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Bulimia Nervosa (Part 1)

Bulimia nervosa, often called bulimia, is a type of eating disorder. People with bulimia eat large amounts of food at one time, then try to get rid of the food or weight gain by throwing up, taking laxatives, fasting (not eating anything), or exercising a lot more than normal. Bulimia affects more girls and women than boys and men. Bulimia is a serious health problem, but people with bulimia can get better with treatment.

What is bulimia?

Bulimia nervosa, often called bulimia, is a type of eating disorder. Eating disorders are mental health problems that cause extreme and dangerous eating behaviors. These extreme eating behaviors cause other serious health problems and sometimes death. Some eating disorders also involve extreme exercise.

Individuals with bulimia eat a lot of food in a short amount of time and feel a lack of control overeating during this time (called binging). People with bulimia then try to prevent weight gain by getting rid of the food (called purging). Purging may be done by making yourself throw up or taking laxatives. Laxatives can include pills or liquids that speed up the movement of food through your body and lead to bowel movements.

People with bulimia may also try to prevent weight gain after binging by exercising a lot more than normal, eating very little or not at all (fasting), or taking pills to urinate often.

People with bulimia usually have self-esteem that is closely linked to their body image.

What is the difference between bulimia and other eating disorders?

People with eating disorders, such as bulimia, anorexia, and binge eating disorder, have a mental health condition that affects how they eat, and sometimes how they exercise. These eating disorders threaten their health.

Unlike people with anorexia, people with bulimia often have a normal weight. Unlike those with binge eating disorder, individuals with bulimia purge, or try to get rid of the food or weight after binging. Binging and purging are usually done in private. This can make it difficult to tell if a loved one has bulimia or another eating disorder.

It is possible to have more than one eating disorder in your lifetime. Regardless of what type of eating disorder you may have, you can get better with treatment.

Who is at risk for bulimia?

Bulimia affects more women than men. It affects up to two percent of women¹ and happens to women of all races and ethnicities.²

Bulimia affects more girls and younger women than older women. On average, women develop bulimia at age 18 or 19.³ Teenage girls between 15 and 19 and young women in their early 20s are most at risk. However, eating disorders are happening more often in older women. In one recent study, 13 percent of American women over age 50 had signs of an eating disorder.⁴

What are the symptoms of bulimia?

Someone with bulimia may be thin, overweight, or have a normal weight. It can be difficult to tell based on a person's weight whether someone has bulimia. This is because binging and purging is most often done in private. However, family or friends may see empty food wrappers in unexpected places or vomit in the home.

Over time, some symptoms of bulimia may include⁵

• Swollen cheeks or jaw area
• Calluses or scrapes on the knuckles (if using fingers to induce vomiting)
• Teeth that look clear instead of white and are increasingly sensitive and decaying
• Broken blood vessels in the eyes
• Acid reflux, constipation, and other gastrointestinal problems
• Severe dehydration

Girls or women with bulimia may also have behavior changes such as

• Often going to the bathroom right after eating (to throw up)
• Exercising a lot, even in bad weather or when hurt or tired
• Acting moody or sad, hating the way she looks, or feeling hopeless
• Having problems expressing anger
• Not wanting to go out with friends or do activities she once enjoyed

People with bulimia often have other mental health problems, including depression, anxiety, or substance abuse.⁶

References

1. Smink, F.R.E., van Hoeken, D., & Hoek, H.W. (2013). Epidemiology, course, and outcome of eating disorders. Current Opinion in Psychiatry, 26(6), 543–548.
2. Marques, L., Alegria, M., Becker, A.E., Chen, C., Fang, A., Chosak, A., et al. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across U.S. ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders, 44(5), 412–420.
3. National Institute for Health and Clinical Excellence (NICE), National Collaborating Centre for Mental Health (UK). (2004). Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders (NICE Clinical Guidelines, No. 9). Leicester, UK: The British Psychological Society & The Royal College of Psychiatrists.
4. Gagne, D.A., Van Holle, A., Brownley, K.A., Runfola, C.D., Hofmeier, S., Branch, K.E., et al. (2012). Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: Results of the gender and body image (GABI) study. International Journal of Eating Disorders, 45(7), 832–844.
5. Mehler, P.S., & Rylander, M. (2015). Bulimia nervosa – medical complications. Journal of Eating Disorders, 3, 12.
6. Rushing, J.M., Jones, L.E., & Carney, C.P. (2003). Bulimia nervosa: A primary care review. The Primary Care Companion to the Journal of Clinical Psychiatry, 5(5), 217–224.