Charlotte, NC
Aakiriti Karki, MD
Gauri Adhikari, MD
Bulimia nervosa is a significant eating disorder marked by recurrent episodes of eating unusually large amounts of food in a short time, followed by efforts to counteract the overeating through purging (vomiting), using laxatives, or engaging in extreme physical exercise. [1] Feelings of distress and loss of control accompany these episodes. The disorder can severely affect your physical health, causing electrolyte imbalances, damage to your gastrointestinal tract, and serious dental problems. It is estimated that bulimia nervosa affects 1-2% of young women worldwide, though the actual numbers might be higher due to underreporting. [2]
People in this category use self-induced vomiting or misuse laxatives, diuretics, or enemas to eliminate consumed food. The frequent vomiting exposes the body to harmful stomach acids, which can have lasting consequences, such as damage to the esophagus and tooth enamel. [3]
Instead of vomiting, individuals may engage in compensatory behaviors like excessive exercise, fasting, or strict dieting. These activities prevent weight gain and are just as harmful, putting the body under significant physical strain. [3]
Bulimia nervosa impacts more women than men, affecting up to 2% of women across all racial and ethnic backgrounds. [2] Teenage girls between 15 and 19, as well as young women in their early 20s, are the most vulnerable group. [2] However, there’s a rising trend of eating disorders occurring in older women too. A study found that 13% of American women over 50 had signs of an eating disorder. [2]
Bulimia nervosa is a complex eating disorder influenced by a combination of psychological, biological, and social factors. Understanding the causes and risk factors of bulimia is essential to identifying those at risk and providing effective support and treatment.
If you have a relative with an eating disorder, your risk is higher. Research shows that genetic variations may make some people more vulnerable to developing bulimia. [4]
Mental health issues, including low self-esteem, perfectionism, impulsive behavior, and anxiety disorders, are closely associated with bulimia. These psychological struggles often worsen the cycle of binge eating and purging. [4]
Living in a society that idealizes thinness can have a powerful impact. The constant exposure to body image standards through social media and advertisements can trigger unhealthy attitudes toward food and body shape. [5]
Experiencing trauma, abuse, or high levels of stress can be a catalyst for developing bulimia. Coping with major life changes, like moving to a new place or dealing with the death of a loved one, can also increase the risk. [6]
Dieting is a common trigger for bulimia. Restrictive eating can lead to a feeling of deprivation, making it more likely that you’ll binge eat. People who are overly focused on their body weight are especially vulnerable. [4]
Recognizing the signs and symptoms of bulimia nervosa is crucial for early intervention and effective treatment. Understanding these warning signs can help support those struggling with this condition.
People may consume large amounts of food in a short period, often feeling out of control during these binges. The food is typically high in calories and easy to eat quickly, like snacks or desserts. This behavior is usually done secretly, adding to feelings of shame and isolation. [7]
To compensate for the binges, they might induce vomiting, misuse laxatives, or engage in excessive exercise. These actions prevent weight gain but can severely damage the body over time. [7]
People with bulimia often maintain a normal or near-normal weight, but frequent weight changes may still occur. This can make it difficult to detect and mask the severity of the disorder. [8]
A persistent fear of gaining weight and an obsession with body shape are common. They may feel extreme dissatisfaction with their body, which worsens the cycle of unhealthy eating behaviors. [7]
There might be swollen cheeks or jaw areas from enlarged salivary glands, chronic sore throat, and acid reflux. Teeth may show enamel erosion, leading to increased cavities and tooth sensitivity. [9]
These are sometimes referred to as “Russell’s sign,” resulting from using hands to induce vomiting. The skin on the knuckles may become rough or scarred from repeated contact with teeth. [10]
People may experience bloating, constipation, or abdominal pain due to disrupting normal digestion and using laxatives or other purging methods. These symptoms can become chronic and interfere with daily life. [11]
Mood swings, irritability, and withdrawal from friends or family can occur. They may also exhibit signs of anxiety, depression, or obsessive-compulsive behaviors, which can be both causes and consequences of bulimia. [7]
Bulimia nervosa can lead to a range of severe complications that affect both physical and mental health. Recognizing these complications highlights the importance of timely treatment and support.
Vomiting and laxative abuse can lower your potassium, sodium, and calcium levels. These imbalances can cause irregular heartbeats and even lead to heart failure or sudden death. [12]
Repeated vomiting can cause chronic sore throats, inflammation of the esophagus, and a condition known as acid reflux. Laxative abuse can lead to long-term colon damage and constipation. [13]
Stomach acid from vomiting can erode your teeth’s enamel, increasing your risk of cavities, tooth sensitivity, and gum disease. You might also experience swollen salivary glands, which can alter your face’s appearance. [9]
The strain caused by severe dehydration and the constant disruption of electrolyte levels can impair kidney function, sometimes permanently. [12]
Bulimia often coexists with mood disorders like depression and anxiety. Substance abuse is also more common in people with bulimia, further complicating treatment and recovery. [14]
The diagnosis of Bulimia Nervosa is entirely clinical. Some of the tests are done to assess the effect of the condition on the body.
Your doctor can look for physical signs of bulimia, such as swollen glands, dental issues, and calluses on your hands from induced vomiting.
A mental health specialist will discuss your eating behaviors, attitudes toward body weight, and emotional state. This step is crucial to understanding the severity and root causes of the disorder. [14]
These tests check for nutritional imbalances, dehydration, and electrolyte abnormalities. They also help assess the disorder’s overall impact on your organs. [15]
Since bulimia can affect heart health, an ECG may monitor your heart’s rhythm and function. [15]
A bone scan detects osteoporosis or bone thinning, especially if there is severe or long-standing malnutrition. [16]
Effective treatment for bulimia nervosa involves:
This therapy helps you change negative thought patterns related to food and body image. CBT teaches practical coping strategies and emphasizes the importance of developing a healthy relationship with food. [17]
Dietitians work with you to create a balanced meal plan that eliminates the cycle of bingeing and purging. They also educate you on the importance of proper nutrition for overall well-being. [18]
Antidepressants, particularly SSRIs like fluoxetine (Prozac), can be effective in reducing binge-purge cycles and managing co-occurring depression or anxiety. It is the only medication approved by the Food and Drug Administration (FDA) for treating bulimia in adults. However, these medications work best when combined with therapy. [19]
This approach involves family members in the treatment process, especially for adolescents. Families learn to support the individual without judgment and help them build healthier habits. [20]
In severe cases, hospitalization may be needed to address medical complications and stabilize weight. Inpatient programs offer intensive therapy and a structured environment for recovery. [21]
Bulimia nervosa can significantly impact fertility, as the disorder often disrupts normal reproductive function. Frequent bingeing and purging behaviors can lead to nutritional deficiencies, hormonal imbalances, and irregular menstrual cycles, which make it more difficult for someone to conceive. Chronic stress and extreme fluctuations in weight further impair reproductive health, affecting the body’s ability to support a healthy pregnancy. Additionally, the physical strain of bulimia may reduce ovarian function and affect the quality of eggs released during ovulation. [22]
