Bulimia Nervosa

Condition Basics

What is bulimia?

Bulimia is a type of eating disorder. People with bulimia will eat a larger amount of food than most people would in a similar situation, in a short period of time (binge). Then, to prevent weight gain, they will do something to get rid of the food (purge). They may vomit, exercise too much, or use medicines like laxatives.

People who have bulimia judge themselves harshly on their body weight and shape. To help them cope with these feelings, they follow a strict diet to try to lose weight. But over time the hunger from the strict diet triggers them to binge eat. After binge eating, they feel out of control, ashamed, guilty, and afraid of gaining weight. This distress causes them to purge, in hopes of "undoing" any possible weight gain from the binge.

Without treatment, this "binge and purge" cycle can lead to serious, long-term health problems.

What causes it?

Experts don't know what causes eating disorders such as bulimia. But they may be caused by a mix of family history, social factors, and personality traits. Some things may make you more likely to have bulimia, such as a family history of eating disorders, dieting often, or having a poor body image.

What are the symptoms?

People with bulimia binge eat on a regular basis. To avoid weight gain, they may make themselves vomit, exercise very hard or for a long time, or misuse laxatives or other medicines. They tend to base how they feel about themselves on how much they weigh and how they look.

How is it diagnosed?

If your doctor thinks that you may have an eating disorder, he or she will check you for signs of problems caused by your diet and purging, such as poor nutrition or electrolyte imbalances. The doctor will do a physical exam and ask questions about your medical history, including your physical and emotional health.

How is bulimia treated?

Bulimia can be treated with counseling and sometimes medicines, such as antidepressants. Getting treatment early can make recovery easier. And it can prevent serious health problems.

What should you do if you think someone has an eating disorder?

If you think your child has an eating disorder:

• Talk to them. Tell your child why you're worried. Let them know you care.
• Make an appointment for you and your child to meet with a doctor or a counselor.

If you're worried about someone you know:

• Tell someone who can make a difference, like a parent, a teacher, a counselor, or a doctor. A person with an eating disorder may say that they are okay and don't need help. You can help by encouraging them to talk to someone they trust.

What Increases Your Risk

Experts don't know for sure what causes someone to have an eating disorder such as anorexia, bulimia, or binge eating. But certain things put a person at greater risk for getting an eating disorder. Some of these things include:

• Having a family history of an eating disorder.
• Struggling with depression, anxiety, low self-esteem, or obsessive behaviors.
• Feeling a need to be perfect.
• Feeling social or cultural pressure about thinness or weight.
• Having a poor body image.
• Taking part in sports or activities that encourage thinness. Modeling and dance are examples.
• Having a history of physical or sexual abuse.

Having risk factors for it doesn't mean a person will get an eating disorder. But knowing some of the things that can add to the risk may help to see a problem early when it is easier to treat.

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Prevention

There is no known way to prevent an eating disorder. But knowing the early signs and seeking treatment right away can help prevent problems caused by an eating disorder. Early treatment may be the best way to prevent it from getting worse.

Symptoms

People with bulimia:

• Binge eat on a regular basis. They eat larger amounts of food than most people would in a similar situation, in a short period of time (2 hours or less). During a binge, they feel out of control and feel unable to stop eating.
• Purge to get rid of the food and avoid weight gain. They may make themselves vomit, exercise very hard or for a long time, or misuse laxatives, enemas, water pills (diuretics), or other medicines.
• Base how they feel about themselves on how much they weigh and how they look.

Any one of these can be a sign of an eating disorder that needs treatment.

Other signs that a person may have bulimia

If you are concerned that someone you know has bulimia, look for these signs. A person may have bulimia if he or she:

• Goes to the bathroom right after meals.
• Is secretive about eating, hides food, or won't eat around other people.
• Exercises a lot, even when he or she does not feel well.
• Often talks about dieting, weight, and body shape.
• Uses laxatives or diuretics often.
• Has teeth marks or calluses on the back of the hands or swollen cheeks or jaws. These are caused by making oneself vomit.

People who have bulimia may not be thin. They may be a normal size. They may binge in secret and deny that they are purging. This makes it hard for others to know that a person with bulimia has a serious problem.

