21st Nov 2022
Bulimia nervosa is an eating disorder associated with binge eating, followed by behaviors like purging or excessive exercising to compensate for the binge. The condition is often treated with a combination of medication and therapy .
Bulimia nervosa is an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). People with bulimia are fixated on their body shape and weight and they evaluate themselves based on physical appearance. As a result, they engage in episodes of binge eating, during which they feel a lack of control over their food intake .
After a binge, people with bulimia compensate to prevent weight gain. They may abuse laxatives, purge, or excessively exercise to attempt to rid the body of calories consumed during the binge . If left untreated, bulimia nervosa can interfere significantly with daily life and lead to critical medical complications .
The DSM specifies two types of bulimia nervosa: purging and non-purging type. These are described in more detail below .
If a person has bulimia nervosa, they will display both physical and psychological or behavioral signs and symptoms of the eating disorder. Below, these symptoms are described in more detail.
The purging behaviors associated with bulimia can lead to physical symptoms and side effects, including the symptoms below :
Beyond the physical toll on the body, bulimia is associated with behavioral and psychological changes, such as :
Bulimia doesn’t just affect psychological functioning; it harms multiple systems in the body because of repeated binging and purging behaviors. When it is not treated or managed, bulimia increases the risk of the following health problems :
In addition to these physical health problems, bulimia nervosa is associated with other mental health disorders, including depression and personality disorders .
A doctor or mental health clinician will diagnose bulimia nervosa using criteria in the DSM. Before making a diagnosis, a doctor will typically perform a physical examination to assess for common warning signs of bulimia, including bloating, abdominal pain, constipation, irregular menstrual cycles, and sore throat. A physician performing a diagnosis will also check a patient’s height, weight, vital signs, and blood pressure and check the skin and mouth for signs of bulimia .
Since bulimia nervosa is also associated with medical complications, a thorough evaluation during diagnosis will usually involve blood work to test electrolyte levels, liver functioning, and lab tests. Beyond performing these medical tests, a doctor will also rule out alternative diagnoses, such as neurological conditions, biliary disease, or binge eating disorder .
Ultimately, a bulimia nervosa diagnosis occurs when a patient meets the following criteria :
Once a diagnosis is made, bulimia is classified as mild (1-3 episodes of binging/compensatory behaviors per week), moderate (4-7 episodes of binging/compensatory behaviors per week), or severe (8-13 episodes of binging/compensatory behaviors per week) .
There is not one single cause of bulimia nervosa. Several risk factors can make a person more likely to develop this condition. Some common risk factors for bulimia are listed below :
Beyond these specific risk factors, research suggests that individuals with bulimia nervosa have abnormalities in the structure and function of the brain .
The best way to prevent bulimia nervosa is to intervene early when a person demonstrates risk factors. For example, a teen who is beginning to diet and is deeply concerned with weight and body shape may benefit from working with a counselor and/or a nutritionist to help them develop a healthier relationship with food and their body.
If you are concerned about your child, the behaviors you practice at home can reduce their risk of developing bulimia nervosa. For example, avoid making critical comments about your own body or pressuring your child to maintain a certain weight or body shape. If your child makes negative comments about their body, discloses they have been bullied, or seems to have extreme negative moods, they may be at higher risk for developing bulimia. You can help by talking with them and connecting them with a mental health professional to reduce the likelihood of developing an eating disorder like bulimia nervosa.
Medication and therapy are the first lines of treatment for bulimia nervosa, but working with a dietician is also essential for recovery. Learn more about these three treatment options below.
Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat bulimia nervosa because they effectively reduce symptoms of the disorder. The SSRI medication fluoxetine is FDA-approved specifically for the treatment of bulimia nervosa. Other medications in this class, including citalopram and sertraline, may also be used to treat bulimia .
Some other medications that may be used to treat bulimia nervosa include :
Cognitive-behavioral therapy (CBT) and interpersonal therapy are the most common therapeutic modalities used to treat bulimia nervosa . CBT can help patients with bulimia to change unhelpful thinking patterns related to eating disorder behaviors. At the same time, interpersonal therapy aims to help people improve their personal relationships to reduce the symptoms of psychological disorders.
Research suggests that CBT specific to eating disorders is the most effective method for achieving remission among people with bulimia nervosa .
Medication and therapy can reduce some of the symptoms of bulimia, but it is also important for patients to work with a nutritionist to develop healthier eating patterns. A nutritionist is a critical part of an eating disorder treatment team, as they can provide nutrition counseling and help patients to correct any medical complications arising from inadequate nutrition .
If you live with bulimia nervosa, it’s important to seek treatment to manage the condition and reduce the risk of complications from binging and compensatory behaviors. Beyond seeking treatment, the following self-care strategies can improve your mental health:
If a friend or a family member has bulimia nervosa, it’s important to be supportive and help them to find treatment. You can be supportive by learning about the symptoms of bulimia so you have a better understanding of what your loved one is experiencing. You can also show your support by talking with them in a helpful way.
Below are some things you should and shouldn’t say to someone with bulimia nervosa:
The answers to the following questions provide additional information about bulimia nervosa.
Both anorexia and bulimia are eating disorders, but there are differences between the two conditions. Bulimia involves a fixation on weight and body shape. People with this condition engage in binging behavior, followed by compensatory behaviors like vomiting or laxative misuse to compensate for binges.
On the other hand, individuals with anorexia nervosa have an intense fear of weight gain and restrict food intake so severely that they develop a significantly low body weight. While individuals with bulimia tend to be of normal body weight, those with anorexia tend to be significantly underweight and deny the severity of their low body weight. A person with anorexia may fall under the binge/purge subtype, meaning they have episodes of binging and purging, but they continue to restrict calories when not binging. As a result, they maintain a low body weight .
Bulimia nervosa is not a common condition. According to prevalence data, around 0.9% of U.S. adolescents have bulimia nervosa. The prevalence is 1.5% among the general population of adult women and 0.5% among men. Across Europe, North America, and Australia, the prevalence among women ranges from 0.5% to 2.0%, and among men, it ranges from 0.1% to 1.3% .
For most people, bulimia is not a lifelong condition, and people do recover. For example, over a 5-year period, 74% of people with bulimia achieve remission .