Bulimia Nervosa: Symptoms & Treatment

What is Bulimia Nervosa?

Bulimia nervosa is an eating disorder characterized by cycles of binging and purging of food. Eating disorders are mental health conditions that cause individuals to have unhealthy obsessions with food and weight. Unfortunately, if left untreated, bulimia can be fatal due to the medical complications it can cause.

Anyone can develop bulimia but it’s more common in females and usually develops during adolescence or early adulthood. Individuals with bulimia typically have a normal body weight but have a distorted vision of what their body actually looks like.

People with bulimia will consume large amounts of food at one time followed by purging. Those with bulimia may induce vomiting or they may use laxatives, suppositories, enemas, or diuretics to get rid of the food.

In addition, a person with bulimia may go on extended fasts or exercise excessively to burn off the calories they consume.

It is believed that bulimia nervosa is caused by a combination of genetic factors, stress or trauma, learned behaviors and societal influences.

Differences Between Anorexia and Bulimia Nervosa

Both anorexia and bulimia are considered eating disorders. However, there are important differences between anorexia and bulimia.

Individuals with anorexia engage in self starvation, extreme dieting or exercising to lose weight. These individuals are usually underweight and may appear ill.

An individual with bulimia engages in cycles of binge eating and purging. They often have a normal body weight but still consider themselves too heavy.

With both, individuals judge themselves too harshly, have low self esteem and see flaws in their appearance, often unrealistically.

Although both are considered eating disorders, they have different diagnostic criteria. To be diagnosed with bulimia an individual must show a pattern of binging and purging lasting at least three months and including at least one episode per week of binging and purging.

A diagnosis of anorexia is based on a pattern of the extreme restriction of calorie consumption that leads to weight loss or failure to gain weight. People with anorexia also often experience intense fear of gaining weight or becoming fat. They typically have a severely distorted body image and an inability to recognize the seriousness of their physical and mental condition.

In some cases, medical testing can also indicate anorexia, including lab work, electrocardiograms and bone density screens revealing severe nutritional deficiencies.

Binge eating disorder shares characteristics with anorexia and bulimia but occurs when an individual frequently eats large amounts of food in one sitting. Persons with binge eating disorder often find that they have a difficult time stopping, even though they feel “full.” Unlike bulimia, in binge eating disorder, there is no purging after consuming any food and it often involves repeated and restrictive dieting between binging.

FAQs

What are the Health Problems with Bulimia?

Bulimia can lead to a variety of severe and even potentially life-threatening medical conditions including:

• Tooth erosion and decay
• Constant sore throat 
• Stomach and throat ulcers 
• Esophagitis 
• Electrolyte imbalance
• Muscle weakness
• Bone pain with exercise
• Low blood pressure
• Arrhythmias 
• Heart failure
• Swollen salivary glands
• Constipation or other bowel problems
• Poor concentration
• Gastrointestinal problems, including bloating, heartburn, or acid reflux
• Fertility problems
• Scars, scrapes or calluses on your knuckles (from forced vomiting)
• Fainting
• Irregular menstrual cycles
• Dehydration
• Increased risk of suicide

What Causes Eating Disorders Like Bulimia?

While the exact cause of bulimia is unknown, researchers have identified similar characteristics among people with bulimia. Genetics appear to play a role, as having a family member with bulimia increases the likelihood of developing it.

Emotional health may be another factor and societal pressures that encourage unrealistic body and beauty standards may also contribute to developing this eating disorder.

What Condition is Commonly Comorbid with Bulimia?

Studies have shown that people with bulimia often have other mental health conditions. At least 80% of people with bulimia have at least one other diagnosis of a psychiatric disorder.

This may include major depression, anxiety, bipolar disorder, or substance use disorder. Additionally, many people exhibit symptoms of obsessive compulsive disorder (OCD), social phobia, panic disorder or post traumatic stress disorder (PTSD).

Why is Bulimia So Hard to Overcome?

Contrary to popular belief, bulimia is not just about a desire to eat food. It’s a condition that is directly associated with how a person perceives themselves.

They harshly judge themselves and see flaws that do not truly exist. For many, the cycle of binging and purging is in response to stress or the inability to process their feelings appropriately. For others, the cycle may offer them a sense of control over their life, especially during times of crisis.

Another reason bulimia is hard to treat is that eating disorders are defined by unhealthy relationships with food.

Unlike other conditions that are associated with the abuse of a substance, such as alcoholism or drug addiction, a person with bulimia can’t avoid food.

That means that, with bulimia, an abstinence-based approach to recovery isn’t possible. Rather, persons with bulimia often require a comprehensive recovery strategy that combines psychotherapy, behavior modification, and, for some, pharmacotherapy.

