Published on August 30th, 2018
Updated on February 3rd, 2024
Bulimia nervosa (bulimia) is a disorder that many people struggle to live with each day. It is an eating disorder in which a person suffers from a fear of gaining weight. People with bulimia engage in harmful behaviors to prevent weight gain. They will practice extreme dieting and excessive exercising. They will also engage in bingeing and purging.
Bingeing and purging is the act of eating a lot of food in a short amount of time and immediately vomiting or using laxatives. Purging behavior is done to prevent weight gain. A person with bulimia has episodes of eating a large amount of food in a short amount of time, typically within about two hours. They will continue to eat even after they become uncomfortably full. This indulgent behavior will leave them feeling guilty and anxious, which results in purging.
Bulimia is a serious disorder that requires treatment. Without professional treatment, a person with bulimia is at risk of suffering from medical and mental health issues. Life with bulimia is challenging, but with therapy and treatment, people can learn how to overcome the condition and live healthy lives.
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Symptoms of Bulimia Nervosa
Suffering from bulimia is scary, and very challenging to control. A person with bulimia will struggle to feel in control of their condition. They may feel helpless, even if they want to stop the unhealthy behaviors that bulimia causes.
Sometimes it can be difficult to identify symptoms and warning signs of bulimia. This is partially because a person who suffers from bulimia may maintain an average body weight or be overweight. They may also try to hide or downplay their symptoms to avoid attention or confrontation.
Symptoms of bulimia include:
- Bingeing and purging
- Misuse of diuretics or laxatives
- Bad breath or tooth decay
- Withdrawing from friends and family
- Excessive exercise
- Shame about body
- Irritability, especially when confronted with concerns or comments about eating habits or weight
- Struggles with body image
- Low self-esteem
- Suffering from anxiety or depression
- Insecurity about physical appearance
- Deeper emotional issues or life stressors
- Poor ability to manage stress
- Weight loss or gain
- Feeling out of control with life and/or body changes
Symptoms of Bingeing/Purging
- Loss of control of eating habits and binges
- Constipation or irregular bowel movements
- Irregular heartbeat
- Yellowed or discolored teeth
- Sore throat
- Feeling faint
Warning Signs Of Bulimia
Maybe you are questioning if someone you know is struggling with this bulimia. It can be a difficult eating disorder to spot, as those suffering are often increasingly private and secretive. If you know the warning signs and what to look out for, you have a better chance of identifying someone struggling with bulimia.
Binge Eating. Binge eating (bingeing) is one of the most obvious signs that someone is struggling with bulimia. Bingeing typically occurs during a short period of time, resulting in discomfort due to feelings uncomfortably full. This intense urge to eat often begins as a way to deal with uncomfortable emotions, but can rapidly become an obsessive pattern. The obsessiveness that often ensues with bulimia can make it easier to spot the warning signs that may indicate the presence of bingeing.
Missing Food. If you have noticed significant amounts of food missing from your refrigerator or pantry, you may be noticing a telltale sign of bulimia. If you are missing food from your kitchen, there is a good chance you will find empty wrappers, containers, or bags hidden elsewhere in the home.
Secrecy Around Food. Those suffering from bulimia often experience guilt and shame around their eating habits. Maintaining secrecy around food is a way that affected people maintain a facade of “normalcy.” They may hide food in their room, bathroom, car, anywhere that it might be out of sight from others. Also, they may leave their house (or their job) to eat. This way, the affected person can binge on as much food as they desire, without having to be confronted by someone they know.
No Weight Changes Regardless of Food Intake. If you suspect someone you know is struggling with bulimia, an obvious first sign is the quantity of food intake. Yet more suspicious is if there are no weight changes regardless of the immense amounts of food being eaten. People with bulimia may attempt to trick their loved ones into thinking they have not binged throughout the day. They may say things like “I am so hungry” or “I have not eaten at all today” to help prevent questions about the lack of weight fluctuations.
Warning Signs of Bingeing
- Disappearance of food
- Eating large quantities of food at one sitting
- Finding hidden food, wrappers, etc.
- Eating to the point of discomfort
- Secrecy around food
Purging. The physical discomfort and emotions that arise following a binge can leave people with bulimia feeling anxious and overwhelmed. The desperation resulting from a binge frequently creates the urge to purge. While purging is traditionally viewed as throwing up, purging can also take the form of exercising or misuse of laxatives or diuretics.
Getting Up Immediately After Meals. If you suspect someone you know may be suffering from bulimia, begin taking note of their behaviors after a meal. It may arouse some suspicion in you if they are immediately getting up and leaving the table, especially if they go directly to the bathroom.
