Navigating Bulimia Nervosa: Causes, Symptoms, Treatments
Given the intense focus modern society places on thinness, just about everyone worries about their weight from time to time. Yet as a resource created by the American Psychiatric Association explains, for individuals with bulimia and other eating disorders, that concern escalates to an extreme place, engaging in eating behaviors that threaten their well-being and even their lives.
Unfortunately, eating disorders often go untreated, which can have serious consequences for an individual's mental and physical health. The good news is, those who do seek treatment almost always find relief.
Read on to learn about the causes of bulimia, signs that you or a loved one may be at risk, and how treatment can lead to long-term recovery.
What Is Bulimia?
British psychiatrist Gerald Russell, who was the first to define the medical parameters of the condition, derived the term bulimia nervosa from a Greek word meaning ravenous hunger in 1979. Though it can be difficult to compile precise data on the prevalence of eating disorders, experts believe bulimia nervosa, usually referred to simply as bulimia, is one of the three most common (alongside anorexia and binge eating disorder).
This mental health condition—which can be life-threatening—has two primary features. First, the consumption of unusually large amounts of food in a short period of time, accompanied by feeling a loss of control over eating behaviors during that period. Second, attempts to prevent weight gain or induce weight loss by somehow offsetting the food consumed during the binge.
Often, but not always, the second part of the cycle of bulimia involves purging. In fact, doctors categorize bulimia patients as either purging or non-purging.
Vomiting is most likely the best-known method of purging; however, it's also common for individuals with bulimia to ingest laxatives, which speed up the movement of food through the intestines and bowels following a binging episode.
Individuals with bulimia who do not purge still engage in behaviors intended to prevent weight gain, such as exercising for an unhealthy period of time in an effort to burn off the calories they've just ingested, or fasting to compensate.
Key Statistics About Bulimia
According to statistics published by The Lancet, a highly-regarded, peer-reviewed medical journal, bulimia affects 3.6 million people worldwide. Three factors that have greatest impact on a person's likelihood of developing bulimia are gender, age, and country of residence.
The American Psychiatric Association has stated that women develop bulimia at about nine times the rate men do. Research shows that between 2% and 3% of women develop bulimia at some point during their lives.
Bulimia is more prevalent in industrialized than non-industrialized countries, per the findings of a systematic review published in BMJ Clinical Evidence.
Young women show symptoms of bulimia nervosa more frequently than any other demographic.
All that said, this eating disorder can certainly affect individuals of genders and ages living all across the globe. And in some cases, those who do not fit the profile of the typical bulimia patient may face additional barriers to treatment and recovery.
Understanding the Causes of Bulimia
Doctors don’t know exactly what causes bulimia. However, most eating disorders are believed to result from a combination of risk factors, including genetics, underlying psychological conditions, and cultural and environmental considerations.
Experts think genetics account for at least 50% of an individual's risk of developing an eating disorder, which as a resource shared by Eating Recovery Center put it, underscores the "strong familial component."
A review of molecular genetic research into the origins of eating disorders found that women with mothers or sisters who developed bulimia are 4 times more likely to develop bulimia themselves.
As is the case for many eating disorders, bulimia often arises in part from a combination of poor self-esteem and body image issues. Researchers who study bulimia have identified a consistent set of psychological characteristics shared by those who develop bulimia:
- Rigid thought patterns
- Tendency to hyper-focus on details
- Strong link between body image and self-worth
- High harm avoidance, meaning excessive worrying, pessimism, and self-doubt
- Low self-directedness
Culture and Environment
Genetics and psychology do not exclusively determine who will develop an eating disorder. Some individuals with family histories of bulimia will nevertheless form healthy relationships with food while others will be the first in their families to experience an eating disorder.
Often, cultural pressure in combination with triggering events and circumstances can instigate symptoms of bulimia. Some of those factors include:
- Previous experiences of abuse and other types of trauma
- Challenging life transitions
- External pressure to diet and lose weight
- Misguided "heathy eating" messages from parents, coaches, trainers, and other authority figures
31 Bulimia Symptoms to Know
If you're concerned that you or a loved one may be struggling with bulimia or another eating disorder, understanding the signs and symptoms of the condition is an essential precursor to finding the help necessary to break a cycle of disordered eating behaviors.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) lists the following official diagnostic criteria for bulimia nervosa:
- Recurrent episodes of binge eating. An episode of binge eating is characterized by each of the following:
- Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
- A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
- Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics or other medications, fasting, or excessive exercise.
- The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of anorexia nervosa.
Wondering how that translates to a person's lived experience? Experts in the field of eating disorders report the following as some of the most common warning signs and symptoms of bulimia:
- An obsession or preoccupation with body weight
- Frequent instances of binging or eating past the point of comfort
- Regular trips to the bathroom after eating
- Persistent fear of gaining weight
- Compulsive or excessive exercise habits
- Use of laxatives or diuretics
- Unhealthy (often dry) hair, skin, nails, and lips
- Intense focus on dieting and control of food intake
- Evidence of binge eating, including the disappearance of a large amount of food in a short period of time such as empty wrappers or containers
- Discomfort eating around others
- Development of food rituals, such as excessive chewing or dislike of foods touching on a plate
- Experimentation with restrictive diets, namely those that involve cutting out an entire food group
- Stashes of food in strange places
- Extreme consumption of water or other zero-calorie beverages
- Frequent use of mouthwash, mints, and gum (to disguise indications of purging)
- Preference for baggy clothes
- Swelling of cheeks or jaw area
- Calluses on backs of hands and knuckles from self-induced vomiting
- Discolored, stained teeth and dental problems such as cavities, enamel erosion, and tooth sensitivity
- Withdrawal from friends and social activities
- Intense mood swings
- Fluctuations in body weight
- Recurrent stomach cramps and gastrointestinal complaints
- Increased susceptibility to cold
- Dizziness and fainting/syncope
- Difficulties with concentration
- Growth of fine hair on the body
- Poor wound healing
- Decreased immune function
- Abnormal laboratory findings such as anemia, low thyroid and hormone levels, low potassium, low blood cell counts, and a slow heart rate.
