Bulimia Nervosa

Bulimia nervosa, also called bulimia, is a serious type of eating disorder. It’s characterized by eating a large amount of food in a short amount of time (binging), followed by getting rid of the food (purging).

You may feel like you have no control over what you eat. You might eat large amounts in one sitting, sometimes in secret, leading to guilt or shame. To cope, you may try to compensate by vomiting, using laxatives or exercising excessively.

This condition also affects how you see yourself. You may judge your worth based on your appearance and feel like the only thing you can manage is how food leaves your body. This cycle is unhealthy and can lead to serious, even life-threatening, consequences. But you’re not alone. Help is available.

Types of bulimia

There are two types based on the ways you may try to clear food from your system or reduce weight gain:

• Purging. You may make yourself vomit, use laxatives, diuretics, enemas or other medicines to remove food from your body.
• Nonpurging. You may over-exercise or fast (not eat) in a way that interferes with your daily routine or general health.

Bulimia nervosa symptoms

Symptoms of bulimia include:

• Eating large amounts of food in one sitting (binging)
• Getting rid of the food you just ate by purging
• A fear of gaining weight and a willingness to do whatever it takes to lose weight
• A loss of control when it comes to eating
• Low self-esteem and low self-worth
• Shame or guilt after eating
• Depression, anxiety, extreme mood swings or substance use
• Fainting
• Constipation
• Irregular menstrual periods
• Muscle weakness
• Bloodshot eyes
• Facial swelling (chipmunk cheeks)

This condition can look different for each person. For example, you might not eat a large amount of food before purging. Sometimes, any amount of food can trigger negative feelings that may make you want to purge. The method for purging may also vary.

Bulimia causes

The exact cause of bulimia nervosa isn’t known. But researchers think it may be a combination of genetics and learned behaviors.

Popular culture and the media may put pressure on you to have a certain body type. These outside influences can affect your body image and self-esteem. Also, feeling stressed, upset or out of control may all lead to the development of this eating disorder.

Risk factors of bulimia

Bulimia nervosa can affect anyone. You’re more at risk of the condition if you’re:

• An adolescent or young adult
• Biologically related to someone diagnosed with an eating disorder
• Diagnosed with a mental health condition like anxiety or depression
• Female

Complications of bulimia

This eating disorder comes with many health risks. These are dangerous and many can be life-threatening. Complications may include:

• Abnormal heart rhythm (arrhythmia)
• Damage to your intestines and stomach
• Dental issues (tooth erosion, translucent teeth or decay)
• Esophagus inflammation (esophagitis) and tears
• GERD
• Heart failure
• Irritable bowel syndrome (IBS)
• Increased risk of suicide
• Malnutrition and dehydration
• Swollen cheeks
• Throat and stomach ulcers
• Type 2 diabetes

Treating bulimia early may prevent complications and any long-term effects that the condition may cause.

How doctors diagnose bulimia

To diagnose this condition, your healthcare provider will perform a physical examination. They’ll ask you about your medical history and symptoms. It’s OK to be nervous when talking with your provider. But they want to help you get better and won’t judge you. So, it’s important to be honest about your eating habits and behaviors.

Your provider will review your symptoms with the criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5-TR). They may ask you the following questions:

• Do you have repeated episodes of binge eating?
• Do you feel a lack of control over your eating?
• Do you engage in purging behaviors?
• Have you experienced binge eating at least once a week for three months?
• Does your body weight or shape have a strong influence on your self-image?

There aren’t any tests to specifically diagnose this eating disorder. Your provider may order tests to see how it affects your health. These tests may include:

• Blood tests
• Electrocardiogram (EKG)
• Kidney function test
• Urinalysis

How is bulimia treated?

A healthcare provider may recommend the following treatment options:

• Therapy. Cognitive behavioral therapy is a type of talk therapy. You’ll meet with a therapist and set goals to adjust how your thoughts affect your behaviors.
• Nutritional counseling. You’ll work with a registered dietitian or counselor to build a healthier relationship with the foods you eat.
• Medication. Selective serotonin reuptake inhibitors are a type of antidepressant. They may reduce binge eating and vomiting episodes. They may also treat anxiety and depression.
• Support groups. Support groups can be a helpful addition to other treatments. Connecting with others who share similar experiences may be beneficial to your recovery.

There isn’t one treatment that works best for everyone. You may need to try different techniques or paths to reach your goals.

When should I see my healthcare provider?

If your relationship with food causes you stress or gets in the way of your everyday life, you should talk to a healthcare provider.

Seek immediate treatment if you also have any of the following symptoms:

• Chest pain
• Dizziness
• Fainting
• Heart palpitations
• Shortness of breath (dyspnea)
• Severe sore throat

If you’re thinking about suicide, someone is available to help you 24/7. Call or text 988. This is the Suicide and Crisis Lifeline (U.S.). Don’t hesitate to reach out, even if you’re not in a crisis.

If you’re in immediate danger, call 911 or your local emergency services number.

Bulimia recovery

Recovery is possible. It takes time to get there. Your healthcare providers will work with you to create a treatment plan that’s right for you and your symptoms. Your therapist will help you set realistic goals and work with you to achieve them.

It’s important to know that relapses are possible. A relapse is when you go back to unhealthy behaviors after a period of practicing healthy ones. It’ll be easy to see a relapse as a failure, but it’s not a judgment of who you are. Recovery is challenging and hard work. But remember, you’re never alone. Your care team can help you get back on track. They’ll make adjustments to your treatment plan as needed.

If untreated, you may develop serious, often life-threatening complications. It’s important to seek treatment if you haven’t already.

What is it like living with bulimia?

Everyone’s experience with this eating disorder is different. Here are some examples of what it might feel like to live with bulimia:

• I worry about going out to eat in public because I don’t want to eat too much too fast and not have access to a restroom.
• I avoid looking at myself in mirrors because I don’t like the way I look.
• I feel like the only control I have in my life is purging.
• Binging is comforting when I’m stressed, but I eat so fast that I don’t even taste the food.
• I feel so guilty (like I committed a crime) after eating. I feel like purging is the only way I can undo the damage.

If these thoughts sound familiar, it’s time to reach out to a healthcare provider or mental health professional. They can help you build a better relationship with food and your self-image.