What is Bulimia?
- Bulimia (boo-LEE-me-uh) nervosa, commonly called bulimia, is a serious, potentially life-threatening eating disorder.
- People with bulimia may secretly binge — eating large amounts of food — and then purge, trying to get rid of the extra calories in an unhealthy way.
- For example, someone with bulimia may force vomiting or engage in excessive exercise. Sometimes people purge after eating only a small snack or a normal-size meal.
Bulimia can be categorized in two ways:
- Purging bulimia. You regularly self-induce vomiting or misuse laxatives, diuretics or enemas after bingeing.
- Nonpurging bulimia. You use other methods to rid yourself of calories and prevent weight gain, such as fasting, strict dieting or excessive exercise.
However, these behaviors often overlap, and the attempt to rid yourself of extra calories is usually referred to as purging, no matter what the method.
If you have bulimia, you’re probably preoccupied with your weight and body shape.
You may judge yourself severely and harshly for self-perceived flaws. Because it’s related to self-image — and not just about food — bulimia can be hard to overcome.
Effective treatment can help you feel better about yourself, adopt healthier eating patterns and reverse serious complications.
Bulimia signs and symptoms may include:
- Being preoccupied with your body shape and weight
- Living in fear of gaining weight
- Feeling that you can’t control your eating behavior
- Eating until the point of discomfort or pain
- Eating much more food in a binge episode than in a normal meal or snack
- Forcing yourself to vomit or exercise too much to keep from gaining weight after bingeing
- Misusing laxatives, diuretics or enemas after eating
- Restricting calories or avoiding certain foods between binges
- Using dietary supplements or herbal products excessively for weight loss
When to see a doctor
- If you have any bulimia symptoms, seek medical help as soon as possible.
- If left untreated, bulimia can severely impact your health.
- Talk to your primary care provider or a mental health provider about your bulimia symptoms and feelings.
- If you’re reluctant to seek treatment, confide in someone about what you’re going through, whether it’s a friend or loved one, a teacher, a faith leader, or someone else you trust.
- He or she can help you take the first steps to get successful bulimia treatment.
Helping a loved one with bulimia symptoms
- If you think a loved one may have symptoms of bulimia, have an open and honest discussion about your concerns.
- You can’t force someone to seek professional care, but you can offer encouragement and support.
- You can also help find a qualified doctor or mental health provider, make an appointment, and even offer to go along.
- Because most people with bulimia are normal weight or slightly overweight, it may not be apparent to others that something is wrong.
Red flags that family and friends may notice include:
- Constantly worrying or complaining about being fat
- Having a distorted, excessively negative body image
- Repeatedly eating unusually large quantities of food in one sitting, especially foods the person would normally avoid
- Not wanting to eat in public or in front of others
- Going to the bathroom right after eating or during meals
- Exercising too much
- Having sores, scars or calluses on the knuckles or hands
- Having damaged teeth and gums
- The exact cause of bulimia is unknown.
- There are many factors that could play a role in the development of eating disorders including…
- emotional health
- societal expectations and other issues.
- Risk factors
Factors that increase your risk of bulimia may include:
- Being female. Girls and women are more likely to have bulimia than boys and men are.
- Age. Bulimia often begins in the late teens or early adulthood.
- Biology. People with first-degree relatives (siblings, parents or children) with an eating disorder may be more likely to develop an eating disorder, suggesting a possible genetic link. It’s also possible that a deficiency in the brain chemical serotonin may play a role. And, being overweight as a child or teen may increase the risk.
- Psychological and emotional issues. Psychological and emotional problems, such as anxiety disorder or low self-esteem, can contribute to eating disorders. Triggers for bingeing may include stress, poor body self-image, food, restrictive dieting or boredom. In some cases, traumatic events and environmental stress may be contributing factors.
- Media and societal pressure. The media, such as TV and fashion magazines, frequently feature a parade of skinny models and actors. These images seem to equate thinness with success and popularity. But whether the media merely reflect social values or actually drive them isn’t clear.
