Bulimia nervosa; Binge-purge behavior; Eating disorder - bulimia
Bulimia is an illness in which a person has regular episodes of eating a very large amount of food (bingeing) and feels a loss of control over eating. The person then uses different ways, such as vomiting or laxatives (purging), to prevent weight gain.
Many people with bulimia also have anorexia nervosa.
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Many more women than men have bulimia. The disorder is most common in teenage girls and young women. The person usually knows that her eating pattern is abnormal. She may feel fear or guilt with the binge-purge episodes.
The exact cause of bulimia is unknown. Genetic, psychological, family, society, or cultural factors may play a role. Bulimia is likely due to more than one factor.
With bulimia, eating binges may occur as often as several times a day for many months. The person often eats large amounts of high-calorie foods, usually in secret. During these episodes, the person feels a lack of control over the eating.
Binges lead to self-disgust, which causes purging to prevent weight gain. Purging may include:
- Forcing oneself to vomit
- Excessive exercise
- Using 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.
Symptoms that other people can see include:
- Spending a lot of time exercising
- Suddenly eating large amounts of food or buying large amounts of food that disappear right away
- Regularly going to the bathroom right after meals
- Throwing away packages of laxatives, diet pills, emetics (drugs that cause vomiting), or diuretics
Exams and Tests
A physical exam may also show:
- Broken blood vessels in the eyes (from the strain of vomiting)
- Dry mouth
- Pouch-like look to the cheeks
- Rashes and pimples
- Small cuts and calluses across the tops of the finger joints from forcing oneself to vomit
People with bulimia rarely have to go to the hospital, unless they:
- Have anorexia
- Have major depression
- Need drugs to help them stop purging
Most often, a stepped approach is used to treat bulimia. Treatment depends on how severe the bulimia is, and the person's response to treatments:
- Support groups may be helpful for mild bulimia without other health problems.
- Counseling, such as talk therapy and nutritional therapy are the 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 talk therapy and SSRIs is very effective if talk therapy does not work alone.
People may drop out of programs if they have unrealistic hopes of being "cured" by therapy alone. Before a program begins, you should know that:
- You will probably need to try many different therapies to overcome this difficult disorder.
- It is common for bulimia to return (relapse), and this is no cause for despair.
- The process is painful, and you and your family will need to work hard.
Support groups like Overeaters Anonymous may help some people with bulimia. The National Eating Disorders Association is a source of information about this disorder.
Bulimia is a long-term illness. Many people will still have some symptoms, even with treatment.
People with fewer medical complications of bulimia and those willing and able to take part in therapy have a better chance of recovery.
Bulimia can be dangerous. It may lead to serious health problems over time. For example, vomiting over and over puts stomach acid in the esophagus (the tube that moves food from the mouth to the stomach). This can lead to permanent damage of this area.
Possible health problems include:
When to Contact a Medical Professional
Call for an appointment with your health care provider if you (or your child) have symptoms of an eating disorder.
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American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013.
Hay PPJ, Bacaltchuk J, Stefano S, Kashyap P. Psychological treatments for bulimia nervosa and binging. Cochrane Database Syst Rev. 2009;(4):CD000562. PMID: 19821271 www.ncbi.nlm.nih.gov/pubmed/19821271.
Rosen DS, American Academy of Pediatrics Committee on Adolescence. Clinical report -- identification and management of eating disorders in children and adolescents. Pediatrics. 2010;126:1240-1253. PMID: 21115584 www.ncbi.nlm.nih.gov/pubmed/21115584.
Sim LA, McAlpine DE, Grothe KB, Himes SM, Cockerill RG, Clark MM. Identification and treatment of eating disorders in the primary care setting. Mayo Clin Proc. 2010;85:746-751. PMID: 20605951 www.ncbi.nlm.nih.gov/pubmed/20605951.