Bulimia: Symptoms, Treatments, and Prevention

What Is Bulimia?

Bulimia is a psychological eating disorder in which you have episodes of binge eating (consuming a large quantity of food in one sitting). During these binges, you have no sense of control over your eating. Afterward, you try inappropriate ways to lose weight such as:

• Vomiting
• Fasting
• Enemas
• Excessive use of laxatives and diuretics
• Compulsive exercising

Bulimia, also called bulimia nervosa, tends to start in late childhood or early adulthood. You usually binge and purge in secret. You feel disgusted and ashamed when you binge, and relieved once you purge.

People with bulimia usually weigh within the normal range for their age and height. But they may fear gaining weight, want to lose weight, and feel very dissatisfied with their bodies.

What Are the Causes and Risk Factors for Bulimia?

We don't know the exact cause of bulimia. But research suggests that a mixture of certain personality traits, emotions, and thinking patterns, as well as biological and environmental factors, might be responsible.

Researchers believe this eating disorder may begin with dissatisfaction with your body and extreme concern with your size and shape. Usually, you have low self-esteem and fear becoming overweight. The fact that bulimia tends to run in families also suggests that you might inherit a risk for the disorder.

Other risk factors include:

• Being female
• Depression and anxiety disorders
• Substance use disorders
• Traumatic events
• Stress
• Frequent dieting

What Are Symptoms of Bulimia?

Different people may have different symptoms of bulimia. You may notice changes in both your body and your behavior. Unlike the eating disorder anorexia, someone with bulimia may not lose a lot of weight, so it can be harder to tell what’s going on.

Physical symptoms of bulimia can include:

• Dental problems
• Sore throat
• Swollen glands in your neck and face
• Heartburn, indigestion, bloating
• Irregular periods
• Weakness, exhaustion, bloodshot eyes
• Calluses on your knuckles or backs of your hands from making yourself vomit
• Gaining and losing weight often. Your weight is usually in the normal range, but you may be overweight.
• Dizziness or fainting
• Feeling cold all the time
• Sleep problems
• Dry skin, and dry and brittle nails

Behavioral symptoms of bulimia may include:

• Eating uncontrollably, followed by purging. The National Institutes of Health says you have bulimia if you do this at least twice a week for 3 months.
• Hoarding or stealing food
• Food rituals, like eating only a certain food, chewing more than necessary, or not allowing foods to touch
• Skipping meals or eating only small portions during meals
• Feeling out of control
• Vomiting or abusing laxatives, diuretics, enemas, or other medications to try to lose weight
• Using the bathroom frequently after meals
• Excessive exercising
• Preoccupation with body weigh. Your thoughts about body weight and shape even determine how you feel overall.
• Depression or mood swings
• Drinking large amounts of water or calorie-free beverages
• Often using mints, gum, or mouthwash
• Avoiding friends and activities you used to enjoy

If you or any member of your family has an unhealthy focus on weight and size and/or appears overly interested in food, call a doctor. The sooner you're treated, the better your chances for a successful outcome.

Does Bulimia Have Complications?

Another reason to get prompt treatment is to avoid the serious problems bulimia can cause. They include:

• Erosion of tooth enamel because of repeated exposure to stomach acid
• Dental cavities and discolored teeth
• Tooth sensitivity to hot or cold food
• Gum infections
• Swelling and soreness in your salivary glands (from repeated vomiting)
• Sore and inflamed throat
• Stomach ulcers
• Ruptures of your stomach or esophagus
• Disruption of your poop habits
• Dehydration. This can cause imbalances in certain minerals, called electrolytes, such as calcium and potassium. Low levels of potassium or sodium can cause potentially life-threatening heart or kidney problems. Abnormal electrolyte levels, and drops in blood sugar levels, can also cause seizures.
• Irregular heartbeat
• Heart attack (in severe cases)
• Lower sex drive
• Higher risk for suicidal behavior
• Self-harm, such as cutting yourself
• Alcohol or drug misuse
• Gastroparesis, in which your stomach takes too long to digest food

How is Bulimia Diagnosed?

