Bulimia nervosa is a serious mental health condition and eating disorder. Without treatment, it can be life threatening.
A person with bulimia nervosa eats large amounts in short periods, then tries to compensate by overexercising, fasting, or purging, for example. Purging might involve vomiting or using laxatives or diuretics.
Statistics suggest that bulimia nervosa affects 1% of females and 0.1% of males at any one time. On average, it develops in a person’s late teens or early 20s, but it can do so at any time.
Below, learn about complications, treatment options, resources for recovery, and more.
This condition has two main symptoms. The first involves regularly eating a lot of food in short periods, usually 2-hour windows.
This is sometimes called bingeing, and during these periods, a person may feel unable to stop eating.
The second symptom involves taking steps to compensate for overeating, such as purging, fasting, or doing a lot of exercise.
People with bulimia nervosa often have what doctors consider a healthy body mass index (BMI). This can make it hard to tell whether a person has bulimia.
Someone with bulimia eats large quantities of food over short periods. They then take steps to compensate, such as fasting, overexercising, vomiting, or using laxatives or diuretics.
They may also worry about gaining weight and experience mood changes and social withdrawal.
Nutritional deficiencies, chemical imbalances, and effects on the digestive system can lead to physical signs and symptoms. These can develop over time and include:
- brittle nails
- dry hair and skin
- weakness
- fatigue
- dental problems, due to the impact of stomach acid on the teeth
- irregular menstruation
- swollen lymph nodes
- constipation and other bowel-related issues
- a persistently inflamed sore throat
- swollen salivary glands in the neck and jaw
- acid reflux
- kidney problems
- muscle spasms
- bones that fracture easily due to osteoporosis
- an electrolyte imbalance, increasing the risk of a heart attack or stroke
- heart problems
- severe dehydration
- seizures
Bulimia often involves another mental health problem, such as anxiety or depression. Without treatment, these, too, can cause complications.
The National Eating Disorders Association (NEDA) list a number of signs that could indicate to someone else that a person has bulimia. Here are some of them:
- excessive concern with weight loss, dieting, and the control of food
- food disappearing
- food appearing in unusual places
- signs of secretive eating, such as empty food packaging in the garbage
- regular visits to the bathroom right after eating
- signs of frequent vomiting
- preferring to eat alone or eating little with others
- rituals around food or eating, choices, such as such as excessive chewing or only eating one food group
The person may be aware that they have a problem but feel unable to talk to anyone about it.
Anyone who suspects that a loved one may have bulimia could start by reaching out to a physician or a mental health provider. Also, NEDA provide a “How to Help” guide with resources, as well as information about the stages of recovery.
Treatment for bulimia may be long-term. It will address the person’s mental health and any underlying physical issues. The approach will include nutrition counseling and possibly medication.
Before beginning, the person needs to recognize that the problem exists. The sooner the treatment starts, the less likely it is that the person will experience long-term complications.
Many people recover from eating disorders. It is important to be aware that recovery can take time and be challenging. Stressful life events may trigger relapses.
Loved ones can help by learning as much as they can about bulimia and other eating disorders and by providing empathy and support. Helplines and resources for the person and their friends and family are available.
The treatment might involve:
Counseling
Cognitive behavioral therapy, which is sometimes called CBT, can help a person identify and address the thinking patterns that lead to unhealthful eating habits.
Interpersonal therapy sets bulimia in a social and interpersonal context. It addresses underlying issues such as grief and interpersonal conflicts.
Support from family and friends can play a key role during recovery. The Maudsley Method is one form of therapy that focuses on how family members can support their loved one in establishing healthy eating habits.
Medications
Antidepressants, antipsychotics, and mood stabilizers may help treat eating disorders, as well as anxiety and depression.
The Food and Drug Administration (FDA) have approved Fluoxetine (Prozac) as a treatment for bulimia nervosa, but experts call for the development of more targeted therapies.
Hospitalization
In some cases, the person may need to spend time in the hospital. This might be necessary if the physical complications of bulimia have become severe, or if there is a risk of self-harm or suicide.
Find resources that support people with eating disorders and other mental health conditions.
Doctors are unsure precisely why bulimia develops. It may stem from a combination of genetic, biological, psychological, social, and behavioral factors.
What is clear is that bulimia nervosa is a mental health condition — the person’s behaviors are a way of coping with emotional stress.
Genetic factors
The National Institute of Mental Health observe that eating disorders seem to run in families, suggesting that genetic factors may play a role.
Biological factors
A 2013 study using brain imaging technology reported differences in brain responses between females with bulimia and those without it who were shown pictures of slim females. The results suggest that there is different brain processing among people with bulimia.
Also, eating disorders often emerge during puberty, a time of major hormonal changes and growing awareness of the body. Findings of a 2007 study suggest that changes in ovarian hormones may increase the risk.
Environmental factors
People who experience sexual abuse or criticism of their body or eating habits may be more likely to develop bulimia.
Other environmental factors may include social pressure to aspire to certain physical norms, which are often unnatural and unrealistic. Also, pressures of sports and other activities can play a role, especially those that emphasize weight.
Other conditions
Conditions associated with bulimia include:
- personality disorders
- anxiety disorders
- depression
- post-traumatic stress disorder, or PTSD
- obsessive-compulsive disorder, or OCD
These conditions may develop at the same time as an eating disorder or before or after it. They may result from bulimia or contribute to it.
An early diagnosis can improve the chances of a full recovery. The diagnosis can be challenging because the person’s BMI might be in the normal or overweight range, and they may take care to hide their eating habits.
If someone seeks medical help for bulimia, the doctor will likely:
- ask about their mental and physical health
- consider their personal and family medical histories
- perform a physical examination
Also, diagnostic tests can help rule out other underlying diseases or conditions.
If the doctor suspects that the person has bulimia nervosa, they may refer them to a mental health specialist.
Diagnostic criteria
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition lists diagnostic criteria that doctors use when determining whether a person has bulimia.
To receive the diagnosis, the person must:
- experience recurrent episodes of binge eating that they feel unable to control
- use compensatory strategies to prevent weight gain, such as vomiting, fasting, overexercising, or misusing enemas, laxatives, diuretics, or other drugs
- have been bingeing and purging at least once a week for the last 3 months
- have feelings of self-worth that are excessively influenced by their body shape and weight
- not have anorexia nervosa
It is important to note that a person may have an eating disorder, even if they do not meet these criteria.
With treatment, many people recover from eating disorders. However, the recovery can take months or years, and relapses are common.
Some research indicates that 55% of people who sought treatment for bulimia had recovered 5 years later.
The sooner a person seeks treatment, the more likely they are to recover and avoid complications. Support from family and friends can be key.
Bulimia nervosa is an eating disorder and a mental health condition that can be severe.
Help is available for anyone who may have bulimia, as well as for their loved ones. Seeking treatment and support early can improve the chances of a full recovery without complications.