Purging is most often carried out in a bathroom, but it is not the only place an affected person may purge. They may be secretly throw up in other places. They may vomit into containers and hide them in their room or somewhere else throughout the home, or they may purge outside. If you are smelling vomit in a bathroom or elsewhere in your home, this may be an indicator of purging.
Use of Laxatives or Diuretics. Laxative and diuretic use, which can be difficult to notice, are other ways that people with bulimia carry out purging behavior. Using laxatives and/or diuretics is another attempt for affected people to flush their bodies of the food they have eaten. While this has been proven to be an ineffective way to control weight or get rid of unwanted food and calories, many people with bulimia continue to use these methods. Misuse of laxatives is dangerous and can cause serious side effects to a person’s health.
Warning Signs of Purging
- Going to the bathroom immediately after eating
- Use of laxatives or diuretics
- Spending a long time in the bathroom
- Secrecy (locked doors, running water) while in the bathroom
- The smell of vomit
Causes of Bulimia Nervosa
Several factors may contribute to the onset of bulimia. Each factor that may cause bulimia will put an affected person at higher risk for serious life consequences. These consequences will affect both the body and the mind.
Mental Health Issues. People with bulimia have deeper emotional issues that they may not understand or know how to cope with. This causes the affected person to project their mental health issues onto their body image. They will use bingeing and purging and extreme dieting behaviors in an effort to relieve the pain and stress brought about by their emotional issues. This quickly becomes a maladaptive cycle as the affected person begins to engage in bulimic behaviors as a way to cope with stress.
Mental health issues that can co-occur with bulimia include:
- Low self-esteem
- Low self-worth
- Body dysmorphia (Seeing their body as flawed or malformed)
- Poor stress management skills
Low Self-Esteem. Low self-esteem and a lack of self-confidence may cause a person to engage in harmful behaviors to compensate for their poor self-image. This can be especially prevalent for those who struggle with managing stress in a healthy way. Such people may project their struggles with coping with stress onto their body image because it is a tangible target for their frustration.
Family Influence. Eating disorders can run in families. People with bulimia may have family members who suffer from bulimia or other eating disorders as well. A person can learn behaviors of bulimia when there is someone to model behaviors of bulimia or other eating disorders. Families who value unhealthy body image beliefs can also cause a person to develop unhealthy beliefs and expectations about their own body.
A person with bulimia nervosa will often feel ashamed of their bulimic behaviors, like purging, bingeing, and obsessing about body image. They may also grow fearful of their loved ones discovering their unhealthy behaviors and try to stop them. In an effort to keep the bulimic behaviors a secret, affected people will typically withdraw from their family and friends, who often grow concerned about the warning signs they are noticing.
How Bulimia Nervosa Affects The Body
Bulimia has serious medical and physical health consequences. The destructive behaviors of bingeing and purging have an effect on the affected person’s overall health. Over time, a person with bulimia may suffer from significant medical consequences.
Internal Damage. The act of purging causes stomach acid to be pushed throughout the body. It also causes strain on the stomach muscles and internal organs as the muscles forcefully retract when vomiting and other purging efforts are induced. Common side effects of bingeing and purging include:
- Stomach pain
- Sore throat
- Tooth decay and gum disease
- Fatigue and muscle exhaustion
- Acid reflux
- Swelling of the mouth, cheeks, and jaw
- Constipation or diarrhea from overuse of diuretics, laxatives, and diet pills
These side effects cause discomfort for the affected person. They also serve as warning signs for more serious and long-term health consequences. Such long-term health consequences include:
- Tearing of the esophagus and stomach lining
- Kidney and liver damage
- Amenorrhea (Absence of a menstrual cycle)
Blood in your vomit may be due to tearing of the esophagus, and the need to seek medical attention. Vomiting on a regular basis can also create stomach issues that seriously impact your body’s ability to break down and process food.
Heart Failure. If you struggle with bulimia, you may not realize the internal damage being done to your body. If you purge through vomiting, your body’s electrolyte levels are likely out of balance. Electrolyte imbalances take an extreme toll on the heart’s functioning, causing uncomfortable heart palpitations. These heart palpitations are an indicator of a more serious heart condition and should not be ignored.
Anorexia Nervosa. Bulimia has the potential to develop into anorexia nervosa. The basic goal of bulimic behavior is to prevent weight gain. People with bulimia are not underweight and do not restrict their diets as severely as those with anorexia. The indicative factor that the condition has progressed to anorexia is a low body weight. Once an affected person’s body mass index (BMI) reaches a level below average they are at risk of developing anorexia.
Anorexia is a serious condition that causes a person to restrict their diet and engage in excessive measures to prevent weight gain. It puts people at risk for serious medical issues, including heart failure and sudden death.