If your doctor thinks you might have bulimia, they'll probably ask you about your eating habits, if you've lost or gained weight, and whether you have any physical symptoms. They may also:

• Give you a complete physical exam
• Do blood and urine tests
• Give you an EKG to see if you have heart problems resulting from bulimia
• Do a psychological exam that includes questions about your body image

You may also have other tests to rule out medical causes for weight loss or gain.

What Are Bulimia Treatments and Home Remedies?

To treat bulimia, your doctor will consider your physical and psychological needs. Your treatment may include counseling and medications. Often, it involves a team of medical, nutritional, and mental health professionals. They'll try to help you restore your health and healthy eating patterns.

Medical treatments

• Medications. The antidepressant fluoxetine (Prozac) is FDA-approved for the treatment of bulimia. Doctors sometimes recommend other antidepressants or types of medicines.
• Hospitalization. This doesn't happen often. But with serious cases of bulimia, you might be treated in a hospital for a short time. Most eating- disorder programs offer outpatient treatment.

Psychotherapy

• Cognitive behavioral therapy (CBT). In this type of therapy, you learn normal eating habits and watch out for things that lead you to binge or purge. You challenge irrational thoughts and unhealthy behaviors as they arise.
• Family- based treatment (FBT). Often used in children and teens with bulimia, it helps the family deal with the illness and the issues it can cause.
• Interpersonal psychotherapy (IPT). This focuses on problems in your relationships with other people in your life. The way you interact with others can affect your emotional state and mental health.

Nutritional therapy

The goal is to teach you good eating habits. You work with a dietitian to learn to recognize your body's signals of hunger and fullness. They help you stabilize your weight and gain a healthier attitude toward food.

Self-care for bulimia

Along with following your treatment and therapy plan, you can take steps to care for yourself:

• Look after your body. Include healthy foods in your diet to make sure you're getting the nutrients you need. Ask your doctor whether supplements are right for you. And check with your doctor about how much exercise is healthy for you.
• Connect with others. Support from friends and family can help you overcome unhealthy habits and feel better about yourself. A support group might help, too. The National Association of Anorexia Nervosa and Associated Disorders lists several. The National Eating Disorders Association also offers help via chat, text, or phone.
• Avoid your triggers. Don't linger over social media images of people with bodies that are unrealistic for you. Stay away from the scale and your mirror. If stress or boredom triggers binges, practice using healthier ways to deal with them.

What’s the Outlook for People With Bulimia?

Bulimia is difficult to cure. Many people improve, but some may relapse from time to time. In addition, some people who are considered "cured" continue with less-than-normal eating patterns throughout their lives.

But in general, the outlook for people with bulimia is more positive than the outlook for people with anorexia, another eating disorder.

Can Bulimia Be Prevented?

Because we don't know exactly why people get bulimia, it's hard to know how to prevent it. But there are ways to teach children and teens healthy attitudes and behaviors about food and body image. They include:

• Have regular family mealtimes as often as possible.
• Don't talk about weight with your children. Instead, focus on healthy habits.
• Try to promote a healthy, realistic body image in your kids.
• Discourage fad dieting.

Once bulimia has developed, prevention mostly focuses on trying to keep it from getting worse and harming a person's body and sense of self. This can be difficult, since eating disorders can go on secretly for a long time before others suspect what is happening and intervene.

The same is true for relapses during recovery. You might need to go back to the doctor if bulimia symptoms come back.

Call your doctor if:

• You find yourself secretly binge eating, then vomiting or using laxatives.
• You avoid eating in front of other people.
• Your child has an unreasonable fear of being fat and thinks they are fat when they are not.
• Your child avoids eating with others or often visits the bathroom immediately after meals.

When to Call 911

Sometimes, people with bulimia have depression as well as their eating disorder. Call 911 if you or someone who has this condition are thinking about committing suicide.

You can also call the national suicide prevention hotline at 800-273-8255.

Read more on: mental health, eating disorders, bulimia nervosa