What is Bulimia?

Ever had negative thoughts about your weight and appearance? Most of us have. People suffering from bulimia nervosa have more than just negative thoughts about it. If you are experiencing bulimia nervosa, you have an overwhelming preoccupation with your body weight and shape. It’s brought on by a negative self-image where you are unusually harsh on yourself for real or imagined perceived self flaws. Characterized by a chronic cycle of bingeing and purging, bulimia nervosa is one of the most common eating disorders in the world—and one of the most debilitating. If you are living with bulimia nervosa, you likely spend large amounts of time bingeing on food—that is, eating excessive amounts of food in one sitting. And then, engaging in some type of behavior to rid your body of the food you just ingested. This purging behavior can come in several forms, including self-induced vomiting, misuse of diuretics, laxatives, and/or enemas, fasting, strict dieting, or excessive exercise.

Two types of behaviors exist to get rid of excess calories consumed during bingeing episodes: purging behaviors and non-purging behaviors. If you are categorized as having purging bulimia, you will use self-induced vomiting and/or increased use of laxatives, diuretics, and enemas to get the unwanted food out of your body. If you are categorized as having non-purging bulimia, you’ll use other methods to prevent weight gain from unwanted calories—such as excessive exercise, strict dieting, and fasting. Frequent bingeing and purging (whether true purging or non-purging) is potentially life-threatening and negatively impacts your daily living experiences.

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Approximately 1.5% of American women are affected by bulimia in their lifetime. Research shows the median age of onset of bulimia in the US is quite young. Just 12 years old. Eating disorders are the 3rd most common chronic illness among adolescent females, according to the Eating Disorder Coalition (EDC)1. Even though sufferers of this disorder are constantly ridding their bodies of the excess calories they consume during binge sessions, most individuals engaging in this type of behavior are of average weight. If you are coping with bulimia nervosa, chances are you know what you are doing is harmful to your body’s health and your mental well-being—but you just can’t stop. Much like individuals that suffer from anxiety disorders—you understand your behaviors are unusual compared to the general population – but you just can’t stop yourself from engaging in them. This is a very normal thought process for those living with this condition.

If diagnosed with bulimia nervosa, you also have a higher likelihood of showing signs of depression, anxiety, engagement in self-harm, problems with drugs and alcohol, and changes in social adjustment. 3 Individuals suffering from an eating disorder, in general, are at a higher risk of death from suicide or medical complications that are caused by the eating disorder. Bulimia nervosa is related to negative self-image and not just food – which is why it is harder to treat. You have to figure out a way to gain back a positive self-image and not just learn a way to put the food down. In the next section, we’ll take a look at the signs and symptoms you might notice if you or a friend or family member is suffering from bulimia nervosa. We’ll then discuss treatment options for this debilitating disease.

What are the Symptoms?

The most commonly known and recognized symptoms of bulimia nervosa are the bingeing and purging behaviors. However, if you are suffering from bulimia nervosa, you are likely to be exhibiting many more symptoms than that. A lot of the symptoms are brought on by the actual bingeing of excessive quantities of food in one sitting that leads to stomach pain from over-extension, followed by some form of purging to relieve the discomfort and rid the body of calories.

If you suffer from bulimia nervosa, you likely experience this cycle of bingeing and purging multiple times a week, or in severe cases, multiple times per day. Included below is a list of some of the more well-known signs and symptoms of bulimia nervosa.

