What is bulimia nervosa?
Bulimia nervosa is an eating disorder, commonly
referred to simply as bulimia. It’s a serious condition that can be life-threatening.
It’s generally characterized by binge eating
followed by purging. Purging can occur through forced vomiting, excessive
exercise, or by taking laxatives or diuretics.
People with bulimia purge, or display purge
behaviors, and follow a binge-and-purge cycle. Purge behaviors also include
other strict methods to maintain weight like fasting, exercise, or extreme
People with bulimia often have an unrealistic
body image. They are obsessed with their weight and are intensely
self-critical. Many people with bulimia are of normal weight or even
overweight. This can make bulimia hard to notice and diagnose.
Research indicates that roughly 1.5 percent
of women and .5 percent of men will experience bulimia at some point during
their life. It is most common in women, and especially common during the
teenage and early adult years.
Up to 20 percent of college-age women report
symptoms of bulimia. Performers are also at greater risk for eating disorders,
as are athletes whose bodies and weights are closely monitored. And dancers,
models, and actors may also be at a higher risk.
What are the symptoms of bulimia nervosa?
The most common symptoms of bulimia include:
- long-term fear of gaining weight
- comments about being fat
- preoccupation with weight and body
- a strongly negative self-image
- binge eating
- forceful vomiting
- overuse of laxatives or diuretics
- use of supplements or herbs for weight loss
- excessive exercise
- stained teeth (from stomach acid)
- calluses on the back of the hands
- going to the bathroom immediately after meals
- not eating in front of others
- withdrawal from normal social activities
Complications from bulimia can include:
- kidney failure
- heart problems
- gum disease
- tooth decay
- digestive issues or constipation
- nutrient deficiencies
- electrolyte or chemical
Women may experience the absence of a
menstrual period. Also, anxiety, depression, and drug or alcohol abuse can be
common in people with bulimia.
What causes bulimia nervosa?
Bulimia has no known cause. However, there
are a couple of factors that can influence its development.
People with mental health conditions or a
distorted view of reality are at higher risk. The same is true for people with
a strong need to meet social expectations and norms. Those who are highly
influenced by the media may be at risk as well. Other factors include:
- anger issues
- past traumatic event
Some research suggests that bulimia is
hereditary, or could be caused by a serotonin deficiency in the brain.
How is bulimia nervosa diagnosed?
Your doctor will use a variety of tests to
diagnose bulimia. First, they will conduct a physical examination. They may also
order blood or urine tests. And a psychological evaluation will help determine
your relationship with food and body image.
Your doctor will also use criteria from the Diagnostic
and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 is a diagnostic
tool that uses standard language and criteria to diagnose mental disorders. The
criteria used to diagnose bulimia includes:
- recurrent binge eating
- regular purging through vomiting
- persistent purging behaviors, like excessive exercising, misuse of
laxatives, and fasting
- deriving self-worth from weight and body shape
- bingeing, purging, and purging behaviors that happen at least once
a week for three months on average
- not having anorexia nervosa
The severity of your bulimia can be
determined by how often, on average, you exhibit bingeing, purging, or purging
behaviors. The DSM-5 categorizes bulimia from mild to extreme:
- mild: 1 to 3 episodes per week
- moderate: 4 to 7 episodes per week
- severe: 8 to 13 episodes per week.
14 or more episodes per week
You may need further tests if you’ve had
bulimia for a long period of time. These tests can check for complications that
could include problems with your heart or other organs.
How is bulimia nervosa treated?
Treatment focuses not just on food and
nutrition education but also mental health treatment. It requires development
of a healthy view of the self and a healthy relationship with food. Treatment
- antidepressants, like fluoxetine (Prozac), which is the only
antidepressant approved by the U.S. Food and Drug Administration (FDA) to treat
- psychotherapy, also called talk
therapy, can include cognitive behavioral therapy, family-based therapy, and
- dietitian support and nutrition
education, which means learning about healthy eating habits, forming a
nutritious meal plan, and possibly a controlled weight loss program
- treatment for complications,
which may include hospitalization for severe cases of bulimia
Successful treatment usually involves an
antidepressant, psychotherapy, and a collaborative approach between your
doctor, mental healthcare provider, and family and friends.
Some eating disorder treatment facilities
offer live-in or day treatment programs. Patients participating in live-in
programs at treatment facilities receive around-the-clock support and care.
Patients can take classes, attend therapy, and
eat nutritious meals. They may also practice gentle yoga to increase body
What is the outlook for bulimia nervosa?
Bulimia can be life threatening if it’s left
untreated or if treatment fails. Bulimia is both a physical and psychological
condition, and it may be a lifelong challenge to control it.
However, bulimia can be overcome with
successful treatment. The earlier bulimia is detected the more effective treatment
Effective treatments focus on food,
self-esteem, problem solving, coping skills, and mental health. These
treatments help patients maintain healthy behaviors in the long-term.