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Bulimia nervosa is a baffling disease that causes its victims to binge and purge food. Treatment of bulimia is always complex and takes years, but it is possible to beat the disease.

Bulimia nervosa, more commonly known as just "bulimia",  is an eating disorder that causes its victims to eat large amounts of food over a short period of time and then attempt to avoid weight gain by self-induced vomiting, laxative abuse, or excessive exercise. People who have bulimia are often referred to as "bulimics". In this disease, binge eating is accompanied by a loss of self-control followed by extreme anxiety about its consequences. Only about one percent of cases are fatal, but the condition can cause lasting damage to health and self-image.

Doctors classify bulimia into two types:

  • The purging type of bulimia involves binge eating followed by attempts to remove food from the body by self-induced vomiting, laxatives, or enemas.
  • The non-purging type of buiimia involves binge eating followed by attempts to burn calories with prolonged and vigorous exercise.
Bulimia is most common in older teenagers and young adults. In the United States, about one percent of the population develops the disease, 1.5 percent of women and 0.5 percent of men. The symptoms of bulimia typically persist for about eight years. The condition is more common in people whose hobbies and occupations require gaining weight and losing it quickly, such as wrestlers, weight lifters, boxers, cyclers, runners, gymnasts, figure skaters, dancers, actors, and models. Some scientists believe that up to 20 percent of Americans on active military duty display some features of the disease but not enough to be labeled as bulimic.

What causes bulimia?

People who develop bulimia typically have a negative image of their bodies. They may be dealing with stressful transitions in life, which is one of the reasons the condition is particularly common in young adults. They usually suffer from persistent depression that has interfered with their successes in life, and thus have low self-esteem. They may have a history of trauma or abuse.

What are the symptoms of bulimia?

The DSM-5 defines bulimia as an eating disorder with five key characteristics:

  • Repeated episodes of binge eating, defined as eating more than an average person over a two-hour period, accompanied by a sense of loss of self-control.
  • Repeated attempts to avoid weight gain through inappropriate measures such as vomiting, laxative abuse, or excessive exercise.
  • Binge and purge episodes that occur at least once a week for at least three months.
  • Negative self-image of body weight and size.
  • Absence of anorexia nervosa.

Bulimics usually aren't obese, but they are not unusually thin, either. They often experience a variety of gastrointestinal symptoms, including abdominal pain, bloating, flatulence, constipation, heartburn, and difficulty swallowing. They may lose enough potassium that they become dizzy when they stand up. Women who live with bulimia may have missing or scanty menstrual periods, and both men and women with the condition can develop heart problems.

People who have bulimia usually are particular about their appearance. They are neat, well-dressed, and show meticulous attention to grooming. They often avoid eye contact due to shame and embarrassment. They often are obsessed with food, spending hours watching cooking shows and shopping for groceries. They are often highly intelligent but exercise poor judgment about how they maintain their health.

What are some of the potential complications of bulimia?

Death from bulimia is rare, but hospitalization is common. Some bulimics will require up to six weeks of in-patient care at a time to deal with the psychological issues that often accompany the disease. Stomach acid from forced vomiting can erode the enamel off the teeth, and there can be swelling of the parotid glands at the sides of the face and distortion of the esophagus. Scar tissue and breaks on the skin (Russell's sign) may appear on the knuckles due to repeated attempts to force vomiting. There can be sudden hair loss. The nails may fall out. Bulimics who abuse diuretics and laxatives may develop swelling of the ankles and feet. 

What is the treatment for bulimia?

The first step in treating bulimia is admitting the need for help. Many bulimics delay treatment for years due to shame about their disease. They may be more comfortable beginning with treatments over the Internet or that use a smartphone app until they feel comfortable that they won't lose control while they are under the doctor's care.

Self-help is a start, but it is usually not enough to bring old habits under control. Medication may help in dealing with the anxiety about losing control and binging again. Psychotherapy can help with issues of self-image and personality integration. There can also be a need for help from a nutritionist in restoring nutrient deficiencies causes by purging. And in rare cases there will be a need for gastrointestinal surgery to repair damage done by purging.

The objectives in treating bulimia are first to stop the binge-purge cycle, then to address issues in self-image, and then to address underlying psychological issues that may have caused the disease. There are no miraculous, magic-bullet treatments for bulimia, but with months of dedicated effort it is possible to overcome the disease.

  • Brown CA, Mehler PS. Successful "detoxing" from commonly utilized modes of purging in bulimia nervosa. Eat Disord. 2012. 20 (4):312-20., Keery H, Boutelle K, van den Berg P, Thompson JK. The impact of appearance-related teasing by family members. J Adolesc Health. 2005 Aug. 37(2):120-7.
  • Ribases M, Fernandez-Aranda F, Gratacos M, et al. Contribution of the serotoninergic system to anxious and depressive traits that may be partially responsible for the phenotypical variability of bulimia nervosa. J Psychiatr Res. 2008 Jan. 42(1):50-7. [Medline].
  • Photo courtesy of SteadyHealth

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