Bulimia Nervosa

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What is bulimia nervosa?

Bulimia nervosa is an eating disorder characterized by caloric restriction, food binges and feelings of inability to control eating followed by episodes of compensation, which may include excessive exercise, fasting, laxative or diuretic use, or vomiting. Some people who have bulimia also have anorexia nervosa, which is characterized by distorted body image, emaciation, fear of weight gain, and self-starvation. People who have bulimia are more frequently of normal weight, but have similar fears regarding weight gain and unhappiness with their body size and shape.

Guilt and feelings of disgust are common. Bulimic behaviors are often done secretly, which can make bulimia nervosa difficult to recognize. Other symptoms may include bowel problems; cuts and calluses on the hands and fingers; dehydration; indigestion; sore throat; swollen salivary glands; tooth decay, wear and sensitivity from vomiting; and upset stomach. Coexisting psychological problems, such as anxiety, depression, or drug and alcohol abuse, are common.

The cause of bulimia nervosa is not known, but it is probably related to an interaction of factors, such as genetics, environment, culture, trauma, and psychological and family issues. Bulimia occurs more commonly in adolescent and young adult women than in men or other age groups.

Severe or complicated bulimia nervosa may initially require hospitalization; otherwise, initial outpatient therapy may be an option. Mild bulimia may respond well to support groups. If they are not helpful, a combination of cognitive-behavioral and nutrition therapy is often recommended. If therapy alone is not enough, medications, such as antidepressants, may also be recommended. Bulimia can be difficult to treat; treatment is most successful in early, uncomplicated bulimia.

Bulimia nervosa is a serious medical condition with potentially life-threatening complications, including abnormal heart rhythms, electrolyte disturbances, esophageal tears, severe dehydration, and stomach rupture. Seek immediate m edical care (call 911) for serious symptoms, such as chest pain or pressure; cold and clammy skin; confusion or loss of consciousness for even a moment; decreased urine output; irregular heart rate (arrhythmia); pale skin or pallor; profuse sweating; rapid breathing (tachypnea); rapid heart rate (tachycardia); seizure; severe abdominal pain; vomiting blood, rectal bleeding, or bloody stool; or weakness (loss of strength). Immediate medical care is also warranted for concerns about being a danger to oneself or others.

Seek prompt medical care if you are being treated for bulimia nervosa but symptoms recur or are persistent.

What are the symptoms of bulimia nervosa?

People who have bulimia nervosa have episodes where they feel they are unable to control their eating, which are typically followed by periods of self-disgust and efforts to compensate for overeating. Normal weight and secretive bingeing and purging can make it difficult for others to recognize what is occurring; however, vomiting and using medications to lose weight or encourage bowel movements can create other symptoms.

Common primary symptoms of bulimia nervosa

Common primary symptoms of bulimia nervosa include:

  • Awareness of abnormal eating patterns

  • Eating large quantities of food at one sitting

  • Excessive exercising

  • Feelings of lack of control over eating binges

  • Normal weight

  • Preoccupation with weight, fear of weight gain

  • Secretive behavior

  • Self-disgust and guilt over eating binges

  • Unhappiness over size and body shape

  • Use of emetics to induce vomiting, laxatives or enemas to stimulate bowel movements, or diuretics or diet pills to lose weight

  • Vomiting after eating

Common symptoms related to purging

Purging by vomiting or using medications to lose weight or encourage bowel movements can cause additional symptoms including:

Serious symptoms that might indicate a life-threatening condition

In some cases, bulimia nervosa can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

What causes bulimia nervosa?

The cause of bulimia nervosa is not known, but it is probably related to an interaction of factors, such as genetics, environment, culture, trauma, and psychological and family issues. Bulimia nervosa occurs more commonly in adolescent and young adult women than in men or other age groups.

What are the risk factors for bulimia nervosa?

A number of factors increase the risk of developing bulimia nervosa. Not all people with risk factors will get bulimia nervosa. Risk factors for bulimia nervosa include:

  • Adolescence and early adulthood
  • External pressure to maintain or lose weight
  • Family history of bulimia or other eating disorders
  • Female gender
  • History of sexual, emotional or physical abuse

How is bulimia nervosa treated?

Mild bulimia nervosa may respond well to support groups; otherwise, bulimia is typically treated with a combination of psychotherapy and nutrition therapy. Severe or complicated bulimia may require initial hospitalization. If your bulimia does not improve sufficiently with psychotherapy and nutrition therapy, antidepressants may be added and may prove to have significant benefit.

Any coexisting psychiatric conditions or medical complications also need to be treated.

Common treatments for bulimia nervosa

Treatment of bulimia nervosa may involve psychotherapy, nutrition therapy, antidepressants, hospitalization, and treatment of coexisting psychiatric conditions or medical complications. Common treatments include:

  • Antidepressants to complement psychotherapy and potentially reduce the risk of relapse

  • Cognitive behavioral therapy to work on thought patterns and behavior

  • Family therapy, which is is extremely helpful for adolescent patients

  • Hospitalization for medical complications, coexisting anorexia, major depression, or to treat purging withdrawal

  • Nutrition therapy

  • Support groups, such as Overeaters Anonymous and others

  • Surgery for severe complications, such as stomach obstruction or rupture or esophageal tears

  • Treatment of coexisting psychiatric disorders or medical conditions

What are the potential complications of bulimia nervosa?

Complications of untreated or poorly controlled bulimia nervosa can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of bulimia nervosa include:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 7
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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  2. Eating disorders. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/eating-disorders/bulimia-nervosa.shtml.
  3. Mehler, PS, Anderson, AE. Eating Disorders: A guide to medical care and complications, 2nd ed. Baltimore: The Johns Hopkins University Press, 2010.
  4. Grilo CM, Mitchell JE (Eds). The Treatment of Eating Disorders: A Clinical Handbook. New York: The Guilford Press, 2010.