- Sports, work or artistic pressures. Athletes, actors, dancers and models are at a higher risk of eating disorders. Coaches and parents may inadvertently raise the risk by encouraging young athletes to lose weight, maintain a low weight and restrict eating for better performance.
Bulimia may cause numerous serious and even life-threatening complications.
Possible complications include:
- Dehydration, which can lead to major medical problems, such as kidney failure
- Heart problems, such as an irregular heartbeat or heart failure
- Severe tooth decay and gum disease
- Absent or irregular periods in females
- Digestive problems, and possibly a dependence on laxatives to have bowel movements
- Anxiety and depression
- Misuse of alcohol or drugs
If your doctor suspects you have bulimia, he or she will typically perform:
- A complete physical exam
- Blood and urine tests
- A psychological evaluation, including a discussion of your eating habits and attitude toward food.
- Your doctor may also request additional tests to help pinpoint a diagnosis, rule out medical causes for weight changes and check for any related complications.
Criteris For Diagnosis
For a diagnosis of bulimia, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists these points:
- You recurrently have episodes of eating an abnormally large amount of food ― more than most people would eat in a similar amount of time and under similar circumstances, for example, in a two-hour time period
- You feel a lack of control during bingeing, such as how much you’re eating and whether you can stop eating
- You get rid of the extra calories from bingeing to avoid weight gain by vomiting, excessive exercise, fasting, or misuse of laxatives, diuretics or other medications
- You binge and purge at least once a week for at least three months
- Your body shape and weight influence your feelings of self-worth too much
- You don’t have anorexia, an eating disorder with extremely restrictive eating behaviors
- The severity of bulimia is determined by the number of times a week that you purge.
- Even if you don’t meet all of these criteria, you could still have an eating disorder. Don’t try to diagnose yourself — get professional help if you have any eating disorder symptoms.
When you have bulimia, you may need several types of treatment, although combining psychotherapy with antidepressants may be the most effective for overcoming the disorder.
Treatment generally involves a team approach that includes you, your family, your primary care doctor or other health care provider, as well as a mental health provider and a dietitian experienced in treating eating disorders. You may have a case manager to coordinate your care.
Psychotherapy, also known as talk therapy or psychological counseling, involves discussing your bulimia and related issues with a mental health provider. Evidence indicates that these types of psychotherapy help improve symptoms of bulimia:
- Cognitive behavioral therapy to help you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
- Family-based therapy to help parents intervene to stop their teenager’s unhealthy eating behaviors, then to help the teen regain control over his or her own eating, and lastly to help the family deal with problems that bulimia can have on the teen’s development and the family
- Interpersonal psychotherapy, which addresses difficulties in your close relationships, helping to improve your communication and problem-solving skills
Ask your mental health provider which psychotherapy he or she will use and what evidence exists that shows it’s beneficial in treating bulimia.
Antidepressants may help reduce the symptoms of bulimia when used along with psychotherapy.
The only antidepressant specifically approved by the Food and Drug Administration to treat bulimia is fluoxetine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI), which may help even if you’re not depressed.
Nutrition education and healthy weight
Dietitians and other health care providers can design an eating plan to help you achieve a healthy weight, normal eating habits and good nutrition.
If you have bulimia, you may benefit from a medically supervised weight-loss program.
Bulimia can usually be treated outside of the hospital. But if you have a severe form and serious health complications, you may need treatment in a hospital. Some eating disorder programs may offer day treatment rather than inpatient hospitalization.
Treatment challenges in bulimia
Although most people with bulimia do recover, some find that symptoms don’t go away entirely. Periods of bingeing and purging may come and go through the years, depending on your life circumstances, such as recurrence during times of high stress.
If you find yourself back in the binge-purge cycle, “booster” sessions with your health care providers may help you weather the crisis before your eating disorder spirals out of control again. Learning positive ways to cope, creating healthy relationships and managing stress can help prevent a relapse.
Dietary supplements and herbal products designed to suppress the appetite or aid in weight loss may be abused by people with eating disorders. Weight-loss supplements or herbs can have serious side effects and dangerously interact with other medications. If you use dietary supplements or herbs, discuss the potential risks with your doctor.
(Mayo Clinic – Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.)
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