Bulimia, also called bulimia nervosa, is an eating disorder. It is an illness in which a person binges on food or has regular episodes of overeating and feels a loss of control. The affected person then uses various methods -- such as vomiting or laxative abuse -- to prevent weight gain. Many (but not all) people with bulimia also have anorexia. Like anorexia, bulimia is a psychological disorder. It is another condition that goes beyond out-of-control dieting.
Bulimia was only diagnosed as an eating disorder in its own right the 1980s.
Why should I be aware of this?
- The cycle of overeating and purging can quickly become an obsession similar to an addiction to drugs or other substances. The disorder generally occurs after a variety of unsuccessful attempts at dieting.
- Bulimia is estimated to affect between 3% of all women in the U.S. at some point in their lifetime. About 6% of teen girls and 5% of college-aged females are believed to suffer from bulimia.
- Approximately 10% of identified bulimic patients are men.
- Bulimics are also susceptible to other compulsions, affective disorders, or addictions.
- 20% to 40% of women with bulimia also have a history of problems related to drug or alcohol use, suggesting that many affected women may have difficulties with control of behavioral impulses.
All about Bulimia
Bulimia, also called bulimia nervosa, is a psychological eating disorder. Bulimia is characterized by episodes of binge-eating followed by inappropriate methods of weight control (purging). Inappropriate methods of weight control include vomiting, fasting, enemas, excessive use of laxatives and diuretics, or compulsive exercising. Excessive shape and weight concerns are also characteristics of bulimia. A binge is an episode where an individual eats a much larger amount of food than most people would in a similar situation. Binge eating is not a response to intense hunger. It is usually a response to depression, stress, or self esteem issues. During the binge episode, the individual experiences a loss of control. However, the sense of a loss of control is also followed by a short-lived calmness. The calmness is often followed by self-loathing. The cycle of overeating and purging usually becomes an obsession and is repeated often.
Causes, incidence, and risk factors
Many more women than men have bulimia. The disorder is most common in adolescent girls and young women. The affected person is usually aware that her eating pattern is abnormal and may feel fear or guilt with the binge-purge episodes.
The exact cause of bulimia is unknown. Genetic, psychological, trauma, family, society, or cultural factors may play a role. Bulimia is likely due to more than one factor.
- In bulimia, eating binges may occur as often as several times a day for many months.
- People with bulimia often eat large amounts of high-calorie foods, usually in secret. People can feel a lack of control over their eating during these episodes.
- Binges lead to self-disgust, which causes purging to prevent weight gain. Purging may include:
- Forcing oneself to vomit
- Excessive exercise
- Use of laxatives, enemas, or diuretics (water pills)
- Purging often brings a sense of relief.
People with bulimia are often at a normal weight, but they may see themselves as being overweight. Because the person's weight is often normal, other people may not notice this eating disorder.
- Compulsive exercise
- Throwing away packages of laxatives, diet pills, emetics (drugs that cause vomiting), or diuretics
- Regularly going to the bathroom right after meals
- Suddenly eating large amounts of food or buying large amounts of food that disappear right away
Signs and tests
A dental exam may show cavities or gum infections (such as gingivitis). The enamel of the teeth may be worn away or pitted because of too much exposure to the acid in vomit.
A physical examination may also show:
- Broken blood vessels in the eyes (from the strain of vomiting)
- Dry mouth
- Pouch-like look to the corners of the mouth due to swollen salivary glands
- Rashes and pimples
- Small cuts and calluses across the tops of the finger joints from forcing oneself to vomit
- Tests may show an electrolyte imbalance (such as hypokalemia) or dehydration.
People with bulimia rarely have to go to the hospital, unless:
- Binge-purge cycles have led to anorexia
- Drugs are needed to help them stop purging
- Major depression is present
Most often, a stepped approach is used for patients with bulimia. The treatment approach depends on how severe the bulimia is, and the person's response to treatments:
- Support groups may be helpful for patients with mild conditions who do not have any health problems.
- Cognitive-behavioral therapy (CBT) and nutritional therapy are the preferred first treatments for bulimia that does not respond to support groups.
- Antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) are often used for bulimia. A combination of CBT and SSRIs is very effective if CBT is not effective alone.
Patients may drop out of programs if they have unrealistic hopes of being "cured" by therapy alone. Before a program begins, the following should be made clear:
- A number of therapies are likely to be tried until the patient can overcome this difficult disorder.
- It is common for bulimia to return (relapse), and this is no cause for despair.
- The process is painful, and the patient and family need to work hard.
Bulimia Vs anorexia
Unlike anorexics, bulimics experience significant weight fluctuations, but their weight loss is usually not as severe or obvious as anorexics. The long-term prognosis for bulimics is slightly better than for anorexics, and the recovery rate is felt to be higher. However, many bulimics continue to retain slightly abnormal eating and dieting behaviors even after the recovery period.
- Bulimia nervosa fact sheet