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What is Bulimia Nervosa?

Most often characterized by a chronic cycle of bingeing (overeating) and purging (using various methods to rid the body of excess calories), bulimia nervosa, generally known as simply bulimia, is one of the most common eating disorders in the world. According to research gathered by the National Eating Disorders Association, bulimia affects approximately 1.5% of young American women and 0.1% of young American men, with symptoms often showing up as early as age 12, and sometimes sooner. Most people who suffer from bulimia are of average weight.

If you are living with bulimia nervosa, you spend a lot of your time eating excessive amounts of food and then trying to get rid of the calories you just consumed. You likely experience this cycle of bingeing and purging multiple times a week, or in severe cases, multiple times per day. You may eat secretly and to the point of over-extending your stomach until you are in pain. People with bulimia often prefer foods that are high in carbohydrates.

To eliminate the excess calories you’ve consumed, you may try to purge your body of food by vomiting, or by using diuretics, laxatives, and/or enemas. Or, you may try to make up for your binges with non-purging behaviors, such as fasting, strict dieting, or overexercising.

What Causes Bulimia Nervosa?

Although bulimia manifests in abnormal eating and purging habits, the root of the problem is negative self-image and a distorted body image. If you suffer from bulimia, you are extremely and unfairly critical of yourself for any real or imagined flaws. And while you probably know that bingeing and purging is unusual behavior that can be harmful to your body’s health and mental well-being, you can’t seem to stop yourself. It’s as if you have no control over your eating habits.

As with all eating disorders, there is no single cause, but there are a number of biological, psychological, environmental, and behavioral factors associated with bulimia, and circumstances that can put you at higher risk for developing the condition. These include:

  • A family history of bulimia or other eating disorders. If you have a close relative, such as a mother or sibling, who has bulimia, you are four times more likely than the average person to develop the condition.
  • A family or personal history of mood disorders such as depression or anxiety, or substance abuse.
  • Poor self-esteem, perhaps due to a critical family environment that puts great emphasis on achievement and success.
  • Personality traits such as impulsiveness, rigidity, excessive fearfulness, shyness, pessimism, and difficulty seeing the “bigger picture”
  • Difficult family or personal transitions
  • A history of sexual abuse, physical abuse, and other traumatic experiences
  • Succumbing to cultural, family or peer pressure to lose weight and be thin

How Bulimia Affects Your Health and Well-Being

Inevitably, bingeing and purging behaviors will cause physical health problems such as:

  • Inflamed and sore throat or esophagus, mouth sores, swollen salivary glands
  • Worn tooth enamel and decaying teeth – caused by excessive exposure to stomach acid during frequent self-induced vomiting
  • Fluctuating weight – going up and down
  • Gastrointestinal problems – diarrhea, gas, constipation, acid reflux, nausea, abdominal pain, peptic ulcers
  • Dehydration
  • Bad breath
  • Low blood pressure
  • Electrolyte imbalance due to loss of sodium, calcium, potassium, and other minerals, which can ultimately result in abnormal heart rhythms, heart attack, or death

You may also experience emotional and psychological conditions linked to bulimia, such as:

  • Feelings of guilt and shame
  • Excessive fixation on the number of calories consumed
  • Chronic low self-esteem and negative self-image
  • Depression or anxiety
  • Withdrawal from friends and activities

Where to Get Help and What to Expect

Bulimia nervosa is a serious physical and mental health condition that requires a proper diagnosis and treatment. Once a diagnosis is established, a combination of psychotherapy, medical treatment, and nutrition counseling may be prescribed.

If you don’t already have a mental health care provider, you can start by speaking with your primary care physician. Describe your binge eating symptoms and the feelings that you associate with your behavior. It may be helpful to make a list of symptoms that you are experiencing before the appointment. Be sure to include all relevant personal information, like any family history of eating disorders, major stress, recent life changes, and a typical day’s eating patterns. In addition to a physical exam, including tests to evaluate whether you are suffering any physical effects from binge eating, your physician will likely ask questions about your daily food habits, your thoughts and your thoughts and feelings about your weight and appearance. Don’t hesitate to discuss your emotions, thoughts, or other information that may seem unrelated to binge eating; it is important to give your provider a full picture of your mental and physical health.

If necessary, your physician should be able to refer you to a licensed mental health professional. It is important to seek treatment from someone with the appropriate education, training, and experience to treat bulimia. Be sure you agree with their approach to treating bulimia and understand their proposed treatment plan and what they see as your primary goal for recovery. If you are not satisfied with their answers or feel comfortable working with this person, consider seeking a second opinion.

Mental health professionals who treat bulimia may draw from different styles of therapy and use various tools to help you move on to a state of recovery. The first line of treatment is usually individual cognitive behavioral therapy (CBT), one-on-one, relatively short-term talk therapy that can help you understand the connections between your thoughts, feelings, and eating behaviors. Your therapist will teach you to normalize both your eating behavior and your thinking patterns, with the goal of eliminating or at least reducing binge-purge episodes. At the same time, CBT offers tools for coping with stress and helping you address and reorient negative thinking patterns about yourself, your body type and your weight.

Early studies suggest that another form of talk therapy, known as interpersonal psychotherapy (ITP), might also help people suffering from bulimia, though this type of therapy may not be as efficient as CBT. ITP focuses less on food behavior and more on interpersonal relationship issues that may play a role perpetuating binge-purging behaviors. Some researchers feel that identifying and resolving these relationship issues may help reduce the frequency of those behaviors.

In addition to psychological counseling, other treatments and approaches can help alleviate some of the symptoms and improve the behaviors associated with BED. Antidepressant or anti-anxiety medications may be prescribed to help with mood issues, and studies have found that the use of antidepressants also helps reduce incidents of

bingeing and purging in many people diagnosed with bulimia. In cases of obesity, medications that encourage at least short-term weight loss may also be prescribed.

A registered dietitian or clinical nutritionist can help you achieve or maintain a healthy weight by teaching you more about good nutrition and helping you develop and follow a balanced eating plan. Your health care providers may also suggest adjunctive therapies like movement classes, meditation and mindfulness instruction, yoga, equine therapy, or art therapy. These programs won’t cure bulimia, but they can help lower your stress levels, elevate your mood, improve your body image, and teach you to have a better sense of control over your life.

Even after treatment, the signs and symptoms of bulimia nervosa can return at a later date. These relapses often occur during times of high stress and may come and go throughout the years. If you start to recognize familiar signs or symptoms, immediately contact your health care providers in order to find out what you need to do to curb the binge-purge cycles before they return full-force.

If you need help and you cannot get it from someone in your immediate support circle, call the National Eating Disorders Association helpline toll-free at 1-800-931-223

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Last Updated: Sep 4, 2019