Definition

Bulimia nervosa is an eating disorder. People who have bulimia are overly concerned with weight and body image. They eat very large amounts of food (called binge eating) and use inappropriate means to rid their bodies of the food (called purging). 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.

Causes

The exact cause of bulimia is unknown. Factors that may contribute to this condition include:

• Cultural bias toward thinness
• Changes in the level of brain chemicals
• Emotional stress
• Disturbed self-image

Risk Factors

Bulimia is more young women, especially between 11-20 years old. Other factors that may increase your chance of bulimia include:

• History of obesity
• Anxiety
• Mood disorders
• Family members who have had an eating disorder or mood disorder
• Low self-esteem
• Unhappiness with weight and size
• Career in which physical appearance is important
• Substance abuse

Symptoms

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

Physical symptoms include:

• Abdominal pain and heartburn
• Menstrual problems
• Swollen cheeks and jaw
• Sore throat
• Swollen salivary glands (in the mouth and throat)
• Bloating
• 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
• Thirst
• Muscle cramps
• Weakness
• Constipation
• Irregular heartbeat
• Heart problems, including sudden cardiac arrest, which can be fatal

People with bulimia have a high incidence of psychiatric conditions, including:

• Depression (often with rapid and wide swings in mood)
• Anxiety and panic disorder

Diagnosis

The doctor may suspect bulimia after a physical exam and medical history. The doctor may ask about your dietary and exercise habits..

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.

Treatment

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:

Prevention

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.

National Association of Anorexia Nervosa and Associated Disorders http://www.anad.org

Canadian Mental Health Association http://www.ontario.cmha.ca/

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 June 15, 2009. Accessed August 28, 2012.

What are eating disorders? National Institute of Mental Health website. Available at:
http://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml
Accessed August 28, 2012.