It's also common for individuals with bulimia to struggle with co-occurring conditions, including self-harm, substance abuse, risky sexual behavior, and impulsivity.
The Consequences of Living with Bulimia
The human body has a near-miraculous ability to adapt to handle the stress posed by disordered eating behaviors. In some cases, measurements of health such as laboratory tests of certain key markers may appear normal even when someone is, in actuality, at high risk of serious consequences, including death.
According to the site Eating Disorder Hope, bulimia can result in a wide range of medical complications, including weakness and exhaustion, sore throat, and stomach pain. Patients with purging bulimia often experience tooth and gum damage due to frequent vomiting.
Stereotypes hold that bulimia patients are more likely to be at a normal weight than anorexia patients, which can lead people to mistakenly assume that it is a less serious eating disorder. However, the truth is that not only do the binge-and-purge cycles of bulimia have a severely adverse impact on the digestive system, but they can also lead to electrolyte and chemical imbalances that affect the functioning of the heart and other major organs. Bulimia can also result in arrhythmia, weakened heart muscles, and even heart failure.
Ironically, bulimia can also have a negative impact on metabolism. Individuals who purge, abuse laxatives and diuretics, or routinely restrict food to the point of starvation often suffer a shift in metabolic functions. In the long run, this can make it harder to lose weight and keep it off.
The exact health impact of bulimia will vary from person to person and depend in large part on purging behaviors as well as the frequency of binge-and-purge episodes. A wealth of scientific studies have identified the following possible effects of bulimia:
- Chronic gastric reflux
- Dehydration and hypokalemia (low levels of potassium)
- Esophagitis (inflammation of the esophagus)
- Mallory-Weiss tears and Boerhaave syndrome, conditions in which vomiting tears or ruptures the walls of the esophagus
- Lacerations to the mouth or throat from the repetitive insertion of fingers
- Severe dental erosion of tooth enamel from ongoing exposure to stomach acid
- Delayed gastric emptying
- Peptic ulcers
- Constipation or diarrhea
- Elevated blood sugar, cholesterol, and amylase levels
- Heart palpitations
- Electrolyte imbalances, which can lead to abnormal heart rhythms, cardiac arrest, and death
According to the Eating Disorders Coalition, someone dies every 62 minutes as the direct result of an eating disorder. But there is reason for hope. Strong evidence shows that with the proper treatment, the majority of people with bulimia make a full recovery.
Treating Bulimia Nervosa
Doctors usually recommend a multidimensional approach for the treatment of bulimia. In many cases, patients with bulimia work with case managers who coordinate care among the patient, family members, a primary care physician, and dietitian.
According to the Office on Women's Health, a subdivision of the U.S. Department of Health & Human Services, a plan for the treatment of bulimia typically includes some combination of the following elements.
- Nutrition therapy and counseling: Individuals who purge by vomiting or the use of laxatives may develop electrolyte imbalances that require treatment and, in severe cases in which heart or kidney problems have set in, hospitalization. Ongoing nutritional counseling is often a crucial part of breaking disordered eating cycles and learning genuinely healthy eating habits.
- Psychotherapy: Counseling sessions with a mental health professional can help individuals identify emotional triggers and build coping skills. Cognitive behavioral therapy (CBT), a treatment approach focused on uncovering negative beliefs about the self and replacing them with positive ones, can be especially beneficial.
- Support groups: Meeting with others who have had similar experiences and can offer unique support may be a helpful addition to other elements of a treatment plan.
- Medication: The Food and Drug Administration (FDA) has approved the use of fluoxetine (better known as Prozac) for the treatment of bulimia. Studies show it can help to reduce binging and purging behaviors as well as to shift thoughts about eating. For individuals with anxiety, depression, or other co-occurring mental health conditions, other medications may recommended.
According to a study published in the Journal of Clinical Psychology in 2017, the majority of individuals with bulimia will enter long-term recovery (approximately 66%). In some cases, the path to recovery may involve relapses or adapting an initial treatment plan. It may take time, but it is achievable.
Bulimia: Breaking the Cycle
No matter where you or a loved one are in the process of navigating the cycle of bulimia, there are certain steps you can take to protect your health and begin to restore normal function:
- Get plenty of sleep
- Drink enough water
- Prioritize high-nutrient foods
- Get enough essential amino acids
- Limit stress
- Relax and recharge
Remember too that while it can be extremely isolating to be gripped in the cycle of an eating disorder, you are not alone. Numerous resources exist to connect individuals with bulimia, patients as well as their families, with support networks. Visit Eating Disorder Hope to access contact information for a number of non-profit eating disorder organizations located all across the country.
If you are in a state of crisis and need immediate support, you can also contact the National Suicide Prevention Lifeline 24/7 at 1-800-273-TALK to speak confidentially with a trained counselor who can help.