Bulimia Nervosa

Bulimia nervosa, usually referred to as bulimia, is defined as uncontrolled episodes of overeating (binge eating) in addition to purging through making oneself throw up, misuse of laxatives, enemas, medications that cause increased production of urine, fasting or excessive exercise.

Bulimia typically has an onset late in adolescence or early adulthood.  It may develop after a period of dieting.  The diagnosis is known for the recurring binge-eating behavior. 

There are two types of bulimia that are based on the behaviors following a binge: purging or non-purging type.  

Purging Type

Regularly engages in making themselves throw up or misuses laxatives, diuretics, or enemas.

Non-Purging Type

Uses other unhealthy behaviors, such as fasting or excessive exercise, to prevent weight gain after binge eating.

Although many people with the disorder will try to keep their illness hidden, parents, teachers, coaches, or friends may be able to recognize some of the behaviors or symptoms of bulimia. If you recognize any of these signs, it is important to consult a medical doctor, or trained mental health professional for assessment and diagnosis.  Early treatment is important for recovery. 

The majority of people with bulimia are female of adolescent or young adult age, but males can also develop bulimia. All Westernized industrial countries have reported cases of bulimia. An estimated 3 percent of people in the United States have bulimia.

Factors believed to contribute to the development of bulimia are biological, psychological, and socio-cultural.  People who develop bulimia are more likely to come from families with a history of eating disorders and other mental health problems. 

Psychologically there are some characteristics that individuals with bulimia share: perfectionism, problems controlling emotions, impulsivity, self-destructiveness, very low self-esteem, avoiding conflict, and fear of abandonment. 

Our Western society’s standard of beauty idealizes unrealistically thin body images for women.  Young women take on these unrealistic ideas of the perfect body, leading  to dissatisfaction with their body. For some this can lead to both extreme dieting and bulimia.  The pattern is similar for young men.

The following are common symptoms of bulimia. Each child may experience the diagnosis differently.

Symptoms may include:

  • Preoccupation with eating, weight and body shape
  • Excessive exercise
  • Negative talk about weight or appearance
  • Anxiety
  • May complain of bloating, fatigue, or weakness
  • Low energy level and fatigue
  • Muscle cramps
  • Chest pain or heartburn  
  • Decreased athletic ability, poor performance
  • May have calluses on the back of their hand from making themselves throw up
  • Irritable bowel syndrome from use of laxatives
  • More likely than people with anorexia to talk about feelings, and will have significant insight to their feelings around binging and purging.

The symptoms of bulimia may resemble other medical problems or psychiatric conditions. Always consult your child's physician for a diagnosis. 

Specific treatment for bulimia will be determined by your child's doctor based on:

  • The person's age, overall health, and medical history
  • The severity of the symptoms
  • Tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition

Parents and family play a vital role in the treatment and recovery process. Bulimia is treated with counseling that usually involves a combination of individual therapy, family therapy, behavior modification and nutritional rehabilitation.

Treatment should always be based on an overall evaluation of the adolescent and family. Several different medications have been proven helpful in decreasing the frequency of the binge-purge episodes and in the improvement of mood. The possibility of medical complications during the course of rehabilitative treatment requires both your child's doctor and a registered dietitian to be active members of the management team.

Last Updated 12/2013