What Is Bulimia?

Bulimia nervosa – bulimia for short – is a potentially dangerous eating disorder marked by cycles of overeating followed by compensatory behaviors, including forced vomiting – binging and purging. Other forms of purging include the use of laxatives and diuretics, harsh exercise regimens, and adherence to strict diets. Oftentimes, the binge-and-purge cycle is pursued in secret, to avoid detection by others. Individuals who are susceptible to bulimia are frequently concerned, to an unhealthy degree, with their weight or body shape. Low self-esteem has also been implicated. Both sexes can experience bulimia but it is more common in young women than in other segments of society.

The potential for physical harm with bulimia is considerable, and includes tooth decay, fertility issues, gastrointestinal maladies, arrhythmias, heart disease, and death. If a family member is giving evidence of binge-purge behavior, the eating-disorder specialists at Baptist Health may be able to assist in getting you help for bulimia.

Symptoms

Outward signs of bulimia may include obvious weight fluctuations, broken blood vessels in the face, enlarged glands in the neck, and oral trauma, the latter due to regular forced vomiting.

An overview of bulimia can be characterized by the following symptoms:

• An overriding fear of weight gain
• Excessive focus on body shape and appearance
• Periods of excessive food consumption (2,000 or more calories in a single sitting)
• Compensatory behaviors to purge recently consumed calories, including forced vomiting and the use of laxatives, enemas, and diuretics
• Secrecy about meals or an unwillingness to eat with others
• Frequent bathroom use
• Overly rigorous exercise routines
• Pursuit of fasting routines or highly restrictive diets between binge events
• Use of dietary supplements or weight-loss drugs.

Researchers recognize two types of bulimia: purgative and non-purgative. The majority of bulimia sufferers follow the binge-purge cycle. In a minority of cases, compensatory behaviors are limited to extreme exercise regimens and various forms of fasting or dieting.

What Causes Bulimia?

The cause or causes of bulimia are uncertain. As with many other psychological disorders, it is thought that genetics and environment both play a role. Possible indicators include:

• Negative body image, including concerns over weight and shape
• Low self-esteem
• Traumatic or abusive incidents in childhood or adolescence
• Stressful life changes (e.g., the transition to from adolescence to adulthood)
• Social pressures related to the importance of personal appearance.

Risk factors for bulimia include a family history of eating disorders, habitual dieting, and evidence for other psychological or behavioral disorders, including depression, anxiety, or alcohol and drug abuse.

How Is Bulimia Diagnosed?

Here are some steps that your primary care physician or mental-health provider are likely to take in diagnosing bulimia:

• Symptoms documentation: He or she will want a complete list of symptoms, which can be obtained during a detailed question-and-answer session.
• Family medical history: Because of the prevalence of eating-disorder conditions in some families, your physician will want to know your medical history.
• Physical exam: A bulimia physical exam is important in seeing the behaviors it may be having on your overall well-being. This may include blood and urine tests, as well as an electrocardiogram (EKG), to determine any immediate medical risks to heart health.
• Psychological evaluation: You might be asked to fill out a questionnaire with the purpose of documenting medical and behavioral evidence for bulimia. Your physician can use this information, in conjunction with the criteria published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), to make his or her diagnosis.

Though bulimia nervosa is an eating disorder, it is important to note that it may also be a response to more deeply rooted concerns about one’s self image. Individuals with bulimia are neither necessarily obese nor underweight, so to see the condition as purely about a person’s appearance is an oversimplification.

Bulimia Nervosa Treatments

The treatment of bulimia usually combines multiple approaches. The three primary forms of treatment are psychotherapy, medications, and dietary education.

Psychotherapy

Types of psychotherapy employed to treat social anxiety include:

• Cognitive-behavioral therapy (CBT): Cognitive-behavioral therapy is a pragmatic approach to psychotherapy that identifies certain issues in daily living associated with your condition, and provides you with the tools to confront them. It does this by altering the way you think about them, which leads to changes in your emotional responses and behaviors. 
• Family-based therapy: This approach includes parents, with a focus on learning to identify problematic eating behaviors, and ways of revising or improving them. Also addressed are the impacts that bulimia may be having on family dynamics.  
• Interpersonal psychotherapy: Interpersonal psychotherapy emphasizes strengthening relationships through better communication and problem-solving techniques.

Psychotherapy is most effective when supported by a good case-management program.

Medications

Psychotherapy is often utilized with antidepressant medications in the early stages of bulimia treatment. The most commonly prescribed medication is fluoxetine, which from a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). These have been shown to be effective in reducing the symptoms associated with bulimia.  

Dietary Education

Dietary education is another important avenue for addressing bulimia. Developing sound eating habits, featuring regular, nutritional meals, is one key to breaking the binge-and-purge cycle.

In the most extreme cases of bulimia, hospitalization may be required for treating medical complications arising from extended periods of deficient nutrition and dietary self-abuse.  

Bulimia is a tricky and potentially fatal condition. Contending with it can be difficult, because bulimia has both physical and psychological components. Nevertheless, eating disorder treatment options are increasingly shown to be effective, when delivered in ways that address all aspects of the disease. 

Can Bulimia be Prevented?

Preventing bulimia may not be possible but there are steps you can take to lessen its impact in your family:

• Eat regular meals together
• Avoid talk about ideal body shapes, focusing instead on healthy living
• Discourage dieting
• Encourage exercise but not to an obsessive extent
• Act early if you see evidence of a family member developing an eating disorder.

Learn More About Bulimia at Baptist Health

Helping a loved one with bulimia nervosa can be a challenge. Just remember: the caring providers at Baptist Health are on your side. If you’re looking for treatment options or more information about bulimia, please contact a behavioral health provider with Baptist Health today.