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Bulimia Nervosa

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What is Bulimia Nervosa?

Bulimia nervosa, usually referred to as bulimia, is a serious, potentially life-threatening eating disorder that is characterized by:

Frequent and recurrent episodes of overeating coupled with a loss of control (binge eating)
Inappropriate compensatory behaviors such as self-induced vomiting, fasting, laxative misuse, and excessive exercise
Basing self-esteem (how a person feels about oneself) on body shape and weight
Binge eating and inappropriate compensatory behaviors that happen at least once per week for three months

The severity of bulimia is defined as: mild (1-3 episodes per week), moderate (4-7 episodes per week), severe (8-13 episodes per week), or extreme (more than 13 episodes per week).

How Common is Bulimia?

People with bulimia may be slightly underweight, normal weight or overweight. Bulimia symptoms typically start appearing in the late teen years or early adulthood, and bulimia is more common in females. Younger children, adults and males can also develop bulimia. About 3% of young women and 1% of young men struggle with bulimia.

What Causes Bulimia?

Researchers find that bulimia, and eating disorders in general, are caused by a complex interaction of biological, behavioral, psychological and social factors.

The socio-cultural focus on thinness is an environmental contributor to developing bulimia.

What are the Signs and Symptoms of Bulimia?

Emotional and Behavioral

Behaviors and attitudes that show control over food, weight loss and dieting are a primary concern
Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding lots of empty food wrappers and containers
Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and / or smells of vomiting, wrappers or packages from laxatives or diuretics
Appears uncomfortable eating around others or fears eating in public places
Develops food rituals (e.g., eats only a particular food or food group, excessive chewing, does not allow foods to touch)
Skips meals or takes small portions of food at regular meals
Starts a new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism / veganism)
Steals or hides food in strange places
Drinks excessive amounts of water or non-caloric beverages
Uses excessive amounts of mouthwash, mints and gum
Hides body by dressing in baggy clothes
Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness or injury—due to the need to “burn off” calories
Shows unusual swelling of the cheeks or jaw area
Keeps strict schedules to make time for binging and purging
Tends to isolate or avoid usual friends and activities
Looks bloated from fluid retention
Frequently diets
Shows extreme concern with body weight and shape
Frequently checks appearance in the mirror
Has secret recurring episodes of binge eating (eating a larger amount of food than most individuals would eat under similar circumstances and eating it within a short amount of time) and feeling a lack of control over stopping it
Recurring episodes of purging
Extreme mood swings

Physical

Noticeable fluctuations in weight, both up and down
Stomach cramps or other vague stomach complaints (constipation, acid reflux, etc.)
Difficulties concentrating
Abnormal medical test results such as anemia, low thyroid and hormone levels, low potassium, low blood cell counts, or slow heart rate
Dizziness
Fainting
Feeling cold all the time
Sleep problems
Cuts and calluses across the top of fingers from forced vomiting
Dental problems including discolored or stained teeth
Dry skin, brittle nails
Fine hair on body and face
Thinning of hair on head
Muscle weakness
Cold, splotchy hands and feet or swelling of feet
Menstrual irregularities
Poor wound healing
Impaired immune functioning (getting sick often)

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

How is Bulimia Treated?

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

Age, overall health, and medical history
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 child and family. Several different medicines, combined with cognitive behavioral therapy and family-based treatment, have proven helpful in decreasing the frequency of the binge-purge episodes and in the improvement of mood.

Binge-Eating Disorder vs. Bulimia

Binge-eating disorder is characterized by frequent and recurrent episodes of uncontrolled overeating (binge eating). This results in a great deal of stress for the individual. Binge eating is different from bulimia in that binge eating is NOT followed by purging behavior or behavior that is used to undo the effects of binge-eating.