Understanding bulimia nervosa

Bulimia (boo-LEE-me-uh) nervosa, commonly called bulimia, is a serious, potentially life-threatening eating disorder. People with bulimia may secretly binge — eating large amounts of food with a loss of control over the eating — and then purge, trying to get rid of the extra calories in an unhealthy way.

To get rid of calories and prevent weight gain, people with bulimia may use different methods. For example, you may regularly self-induce vomiting or misuse laxatives, weight-loss supplements, diuretics or enemas after bingeing. Or you may use other ways to rid yourself of calories and prevent weight gain, such as fasting, strict dieting or excessive exercise.

If you have bulimia, you're probably preoccupied with your weight and body shape. You may judge yourself severely and harshly for your self-perceived flaws. Because it's related to self-image — and not just about food — bulimia can be hard to overcome. But effective treatment can help you feel better about yourself, adopt healthier eating patterns and reverse serious complications.

Symptoms

Bulimia signs and symptoms may include: Being preoccupied with your body shape and weight Living in fear of gaining weight Repeated episodes of eating abnormally large amounts of food in one sitting Feeling a loss of control during bingeing — like you can't stop eating or can't control what you eat Forcing yourself to vomit or exercising too much to keep from gaining weight after bingeing Using laxatives, diuretics or enemas after eating when they're not needed Fasting, restricting calories or avoiding certain foods between binges Using dietary supplements or herbal products excessively for weight loss

When to see a doctor

If you have any bulimia symptoms, seek medical help as soon as possible. If left untreated, bulimia can severely impact your health. Talk to your primary care provider or a mental health professional about your bulimia symptoms and feelings. If you're reluctant to seek treatment, confide in someone about what you're going through, whether it's a friend or loved one, a teacher, a faith leader, or someone else you trust. He or she can help you take the first steps to get successful bulimia treatment.

Helping a Loved One with Bulimia Symptoms

If you think a loved one may have symptoms of bulimia, have an open and honest discussion about your concerns. You can't force someone to seek professional care, but you can offer encouragement and support. You can also help find a qualified doctor or mental health professional, make an appointment, and even offer to go along.

Because most people with bulimia are usually normal weight or slightly overweight, it may not be apparent to others that something is wrong. Red flags that family and friends may notice include:

Constantly worrying or complaining about being fat
Having a distorted, excessively negative body image
Repeatedly eating unusually large quantities of food in one sitting, especially foods the person would normally avoid
Strict dieting or fasting after binge eating
Not wanting to eat in public or in front of others
Going to the bathroom right after eating, during meals or for long periods of time
Exercising too much
Having sores, scars or calluses on the knuckles or hands
Having damaged teeth and gums
Changing weight
Swelling in the hands and feet
Facial and cheek swelling from enlarged glands

Causes

The exact cause of bulimia is unknown. Many factors could play a role in the development of eating disorders, including genetics, biology, emotional health, societal expectations, and other issues.

Risk Factors

Girls and women are more likely to have bulimia than boys and men are. Bulimia often begins in the late teens or early adulthood.

Factors that increase your risk of bulimia may include:

Biology. People with first-degree relatives (siblings, parents, or children) with an eating disorder may be more likely to develop an eating disorder, suggesting a possible genetic link. Being overweight as a child or teen may increase the risk.
Psychological and emotional issues. Psychological and emotional problems, such as depression, anxiety disorders, or substance use disorders are closely linked with eating disorders. People with bulimia may feel negatively about themselves. In some cases, traumatic events and environmental stress may be contributing factors.
Dieting. People who diet are at higher risk of developing eating disorders. Many people with bulimia severely restrict calories between binge episodes, which may trigger an urge to again binge eat and then purge. Other triggers for bingeing can include stress, poor body self-image, food, and boredom.

Complications

Bulimia may cause numerous serious and even life-threatening complications. Possible complications include:

Negative self-esteem and problems with relationships and social functioning
Dehydration, which can lead to major medical problems, such as kidney failure
Heart problems, such as an irregular heartbeat or heart failure
Severe tooth decay and gum disease
Absent or irregular periods in females
Digestive problems
Anxiety, depression, personality disorders, or bipolar disorder
Misuse of alcohol or drugs
Self-injury, suicidal thoughts, or suicide

Prevention

Although there's no sure way to prevent bulimia, you can steer someone toward healthier behavior or professional treatment before the situation worsens. Here's how you can help:

Foster and reinforce a healthy body image in your children, no matter what their size or shape. Help them build confidence in ways other than their appearance.
Have regular, enjoyable family meals.
Avoid talking about weight at home. Focus instead on having a healthy lifestyle.
Discourage dieting, especially when it involves unhealthy weight-control behaviors, such as fasting, using weight-loss supplements or laxatives, or self-induced vomiting.
Talk with your primary care provider. He or she may be in a good position to identify early indicators of an eating disorder and help prevent its development.
If you notice a relative or friend who seems to have food issues that could lead to or indicate an eating disorder, consider supportively talking to the person about these issues and ask how you can help.

TED Talks

Lessons from a bulimia recovery journey | Dr Lily Battershill

Dr Lily talks about beauty and success in society while reflecting on her own bulimia recovery journey. Dr Lily speaks about her eating disorder recovery journey and explores what beauty looks like and what success looks like when society's expectations are not at the centre of our identity. Dr Lily Battershill is a scientist currently working within the digital mental health space and a yoga and meditation teacher. Lily is passionate about providing a voice of hope to those struggling with mental health and believes that looking at how we feel within, rather than what we look like on the outside, opens a world of possibility.
Removing the Stigma of Talking About Eating Disorders | Gabrielle Bernstein

Have you ever made a comment about someone's weight? Or made a joke about an eating disorder? This talk alters society's perspective on the way mental illnesses such as eating disorders are viewed. Not only can viewers see through the eyes of a young girl suffering from bulimia, but they can also hear the voices in her mind taunting her. Gabby's vulnerability shines through in this passionate TEDx talk with hopes to help inspire others. Gabby is on a mission to help change the perspectives of those around her. She focuses in on the stigma of talking about what is most difficult in life, in her case, eating disorders.