Appearance Changes. While you may believe that bingeing and purging is a way to control body shape and size, you may not recognize all the negative physical side effects that will come as a result. People with bulimia often use putting their fingers down their throat as the go-to approach to purging. This is due to the easy accessibility but can result in dried, cracked knuckles and hand callouses. Over time, the stomach bile that comes up with the vomit contributes to yellowing teeth, enamel erosion, and swollen gums. Also, many are unaware that vomiting on a regular basis causes puffy cheeks from distended salivary glands.
Mood Changes. Just like anyone else suffering from a serious mental health disorder, people with bulimia have a lot going on in their minds. If you struggle with bulimia, chances are you have noticed mood fluctuations. This is often from a combination of:
- Negative self-talk
- Low self-worth
- Negative body image
- Effects of malnutrition
Depression surrounding self-perception or life circumstances, experiences, and traumas are common. Anxiety around food or the inability to act out in eating disorder behaviors also contributes to mood changes.
Body Image Issues. A person with bulimia will typically have low self-esteem. They have a poor body image and believe they are not valued or valuable. Feelings of inadequacy or discontent cause a person with bulimia to use symptomatic behaviors as a way to cope with emotional stress.
How Is A Person Diagnosed With Bulimia Nervosa?
It can sometimes be a challenge to accurately identify a case of bulimia. Symptoms can appear to be similar to binge eating disorder or anorexia nervosa. Proper diagnosis of bulimia is an important component of ensuring that an affected person is properly treated. Their symptoms may fluctuate and vary in severity.
Without proper diagnosis treatment will likely be ineffective. There are strict criteria to identify symptoms of bulimia. Since bulimia is similar to anorexia, there are key qualifiers that differentiate the two diagnoses.
A person with bulimia will engage in and try to conceal binge eating behaviors. They will eat a large amount of food within a ~2-hour period. During a bingeing episode, the affected person will struggle to feel in control of their eating. They will also engage in compensatory behavior in an effort to prevent weight gain. This includes vomiting or other methods of purging the body of the calories consumed. This cycle will recur at least once a week for at least three months.
Note: A “binge” is defined as eating an excessive amount of food while feeling out of control. Occasional overeating or overindulging may not be defined as a binge. Bingeing may occur over the span of 2 hours and cause physical discomfort and feelings of helplessness or shame.
What Is The Difference Between Anorexia Nervosa And Bulimia Nervosa?
Bulimia nervosa has similar behavioral patterns as anorexia nervosa, but they are not the same disorder. With anorexia nervosa, an affected person will engage in restrictive behaviors. They will restrict food intake to the point of starvation. They may also engage in purging behaviors in an effort to avoid weight gain.
A person with anorexia will either be underweight or on the verge of becoming underweight. A person with bulimia will not see major fluctuations in body weight. They will instead maintain an average weight or be overweight.
Treatment for Bulimia Nervosa
A person who is suffering from bulimia needs to seek treatment. If left untreated, bulimia will have significant effects on the affected person’s mental health and physical health. With time, it can even develop into anorexia.
Proper medical and psychiatric care is often needed to prevent bulimia from worsening. It can be hard to participate in treatment for bulimia, especially in the initial months. Medical and mental health professionals use a combination of treatments to address medical, mental, and emotional issues that contribute to symptoms.
Such emotional issues that may contribute to the condition of bulimia include:
- Low self-esteem
- Low self-worth
- Body dysmorphic disorder
- Poor stress management skills
A person with bulimia will either be treated in an inpatient or outpatient setting. For more severe cases, an affected person may need to reside in a rehabilitation center. This helps to stabilize their physical and mental health. They will be closely monitored and undergo intensive mental health treatment.
Proper medical and psychiatric care is often needed for the treatment of bulimia. Medical and mental health professionals treat affected people with a combination of:
- Medical monitoring
- Psychiatric medication
- Mental health counseling
- Group therapy
- Nutritional education
- Healthy exercise regiments
A person with bulimia may be resistant to treatment. It can be very stressful for a person with an eating disorder to comply with their treatment plan. They are expected to let go of many unhealthy habits that they believe are helping improve their quality of life, which is stressful. It takes patience, trust, and commitment to help a person with bulimia complete treatment.
Common forms of therapy used for treating a person with bulimia include:
- Cognitive therapy
- Behavioral therapy
- Mindfulness training
- Group therapy
- Nutritional education
- Psychiatric treatment
- Family therapy
Treatment for bulimia requires intensive treatment and a recovery process. With commitment from both the affected person and their family, it is possible to learn tools to cope with their condition. It will take time and patience for an affected person to recover. During recovery, they will learn self-love, healthy coping skills, and an improved sense of body acceptance.
Bulimia should be taken very seriously. If you feel you or a friend is suffering from bulimia or a related disorder it is important to seek help from a mental health professional. This will prevent further complications and get the person in question the help they need.