Bulimia Nervosa

What is bulimia nervosa?

Bulimia nervosa, usually referred to as bulimia, is defined as uncontrolled episodes of overeating (bingeing) and usually followed by purging (self-induced vomiting), misuse of laxatives, enemas, or medications that cause increased production of urine, fasting, or excessive exercise to control weight. Bingeing, in this situation, is defined as eating much larger amounts of food than would normally be consumed within a short period of time (usually less than two hours).

What causes bulimia?

The cause of bulimia is not known. Factors believed to contribute to the development of bulimia include cultural ideals and social attitudes toward body appearance, self-valuation based on body weight and shape, and family problems.

Who is affected by bulimia?

The majority of bulimics are female, adolescent, and from a high socioeconomic group. All westernized industrial countries have reported incidence of bulimia. An estimated 1% of the U.S. population are reported to have bulimia. Adolescents who develop bulimia are more likely to come from families with a history of eating disorders, physical illness, and other mental health problems, such as mood disorders or substance abuse. Other mental health problems, such as anxiety disorders, or mood disorders, are commonly found in persons with bulimia.

Family, friends, and health care providers may have difficulty detecting bulimia in someone they know because they binge and purge in secret. Often, they are able to maintain normal or above normal body weight, but hide their problem from others for years. Many individuals with bulimia do not seek help until they reach the ages of 30 or 50 -- when their eating behavior is deeply ingrained and more difficult to change.

What are some common characteristics of persons with bulimia?

Most people with eating disorders share certain personality traits and use abnormal eating rituals as a means of handling stress and anxiety. These personality traits often include, but are not limited to, the following:

  • Low self-esteem

  • Feelings of helplessness

  • Fear of becoming fat

People with bulimia (and binge eating disorder) typically consume huge amounts of food -- often junk food -- to reduce stress and relieve anxiety.

  • With binge eating, however, comes guilt and depression.

  • Purging brings relief that is only temporary.

  • Individuals with bulimia are usually impulsive and more likely to engage in risky behaviors, such as abuse of alcohol and drugs.

What are the different types of bulimia?

There are two subgroups of bulimic behavior aimed at reducing caloric intake, including the following:

  • Purging type. This type regularly engages in self-induced vomiting or misuse of laxatives, diuretics, or enemas, or other cathartics (medications, through their chemical effects, that serve to increase the clearing of intestinal contents).

  • Nonpurging type. This type uses other inappropriate behaviors, such as fasting or excessive exercise, rather than regularly engaging in purging behaviors to reduce caloric absorption of excessive amounts of food by the body.

What are the symptoms of bulimia?

The following are the most common symptoms of bulimia. However, each individual may experience signs differently. Symptoms may include:

  • Usually a normal or low body weight (sees self as overweight)

  • Recurrent episodes of binge eating (rapid consumption of excessive amounts of food in a relatively short period of time; often secretive) , coupled with fearful feelings of not being able to stop eating during the bingeing episodes

  • Self-induced vomiting (usually secretive)

  • Excessive exercise or fasting

  • Peculiar eating habits or rituals

  • Inappropriate use of laxatives, diuretics, or other cathartics

  • Irregular or absence of menstruation

  • Anxiety

  • Discouraged feelings related to dissatisfaction with themselves and their bodily appearance

  • Depression

  • Preoccupation with food, weight, and body shape

  • Scarring on the back of the fingers from the process of self-induced vomiting

  • Overachieving behaviors

The symptoms of bulimia may resemble other medical problems or psychiatric conditions. Always consult your health care provider for a diagnosis.

How is bulimia diagnosed?

Parents, family members, spouses, teachers, coaches, and instructors may be able to identify an individual with bulimia, although many persons with the disorder initially keep their illness very private and hidden. A detailed history of the individual's behavior from family, parents, and teachers, clinical observations of the person's behavior, and, sometimes, psychological testing contribute to the diagnosis. Family members who note symptoms of bulimia in a loved one can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems. Bulimia, and the malnutrition that results, can adversely affect nearly every organ system in the body, increasing the importance of early diagnosis and treatment. Bulimia can be fatal. Consult your health care provider for more information.

Treatment for bulimia

Specific treatment for bulimia will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Extent of the symptoms

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Bulimia is usually treated with a combination of individual therapy, family therapy, behavior modification, and nutritional rehabilitation. Treatment should always be based on a comprehensive evaluation of the individual and family. Individual therapy usually includes both cognitive and behavioral techniques. Medication (usually antidepressants or antianxiety medications) may be helpful if the person with bulimia is also anxious or depressed. The frequent occurrence of medical complications during the course of rehabilitative treatment requires both your health care provider and a nutritionist to be active members of the management team. Families play a vital supportive role in any treatment process.

Medical complications commonly associated with bulimia nervosa

Medical complications that may result from bulimia include, but are not limited to, the following:

  • Stomach rupture

  • Purging may result in heart failure due to loss of vital minerals, such as potassium

  • Vomiting causes other less deadly, but serious, problems, including:

    • The acid in vomit wears down the outer layer of the teeth

    • Scarring on the backs of hands when fingers are pushed down the throat to induce vomiting

    • Esophagus becomes inflamed

    • Glands near the cheeks become swollen

  • Irregular menstrual periods

  • Diminished libido

  • Individuals may struggle with addictions and/or compulsive behavior

  • Many people with bulimia suffer from clinical depression, anxiety, obsessive-compulsive disorder, and other psychiatric illnesses

  • Increased risk for suicidal behavior

Biochemistry and eating disorders

To understand eating disorders, researchers have studied the neuroendocrine system, which is made up of a combination of the central nervous and hormonal systems.

The neuroendocrine system regulates multiple functions of the mind and body. It has been found that many of the following regulatory mechanisms may be, to some degree, disturbed in persons with eating disorders:

  • Sexual function

  • Physical growth and development

  • Appetite and digestion

  • Sleep

  • Heart function

  • Kidney function

  • Emotions

  • Thinking

  • Memory

Eating disorders and depression

Many people with eating disorders also appear to suffer from depression, and it is believed that there may be a link between these two disorders. For example:

  • In the central nervous system, chemical messengers known as neurotransmitters control hormone production. The neurotransmitters serotonin and norepinephrine, which function abnormally in people who have depression, have been discovered to also have decreased levels in both acutely ill people with anorexia and bulimia, and people who have recovered long-term from anorexia.

  • Research has shown that some people with anorexia may respond well to antidepressant medication that affects serotonin function in the body.

  • Biochemical similarities have been discovered between people with eating disorders and obsessive-compulsive disorder (OCD), and people with OCD frequently have abnormal eating behaviors.

  • The hormone vasopressin is another brain chemical found to be abnormal in people with eating disorders and OCD. Levels of this hormone are elevated in people with OCD, anorexia, and bulimia.

Genetic and environmental factors related to eating disorders

Because eating disorders tend to run in families, and female relatives are the most often affected, genetic factors are believed to play a role in the disorders.

But, other influences, both behavioral and environmental, may also play a role. Consider these facts from the National Institute of Mental Health:

  • Although most victims of anorexia and bulimia are adolescent and young adult women, these illnesses can also strike men and older women.

  • Anorexia and bulimia are found most often in Caucasians, but these illnesses also affect African-Americans and other races.

  • People pursuing professions or activities that emphasize thinness, such as modeling, dancing, gymnastics, wrestling, and long-distance running, are more susceptible to these disorders.

Prevention of bulimia

Preventive measures to reduce the incidence of bulimia are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the process of normal growth and development, and improve the quality of life experienced by adolescents with bulimia. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.