Risk Factors for Bulimia

While research has not identified the exact cause of bulimia, certain risk factors for developing the eating disorder have been isolated. These include:

• Familial history of disordered eating
• Depression
• Anxiety
• Unhealthy outside influences, including media and popular culture
• Stress
• Addictive tendencies 
• Trauma or abuse
• A personal history of food insecurity
• A personal history of body dysmorphic disorder

Signs and Symptoms of Bulimia

Identifying bulimia may be difficult, especially in the earliest stages of the eating disorder because, unlike anorexia, bulimia does not typically cause weight loss.

Nevertheless, bulimia can be recognized by some subtle signs and symptoms. Things to watch for include:

• Frequent trips to the bathroom, especially after eating.
• Excessive exercising
• Preoccupation with body image
• Intense fear of gaining weight
• Symptoms of depression, anxiety or substance abuse
• Feeling out of control
• Feeling guilty or shameful about eating
• Withdrawing socially from friends and family
• Dental issues
• Swollen cheeks or jawline
• Gastrointestinal problems including constipation and acid reflux
• Scars, scrapes or calluses on the knuckles from forced vomiting
• Fainting
• Irregular menstrual cycles
• Muscle weakness
• Bloodshot eyes
• Dehydration

Types of Treatment for Bulimia Nervosa

Treatment for bulimia normally involves addressing the condition, triggers, co-occurring conditions, and any underlying causes or conditions. A variety of interventions are usually involved in bulimia treatment including:

Nutritional Counseling

Nutritional counseling helps individuals develop structured meal plans, maintain a healthy weight, learn to recognize and resist disease triggers, manage urges to binge and purge, and develop healthier relationships with food.

Cognitive Behavioral Therapy (CBT-ED)

Cognitive behavioral therapy for eating disorders (CBT-ED) is considered the treatment of choice for individuals with bulimia nervosa because it addresses issues that are unique to people with eating disorders.

It helps individuals to improve their body image, address perfectionism, understand and cope with their emotions, change their obsessive thinking and compulsive behaviors related to food and develop a healthier relationship with it. This may be accomplished through individual, family or group therapy.

Dialectical Behavioral Therapy (DBT).

Dialectical behavioral therapy (DBT) is a psychotherapeutic approach designed to eliminate maladaptive behaviors. Therapists help individuals to identify triggers that induce binging and purging. This structured treatment provides support to help develop core skills for positive change, including mindfulness practices, distress tolerance, emotion regulation and interpersonal relationship building.

Interpersonal Psychotherapy for Eating Disorders

Interpersonal psychotherapy for eating disorders (IPT-ED) addresses how an individual relates to others and how it impacts their emotional and mental health. Clients work to identify and resolve key relationship based factors to resolve eating disorder symptoms.This approach helps them to better handle conflict, loss, transition and relational difficulties.

Specialist Supportive Clinical Management

The specialist supportive clinical management approach combines two therapeutic components that allow for individuals to progress at their own pace. Psychotherapists address the symptoms of bulimia and also the individual’s life issues. This type of treatment is client centered, recovery oriented therapy and provides education that promotes and supports behavioral change.

Medications

Medications may help to reduce the urge to binge and purge. Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) are helpful, particularly in early recovery and should be used in tandem with psychotherapy and other support resources. Other types of antidepressants may be appropriate for individuals who cannot tolerate or don’t benefit from SSRIs.

Finding Treatment for Bulimia Nervosa

Across the nation, there are treatment centers and highly qualified healthcare professionals that provide specialized treatment for eating disorders.

Organizations such as the National Alliance on Mental Illness (NAMI), National Eating Disorders Association (NEDA) and the National Association of Anorexia Nervosa and Associated Eating Disorders (ANAD) are good resources for individuals who are looking for treatment options and education on the eating disorders.

Consulting with a primary care provider may be a good step toward finding the appropriate level of care and a provider or treatment facility that can address your unique recovery needs.

Treatment may include in person talk therapies utilizing a variety of modalities depending on the severity of the symptoms. This may include intensive outpatient programs or partial hospitalization programs.

Online or virtual therapy may be helpful for people who want convenience, greater flexibility for scheduling appointments and to find care that may be difficult to locate in underserved areas. Studies are indicating that virtual therapy is just as effective as in person care.

Medical treatment may be needed to address the damage that the cycle of binging and purging has on the body. This would include monitoring blood work for nutritional deficiencies or potential indicators of organ damage.

Testing may also be needed to look for any cardiac or gastrointestinal changes. Medications may also be a component of comprehensive treatment. Dental care is likely needed because of the erosion repeated vomiting has on tooth enamel.

If you’re experiencing a co-occurring disorder, such as a drug or alcohol addiction, a dual diagnosis treatment facility may be best for you. These dual diagnosis care facilities specialize in the treatment of co-existing conditions, addressing both simultaneously to help you achieve lasting, whole-person wellness.