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 thinness
- Psychological problems due to changes in the level of brain chemicals, such as depression
- Emotional stress
- Distorted self-image
Bulimia is more young women, especially between 11-20 years old. Other factors that may increase your chance of bulimia include:
Behavioral symptoms include:
- Eating unusually large amounts of food at one time
- Feeling like eating is out of control
- Intentional/forced vomiting
- Taking laxatives, enemas, water pills, or diet pills
- Exercising excessively
- Having dramatic changes in mood
- Having symptoms of depression
- Having difficulty controlling your impulses
- Abusing alcohol or drugs
Typically have a normal weight. Physical symptoms may include:
- Abdominal pain and heartburn
- Menstrual problems
- Swollen cheeks and jaw
- Sore throat
- Swollen salivary glands (in the mouth and throat)
- 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:
- Lightheadedness, which can lead to feeling faint or fainting
- Muscle cramps
- Irregular heartbeat
- Heart problems, including sudden cardiac arrest, which can be fatal
People with bulimia have a high incidence of psychiatric conditions, including:
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 imbalances
- Electrocardiogram (EKG)—to check for abnormal heart rhythms
- Drug screening—to check for drug use
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 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
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.
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 control
- You may be developing an eating disorder
- If you have a friend/family member who may have bulimia, encourage this person to get help.
Bulimia Nervosa Resource Guide for Family and Friends
National Association of Anorexia Nervosa and Associated Disorders
Bulimia Anorexia Nervosa Association
Canadian Mental Health Association
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.