Bulimia (A complete guide)

Bulimia is a disorder that involves an obsessive desire to lose weight which results in extreme overeating followed by depression and self-induced vomiting, purging, or fasting. 

In this blog article, we will discuss the signs and symptoms of bulimia, how it is treated, and how you can support a loved one with the disorder. 

TRIGGER WARNING: The following blog article contains content and images that may disturb some readers.

Please use caution before reading this article. 

What is bulimia nervosa? 

Bulimia nervosa, also called bulimia, is a serious and potentially fatal eating disorder.

People who have bulimia may binge in private, which means they will eat large amounts of food and lose control over how much they eat.

Subsequently after the binge session, they will purge, which is a method for trying to get rid of the calories eaten in an unhealthy way. 

Methods of purging include self-induced vomiting, misusing laxatives, weight-loss supplements, diuretics, or enemas.

Bulimics may also fast or exercise excessively. 

People who have bulimia are usually preoccupied with their body weight and shape, and may judge themselves harshly for self-perceived flaws.

Bulimia is hard to recover from because it is related to self-image and not just food. 

What are the symptoms of bulimia?

Signs and symptoms of bulimia may include the following:

·      Preoccupation with body weight and shape

·      Fear of gaining weight

·      Repeated episodes of eating abnormally large amounts of food in one sitting

·      Feeling a loss of control over food intake during binging 

·      Forcing yourself to vomit or exercise excessively to prevent weight gain after binging 

·      Using laxatives, diuretics, or enemas after eating

·      Fasting, restricting calories, or avoiding certain foods between binge episodes 

·      Using dietary supplements or herbal products for weight loss 

People with bulimia usually purge at least once a week for at least three months. 

How is bulimia diagnosed? 

If your primary care doctor suspects you may have bulimia, he or she typically will do the following:

·     Talk to you about your eating habits, weight-loss methods, and physical symptoms

·     Perform a thorough physical exams and request blood and urine tests

·     Perform an electrocardiogram to test for irregular heart rhythms

·     Perform a psychological evaluation to understand your attitude toward your body and weight 

·     Use the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose bulimia 

What are the causes and risk factors of bulimia?

Women and girls are more likely to develop bulimia compared to men and boys.

The symptoms of bulimia often begin during late adolescence to early adulthood. 

Risk factors for bulimia include the following: 

·      Genetics. People who have a sibling or parent with an eating disorder are more likely to develop an eating disorder, which suggests that genetics play a role in the development of bulimia.

Being overweight as a child or teen may also increase the risk. 

·      Psychological or emotional issues: People who have psychological and emotional problems such as depression, anxiety disorders, or substance use disorders are more likely to develop an eating disorder.

People with bulimia may have a negative self-image.

In addition, traumatic events and environmental stress may also contribute to the development of bulimia. 

·     Dieting. People who diet are at a higher risk for developing an eating disorder.

Many people who have bulimia severely restrict their food intake in between binge episodes, which triggers an urge to binge and purge again.

Other triggers for binging include stress, poor self-image, food, and boredom. 

What are the complications of bulimia?

Bulimia may cause very serious and potentially life-threatening complications including the following: 

·      Low self-esteem and problems with relationships or social functioning

·      Dehydration which can lead to serious medical issues such as kidney failure

·      Heart problems such as arrhythmia (irregular heartbeat) or heart failure

·      Severe tooth decay and gum disease

·      Absence of or irregular periods in females

·      Digestive problems

·      Anxiety, depression, personality disorders, or bipolar disorder

·      Substance abuse 

·      Self-harm, suicidal ideation, or suicide 

Is bulimia preventable?

Unfortunately, there is no surefire way to prevent bulimia.

However, you can be a positive influence on someone to promote a healthy relationship with food and body image.

Here are some actions you can take to foster a healthy environment: 

·     If you are raising children, reinforce a healthy body image and help them build confidence regardless of their shape or size 

·     Have regular family meals 

·     Avoid talking about weight at home and focus instead on healthy eating and exercise 

·     Discourage unhealthy dieting such as fasting, using weight-loss supplements or laxatives, or self-induced vomiting 

·     Talk with your primary care doctor so he or she can identify early indicators of eating disorders or help take preventative measures 

How is bulimia treated? 

A combination of medication and psychotherapy is usually the most effective form of treatment for bulimia.

A team of specialists usually come together to treat a patient with bulimia nervosa.

Ongoing therapy with doctors, mental health professionals, and dieticians are usually needed to aid the patient with recovery. 

Psychotherapy, or talk therapy, is extremely important in the recovery process.

The therapist will discuss bulimia and related issues to help normalize eating patterns and identify negative and unhealthy beliefs.

In addition, family-based treatment can help parents intervene to help stop their teenagers unhealthy eating behaviors and help the family deal with the problems that come with bulimia. 

In addition to therapy, certain antidepressants can help with the treatment of bulimia when combined with psychotherapy.

Currently, the only antidepressant approved for bulimia is  fluoxetine (Prozac), which belongs to the selective-serotonin reuptake inhibitor (SSRI) class of medications. 

Dieticians can help design an eating plan to help the patient achieve healthy eating habits to avoid binging.

Sometimes hospitalization is required to treat severe symptoms of bulimia. This can include inpatient programs or day treatment. 

Even when people recover they may enter into more cycles of binging and purging, so it is important to follow up with the treatment team during high times of stress or other life circumstances in order to prevent a relapse. 

How can I support a loved one with bulimia? 

