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:
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
- Trouble controlling impulses
- ]]>Alcohol]]> or ]]>drug abuse]]>
Physical symptoms include:
- Abdominal pain
- Menstrual problems
- Swollen cheeks and jaw
- ]]>Sore throat]]>
- Swollen salivary glands
- 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:
- Feeling faint
- Muscle cramps
- 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
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.
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 quest for thinness may be getting out of control
- You think you may be developing an eating disorder
- If you have a friend who may have bulimia, encourage your friend to get help.
Bulimia Nervosa Resource Guide for Family and Friends
National Association of Anorexia Nervosa and Associated Disorders
National Eating Disorders Association
Bulimia Anorexia Nervosa Association
Canadian Mental Health Association
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Last reviewed November 2009 by ]]>Rosalyn Carson-DeWitt, 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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