms include:

• Abdominal pain
• Menstrual problems
• Swollen cheeks and jaw
• Sore throat
• Swollen salivary glands
• Bloating
• Stained 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 vomiting
• Changes in body chemistry and fluids due to vomiting and abuse of laxatives or water pills

Symptoms of these complications include:

• Dizziness
• Feeling faint
• Thirst
• Muscle cramps
• Weakness
• Constipation
• Irregular heartbeat
• Heart problems, including sudden death

People with bulimia have a high incidence of personality disorder and of treatable psychiatric conditions, including:

• Depression, often with rapid and wide swings in mood
• Anxiety and panic disorder
• Drug and alcohol abuse or dependence

The doctor will ask about:

• Your medical and psychological history
• The amount of food you eat
• The ways you to try to rid your body of food

The doctor will also perform a physical exam. They will check your teeth for signs of erosion.

Tests may include:

• Blood tests—to look for chemical imbalances
• Electrocardiogram (ECG or EKG)—to look for heart problems due to purging
• Drug screening—to check for drug use

A mental health professional may also perform a psychiatric exam and/or psychological tests.

The goals of treatment are:

• To stop binging and purging
• To focus self-esteem away from body weight and shape

Treatments include:

You may be referred to a registered dietitian. A dietitian can help you learn more about the components of a healthy diet, reasonable weight and calorie goals.

Cognitive behavioral therapy can be very effective. It may be particularly effective when combined with drug treatment.

Other therapies may be less effective, but can help patients:

• Gain insight into the problem
• Recognize what triggers binging and purging
• Develop new coping skills
• Learn and practice stress-management techniques
• Talk about feelings
• Develop a more appropriate idea of thinness
• Develop healthier attitudes about eating
• Learn to eat regularly to reduce the urge to binge

Antidepressant drugs, particularly selective serotonin reuptake inhibitors (SSRIs), have proven effective in helping reduce these behaviors.