If you suspect someone you are close to may have symptoms of bulimia, have an open and honest conversation with them about your concerns.

You can help them find the right specialist that can put them on the right path to treatment.

Most people with bulimia are usually at a normal weight or slightly overweight, so it may be difficult to notice that something is wrong.

The following are specific things to be aware of that might indicate someone is dealing with bulimia: 

·      Constant worry or complaints about being fat

·      Having an excessively negative or distorted body image

·      Repeatedly eating abnormally large amounts of food, especially foods that the person normally avoids

·      Strict dieting or fasting after binge eating

·      Avoiding eating in public or in front of others

·      Going to the bathroom for long periods of time after eating or during meals

·      Exercising excessively

·      Having sore, calluses, or scars on the knuckles or hands

·      Having damaged teeth and gums

·      Fluctuating weight

·      Swelling in the hands and feet

·      Swelling in the face and the cheeks from enlarged glands 

Frequently asked questions (FAQs) about bulimia:

1.   How does bulimia affect the body?

Bulimia is an extremely dangerous disorder.

Chronic, self-induced vomiting can cause a lot of problems in the digestive tract.

Over time, the high acid content of vomit can damage the teeth and cause erosion of the enamel.

Teeth can also become sensitive and gum disease can develop.

In addition, it is possible to rupture the esophagus which can cause blood in the vomit.

2.   Is bulimia a mental illness?

Bulimia nervosa is an eating disorder and mental health disorder.

People who are diagnosed with bulimia try to control their weight by severely restricting the amount of food they consume, and then binge eat and purge food from their body by making themselves throw up or using laxatives.

3.   What are the warning signs and symptoms of bulimia?

There are many symptoms of bulimia, which include the following: 

-Repeated episodes of binge eating

-Self-induced vomiting

-Misusing laxatives and diuretics 

-Distorted body image

-Feelings of guilt or shame about food and eating

-Withdrawal from family and friends after meals

-Hypertensive (high blood pressure) 

4.   How can bulimia kill you?

Bulimia can be fatal because consistent self-induced vomiting can cause many health complications.

These complications include heart failure and extreme electrolyte imbalance caused by severe dehydration.

Vomiting and laxative use can cause this dehydration and is the most common cause of sudden death in people with bulimia. 

5.   Can bulimia cause throat cancer?

Bulimia can cause chronic irritation to the esophagus, which can lead to dysplasia and ultimately tumorigenesis (growth of cancer cells), but only a few cases of esophageal cancer have been reported in patients with bulimia nervosa.

Esophagitis and Barrett’s esophagus are more common complications of bulimia nervosa. 

6.   What medications help bulimia?

Antidepressants may reduce the symptoms of bulimia when used in combination with psychotherapy.

The only antidepressant that is specifically approved for the treatment of bulimia is fluoxetine (Prozac), which is a type of selective serotonin reuptake inhibitor (SSRI). 

7. How do I know if my friend is bulimic?

If your friend has a preoccupation with weight and body shape, he or she may have bulimia.

In addition, feelings of guilt and shame surrounding food and harsh judgement of him or herself may be signs that your friend is suffering from bulimia.

8.   Does bulimia cause heart palpitations?

Your heart is not built to withstand persistent vomiting or use of laxatives.

This type of stress can cause your heart to develop many problems, including irregular heartbeat (arrhythmia), heart palpitations, heart attacks, or death.

Bulimia may also cause gastroparesis, which is when your stomach muscles become partially paralyzed. 

9.   How is someone diagnosed with bulimia? 

In order to diagnose someone with bulimia, doctors will conduct a physical examination along with blood or urine tests.

They will also perform a psychological evaluation to help determine your relationship with food and body image. 

10. Is bulimia an addiction?

Bulimia is a self-destructive eating disorder that can lead to many physical and psychological issues.

People with bulimia feel a loss of control over food and eating, and are more likely to develop an addiction to drugs or alcohol. 

11. What is the death rate of bulimia?

The death rate for bulimia is 3.9%, according to the National Eating disorders Association.

12.   What age group does bulimia affect the most?

Bulimia nervosa affects 2-3 percent of women over their lifetime.

The most common age of onset of bulimia is 12-15 years of age.

Although it is much more common in females, 10 percent of cases have been reported in males. 

Want to learn more about bulimia nervosa? Try these recommended readings!

8 Keys to Recovery from an Eating Disorder: Effective Strategies from Therapeutic Practice and Personal Experience

The authors of this book share their own stories of suffering from and eventually overcoming eating disorders.

Carolyn Costin and Gwen Schubert Grabb walk you through the recovery process including therapy and all the emotions experiences.

If you are suffering from an eating disorder and are seeking help, this book will assure you that you are not alone on this journey and can supplement your therapy and other treatment plans. 

The Bulimia Help Method: A Revolutionary New Approach That Works

This book by Richard and Ali Kerr gives hope that it is possible to recover from bulimia.

It provides a step-by-step guide to recovery to eliminate binge urges and cravings and establish a pattern of regular meals and snacks.

The Kerr’s self-help book will guide you towards building a healthier relationship with food and yourself, as well as effectively deal with setbacks and relapses. 

I am not in recovery. I am in discovery: Journaling my mental illness

Journaling is a great way to help process and keep track of your experiences and feelings while you are going through the debilitating trials and tribulations of bulimia nervosa.

This journal contains 94 daily templates to aid in your discovery process.



Bulimia nervosa.Mayo Clinic. May 10th, 2018.

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