If you have, or think you have bulimia nervosa, you are likely to be experiencing one or many of the following signs and symptoms:

  • Constant inflamed and sore throat and mouth sores
  • Swollen salivary glands
  • Worn tooth enamel and decaying teeth – caused by excessive exposure to stomach acid during frequent self-induced vomiting
  • Acid reflux or other gastrointestinal problems
  • Binge-eating, usually done in secret, of high-carbohydrate foods
  • Self-induced vomiting, misuse of laxatives, diuretics, and enemas
  • Excessive exercising, fasting, or dieting
  • Eating so much that it results in stomach pain
  • Fluctuating weight – going up and down
  • Gastrointestinal problems – diarrhea, gas, constipation, nausea, abdominal pain
  • Dehydration
  • Loss of control over eating normally
  • Feelings of guilt and shame
  • Missed periods or periods stopping altogether
  • Bad breath
  • Feeling depressed
  • Electrolyte imbalance due to loss of sodium, calcium, potassium, and other minerals, which can result in abnormal heart rhythms, heart attack, or death
  • Inflammation of the esophagus
  • Gastroesophageal reflux
  • Gastroparesis or delayed emptying of the stomach contents
  • Peptic ulcers
  • Infertility
  • Calluses or scars on the back of the hands or knuckles due to constant trauma from the incisors during self-induced vomiting episodes
  • Excessive fixation on the number of calories consumed
  • Low self-esteem
  • Constant negative self-image
  • Low blood pressure
  • Frequent trips to the bathroom
  • Depression
  • Withdrawal from friends and activities

How Is it Diagnosed and What Causes It?

To be diagnosed with bulimia nervosa, you have to satisfy a number of criteria: excessive and uncontrollable binge eating activity followed by exaggerated ways to lose weight due to fear of weight gain from the binge eating. These behaviors must occur at least once a week for a period of three consecutive months to be diagnosed with bulimia nervosa.

What is causing your bulimia nervosa? Good question. Scientists have not found a single cause that pinpoints the occurrence of bulimia nervosa in the general population. Genes, the environment, and societal pressures are all theorized to play a role in the prevalence of bulimia nervosa. Although it can affect anyone, white, middle-class women—typically of high school and college age—are diagnosed with bulimia nervosa in addition to individuals who have low self-esteem and family histories of substance abuse and mood disorders. If your family members suffer from bulimia nervosa or other eating disorders, you’re at an increased risk of also suffering from it. Additionally, if you come from a family who puts a strong emphasis on achievement or who is overly critical, you are more likely to experience the signs and symptoms of bulimia nervosa. Cultural pressures to be thin also seem to have an impact. If you have suffered from sexual abuse, obsessive-compulsive disorder, depression, self-mutilation, or substance abuse, you are also more likely to suffer from bulimia nervosa.

What are the Treatment Options?

A combination of drug therapies, psychotherapy, and nutrition counseling is usually prescribed to individuals coping with bulimia nervosa.

Psychological counseling or talk therapy are all types of psychotherapy that can help you when dealing with bulimia nervosa. Cognitive behavioral therapy helps you to understand your negative thoughts behaviors and replace them with positive and healthier ones. Family-based therapy centers around a group session to help all family members cope when one of their loved ones is dealing with bulimia nervosa. It can also help parents learn how to treat and deal with a child who is suffering from the debilitating effects of the disorder.

Antidepressants are often prescribed if you are dealing with bulimia nervosa. Specifically, fluoxetine (known more commonly as Prozac) is the only antidepressant approved by the Food and Drug Administration (FDA) to treat bulimia nervosa.

39537798 - hand with pen drawing the chemical formula of fluoxetine

Dietitians and health providers are also key players in the fight against bulimia nervosa. They can show you how to make a healthy eating plan, educate you about good nutrition, and help you achieve a healthy weight.

One of the challenges of bulimia nervosa is that it tends to be cyclical in its occurrence, treatment, and relapse. Often times, if you are suffering from bulimia nervosa and undergo treatment, the signs and symptoms of bulimia nervosa might come back at a later date. At which point, you would seek treatment again. These re-occurrences of signs and symptoms often occur during times of high stress and may come and go throughout the years. So-called “booster sessions” with your mental health professional and health provider may help you to curb the binge-purge cycles before they organize into full-force. Education and knowledge about the signs of re-occurrence or knowledge about times when signs and symptoms of bulimia nervosa have a higher likelihood to present themselves all help you in your fight to regain control of your eating habits and maintain a healthy, positive lifecycle and well-being.

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Last Updated: Jun 6, 2019