What Happens

People who have bulimia follow a strict diet to try to lose weight. But over time, hunger or stress can trigger binge eating. People with bulimia may then purge to avoid weight gain. This starts the cycle of binging and purging that becomes a habit.

Vomiting causes the body to release endorphins. (These are natural chemicals that make you feel good.) Over time, people with bulimia may vomit even if they haven't eaten too much. Repeated vomiting, fasting, exercising too much, or misusing medicines will lead to serious, long-term health problems.

Health problems caused by bulimia include tooth and mouth problems, dehydration, weakness and fainting, and damage to the esophagus. Mental health problems may also occur along with bulimia. This may make treatment take longer.

After bulimia becomes a pattern, it is very hard to return to normal eating without help. But bulimia can be treated. And most people who seek treatment get better.

When to Call a Doctor

Call 911 or other emergency services immediately if:

• You have severe anorexia, and starvation has become life-threatening.
• You or someone you know is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:
  • You have decided how to kill yourself, such as with a weapon or medicines.
  • You have set a time and place to do it.
  • You think there is no other way to solve the problem or end the pain.
• You feel you can't stop from hurting yourself or someone else.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call the Suicide and Crisis Lifeline at 988.
• Call 1-800-273-TALK (1-800-273-8255).
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers in your phone.

Go to 988lifeline.org for more information or to chat online.

Call your doctor now if you have been diagnosed with bulimia and now:

• Cannot pass urine.
• Notice that your heart skips beats or beats slower than normal.
• Have severe belly pain, are vomiting up blood, or have black, sticky stools that look like tar. These signs may mean that there is bleeding in the digestive tract.

Call your doctor to discuss bulimia if you:

• Binge and then purge to get rid of food.
• Have lost a lot of weight and can't stop losing weight.
• Fear gaining even a small amount of weight, and this interferes with eating healthy meals.
• Notice that you are secretive or lie about your eating habits.
• See yourself as fat and feel that you must diet, even when other people say you look too thin.
• Have been making yourself vomit or are abusing laxatives or diuretics.
• Are not having menstrual periods when you should.
• Feel the need to exercise a lot, and don't give yourself healing or rest time when you are injured or exhausted.

Watchful waiting

Watchful waiting is a wait-and-see approach. It's not a good choice if you think you or someone you know may have an eating disorder. Call a doctor or an eating disorder hotline to discuss your concerns and learn what you can do to help.

Exams and Tests

There is no single test that can diagnose bulimia. But the illness may have a visible effect on your health and eating habits.

If your doctor thinks that you may have an eating disorder, he or she will check you for signs of problems caused by your diet and purging, such as poor nutrition or electrolyte imbalances. The doctor will do a physical exam. He or she may ask questions about your medical history, including your physical and emotional health. It's common for another mental health problem to play a part in an eating disorder. This may include problems such as depression, anxiety, or obsessive-compulsive disorder.

You may have blood tests or X-rays to check for signs of poor nutrition.

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Treatment Overview

Bulimia can be treated with counseling and sometimes medicines. If a person has another health problem along with bulimia, more treatment may be needed. (For example, with depression an antidepressant may be used.) And it may take longer to get better.

Cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are types of counseling used to treat bulimia. In CBT, you learn how to change negative thoughts that you may have about food, your weight, and your body. You learn to change negative beliefs about yourself. In IPT, you learn how relationships can affect binge eating and purging.

These are long-term treatments. It may take weeks or months before you notice changes. You may need treatment with counseling and maybe medicines for more than a year. But getting treatment early can prevent serious health problems. And learning how to manage stress while you recover can make recovery easier.

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Self-Care

Here are some things you can do to take care of yourself during recovery from an eating disorder.

Stick to your treatment plan.

Go to any counseling sessions you have. If you can't go, or don't think the sessions are helping, talk to your counselor about it. And take any medicines you've been prescribed exactly as directed.

Work on healthy eating habits.

Listen to what counselors and nutrition experts say about healthy eating. Learn about what makes a healthy and balanced diet, and then make a plan for your own healthy eating.

Learn healthy ways to deal with stress.

Managing stress is important in recovery. Find what works for you. You could try things like journaling, volunteering, reading, or meditating.

Take it easy on yourself.

Focus on your good qualities. Don't blame yourself for your disorder. And remember that recovery takes time, and that you can make progress one goal at a time.

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