Bulimia is an illness in which a person binges on food or has regular episodes of overeating and feels a loss of control. The affected person then uses various methods -- such as vomiting or laxative abuse -- to prevent weight gain.
Many (but not all) people with bulimia also have anorexia nervosa.
Bulimia nervosa; Binge-purge behavior; Eating disorder - bulimia
Causes, incidence, and risk factors
Many more women than men have bulimia. The disorder is most common in adolescent girls and young women. The affected person is usually aware that her eating pattern is abnormal and may feel fear or guilt with the binge-purge episodes.
The exact cause of bulimia is unknown. Genetic, psychological, trauma, family, society, or cultural factors may play a role. Bulimia is likely due to more than one factor.
In bulimia, eating binges may occur as often as several times a day for many months.
People with bulimia often eat large amounts of high-calorie foods, usually in secret. People can feel a lack of control over their eating during these episodes.
Binges lead to self-disgust, which causes purging to prevent weight gain. Purging may include:
- Forcing oneself to vomit
- Excessive exercise
- Use of 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 can include:
- Compulsive exercise
- Throwing away packages of laxatives, diet pills, emetics (drugs that cause vomiting), or diuretics
- Regularly going to the bathroom right after meals
- Suddenly eating large amounts of food or buying large amounts of food that disappear right away
Signs and tests
A dental exam may show cavities or gum infections (such as gingivitis). The enamel of the teeth may be worn away or pitted because of too much exposure to the acid in vomit.
A physical examination may also show:
- Broken blood vessels in the eyes (from the strain of vomiting)
- Dry mouth
- Pouch-like look to the corners of the mouth due to swollen salivary glands
- Rashes and pimples
- Small cuts and calluses across the tops of the finger joints from forcing oneself to vomit
A chem-20 test may show an electrolyte imbalance (such as hypokalemia) or dehydration.
People with bulimia rarely have to go to the hospital, unless:
- Binge-purge cycles have led to anorexia
- Drugs are needed to help them stop purging
- Major depression is present
Most often, a stepped approach is used for patients with bulimia. The treatment approach depends on how severe the bulimia is, and the person's response to treatments:
- Support groups may be helpful for patients with mild conditions who do not have any health problems.
- Cognitive-behavioral therapy (CBT) and nutritional therapy are the preferred 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 CBT and SSRIs is very effective if CBT is not effective alone.
Patients may drop out of programs if they have unrealistic hopes of being "cured" by therapy alone. Before a program begins, the following should be made clear:
- A number of therapies are likely to be tried until the patient can overcome this difficult disorder.
- It is common for bulimia to return (relapse), and this is no cause for despair.
- The process is painful, and the patient and family need to work hard.
Self-help groups like Overeaters Anonymous may help some people with bulimia. The American Anorexia/Bulimia Association is a source of information about this disorder.
See: Eating disorders - support group
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 who are willing and able to take part in therapy have a better chance of recovery.
Bulimia can be dangerous. It may lead to serious medical complications over time. For example, vomiting over and over again puts stomach acid in the esophagus (the tube from the mouth to the stomach), which can permanently damage this area.
Possible complications include:
Calling your health care provider
Call for an appointment with your health care provider if you (or your child) have symptoms of an eating disorder.
American Psychiatric Association. Treatment of patients with eating disorders, 3rd ed. American Psychiatric Association. Am J Psychiatry. 2006 Jul;163(7 Suppl):4-54.
Hall MN, Friedman RJ 2nd, Leach L. Treatment of bulimia nervosa. Am Fam Physician. 2008 Jun 1;77(11):1588, 1592.
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(8):746-751.
Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583-593.
Fred K. Berger, MD, Addiction and Forensic Psychiatrist, Scripps Memorial Hospital, Ja Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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