Bulimia nervosa

Overview

Bulimia (boo-LEE-me-uh) nervosa, commonly called bulimia, is a serious, potentially life-threatening eating disorder. People with bulimia binge eat. This means people feel like they've lost control over their eating. They eat large amounts of food in one sitting. This often occurs in secret, and they often feel very guilty and shameful. Then they try to get rid of the food and extra calories in an unhealthy way, such as vomiting or misusing laxatives. This is called purging.

If you have bulimia, you probably focus on your weight and body shape even when you're trying to think about other things. You may judge yourself severely and harshly for what you see as flaws in your appearance and personality. Bulimia is related to how you see yourself — not just about food. It can be hard to overcome, and it can be dangerous.

It's important to remember that an eating disorder is not something you choose. Bulimia is a complex illness that affects how your brain works and how you make decisions. But effective treatment can help you feel better about yourself, eat healthier and reverse serious complications.

Symptoms

Bulimia symptoms may include:

• Living in fear of gaining weight and trying to lose weight in unhealthy ways.
• Repeatedly eating unusually large amounts of food in one sitting.
• Feeling a loss of control during binge eating. You may feel like you can't stop eating or can't control what you eat.
• Vomiting on purpose or exercising to extremes after binge eating so that you don't gain weight.
• Using medicines that make you urinate, called water pills or diuretics, or laxatives or enemas to pass stool when they're not needed.
• Fasting, limiting calories or not eating certain foods between binges.
• Using dietary supplements or herbal products for weight loss. These products can be dangerous.
• Being very unhappy with your body shape and weight.
• Letting your body shape and weight guide how you feel about yourself and your worth.
• Having extreme mood swings.

People with bulimia may use different methods to purge. The severity of bulimia depends on the number of times a week that you purge and the problems caused by doing so.

When to see a doctor

If you have any bulimia symptoms, seek medical help right away. If left untreated, bulimia can severely affect your physical and mental health.

Talk to your primary healthcare professional or a mental health professional about your bulimia symptoms and feelings. If you're not sure if you want to seek treatment, talk to someone about what you're going through. This could be a friend or loved one, a teacher, a faith leader, or someone else you trust. This person can help you take the first steps to get help.

Helping a loved one with bulimia symptoms

If you think a loved one may have symptoms of bulimia, talk with the person openly and honestly about your concerns. You can't force someone to get help, but you can give encouragement and support. You also can help find a healthcare professional or mental health professional, make an appointment, and even offer to go along to the appointment.

People with bulimia can be at any weight. For example, they could be average weight or overweight. That's why you can't tell just by looking at someone's size whether that person has bulimia.

Signs of bulimia that family and friends may notice include:

• Always worrying about eating or being overweight.
• Having a distorted or negative body image or both.
• Eating unusually large amounts of food over and over again in one sitting.
• Following a strict diet or fasting after binge eating.
• Having acid reflux, a hard time passing stool and other stomach problems.
• Not wanting to eat in public or in front of others.
• Going to the bathroom right after eating or during mealtime, or for long periods.
• Exercising a lot.
• Having sores, scars or calluses on the knuckles or hands.
• Having damaged teeth and gums.
• Changing weight — up and down.
• Swelling in the hands and feet, and cheeks and jaw area.

Causes

The exact cause of bulimia is not known. Genes may play a role in the development of bulimia and other eating disorders. Emotional health and family history may play a role. Also, pressures from society to be thin may play a role.

Risk factors

Females are more likely to have bulimia than males. Bulimia often begins in the late teens or young adulthood.

Factors that raise your risk of bulimia include:

• Family history and genes. Having a family history of eating problems and weight-control issues can increase the risk of an eating disorder. People with first-degree relatives — siblings, parents or children — who are diagnosed with an eating disorder may be more likely to have an eating disorder. This suggests a possible genetic link.
• Mental health and emotional issues. Mental health and emotional problems, such as depression, anxiety or substance misuse, are linked closely with eating disorders. People with bulimia may feel badly about themselves, especially if they're bullied about weight or shape. In some cases, distressing events and factors that cause emotional distress may play a part, such as being mistreated as a child.
• Dieting. People who diet are more likely to have eating disorders. Many people with bulimia severely limit calories between binge-eating sessions. This may cause them to binge eat again and then purge. Other causes for binge eating can include stress, strong emotions, having a distorted or negative body image and boredom.

Complications

Bulimia may cause many serious and even life-threatening complications, including:

• Not seeing yourself as worthy and feeling hopeless or even suicidal.
• Problems getting along with others or being socially isolated.
• Poor nutrition.
• Not drinking enough fluids, which can lead to major medical problems, such as kidney failure.
• Heart problems, such as an irregular heartbeat or heart failure.
• Severe tooth decay and gum disease.
• Not having a period or not having a period on a regular schedule.
• Gastrointestinal problems, including tears in the tube that carries food, or a hole in your stomach or small intestine. You also could have rectal prolapse, which is when part of the large intestine slips outside the anus.

Conditions that often occur along with bulimia include anxiety, depression, personality disorders or bipolar disorder, and misuse of alcohol or drugs. Self-harm, thoughts about suicide or suicide also can occur.

Prevention

Although there's no sure way to prevent bulimia, you can steer someone toward healthier behavior or professional treatment before it gets worse. Here's how you can help:

• Promote and support a healthy body image in your children, no matter what their size or shape. Help them become more confident in many parts of their personality, not just how they look.
• Have regular, enjoyable family meals.
• Don't talk about weight or shape at home.
• Discourage dieting. This is especially important when it involves unhealthy weight-control behaviors, such as fasting, labeling foods as good or bad, using weight-loss supplements or laxatives, or vomiting.
• Talk with your primary healthcare professional to look for early signs of an eating problem.
• If you notice a loved one or friend who seems to have food issues that could lead to or suggest an eating disorder, think about talking to the person about these issues and ask how you can help. If you do so, be supportive.