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Bulimia Nervosa


Disease: Bulimia Nervosa Bulimia Nervosa
Category: Psychiatric diseases
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Disease Definition:

Generally, when someone has bulimia nervosa, they live in a world of secret shame and self-disgust. Like any addiction, the person will probably feel trapped in this relationship with food.

One of the types of eating disorders is bulimia, in which people are obsessed with their body shape and weight. A condition that causes them to judge themselves severely for perceived flaws. With this disease, the person is bound to engage in episodes of bingeing and purging; eating large amounts of food and then trying to get rid of all the extra calories by unhealthy ways, such as excessive exercise or self-induced vomiting.  

Bulimia can be quite difficult to overcome, because it is so intimately related to self-image and not just about food. However, effective bulimia treatment can help a person in:


  • Adopting healthier eating patterns
  • Reversing serious complications
  • Feeling better about themselves

Bulimia is a serious and potentially life-threatening eating disorder.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


Eating larger amounts of food than most people would eat under similar situations is considered bingeing. So, in bulimia, a person engages in episodes of binge eating followed by attempts to prevent weight gain regularly.

In case someone has bulimia, they could eat a whole cake instead of one slice and continue eating until they're painfully full; this action will be followed by purging. In some cases, when people with bulimia eat only a small snack or a normal size meal, they still feel the need to purge.

Purging bulimia:
In order to compensate for binges, the person will regularly engage in the misuse of laxatives, diuretics or enemas, or self-induced vomiting.

Non-purging bulimia:
Also called exercise bulimia, in this case, people use other methods to rid themselves of calories and prevent weight gain, including over-exercising and fasting.

Generally, one's attempt to get rid of extra calories is called purging despite the method followed, which makes the line between the two types of bulimia blurry. The signs and symptoms of bulimia are similar in both types.

Some of the physical signs and symptoms of bulimia are:


  • Bloating
  • Dry skin
  • Fatigue
  • Dehydration
  • Irregular heartbeat
  • Loss of menstruation (amenorrhea) or menstrual irregularities
  • Abnormal bowel functioning
  • Swollen salivary glands in the cheeks
  • Damaged teeth and gums
  • Sores in the throat and mouth
  • Scars, calluses or sores on the knuckles or hands.

Some of the emotional signs and symptoms that are usually associated with bulimia are:


  • Depression
  • Hoarding food
  • Anxiety
  • Constant dieting
  • Exercising for hours on end
  • Being obsessed with the body shape and weight
  • Eating until the point of discomfort or pain
  • Misuse of laxatives, enemas or diuretics
  • Having a distorted and excessively negative body image
  • Feeling that they can’t control their eating behavior
  • Going to the bathroom after eating or during meals
  • Eating much more food in a binge episode than in a normal meal or snack

Binges occur in private. During one bingeing episode, a person can make the rounds of several fast-food restaurants and secretly eat in the car between stops.

The purging begins once the binge episode ends, at which time the person will probably hit the treadmill for hours of exercise or head to the bathroom to vomit. In most cases of bulimia, it might not be readily apparent that something is wrong, because most people with this eating disorder are of normal weight, or just slightly overweight.


Although it is thought that just like most mental illnesses a variety of biological, psychological and Sociocultural factors are at play, the specific cause of bulimia is still not known.

Some psychological and emotional characteristics could contribute to this disease. People with bulimia may have low self-worth or perfectionism. They may even have trouble managing moods, expressing anger or controlling impulsive behavior. People with bulimia may have a history of sexual abuse, and their families tend to have more conflicts, more criticism and unpredictability.

Young women with a biological mother or sister with an eating disorder is at a great risk of developing bulimia, meaning that there could be a genetic link and studies of twins also support this idea. Some people could be genetically vulnerable to this disorder. Eating behaviors could also be influenced by serotonin, which is a naturally occurring brain chemical that has a connection to the regulation of food intake.

Being thin is usually equated with being successful and particularly among young girls, peer pressure could fuel the desire to be thin and generally, a desire for thinness is cultivated and reinforced by the modern culture.



Often, serious and even life-threatening complications could be caused by bulimia. However, the complications that someone experiences will depend on how severe their condition is, and their method of purging, such as laxative abuse or over-exercise.

Some of the physical complications of bulimia could be:


  • Tooth decay
  • Anemia
  • Absence of a period (amenorrhea) in women
  • Low blood potassium, sodium, chloride or other electrolyte abnormalities
  • Heart problems, such as abnormal heart rhythms and heart failure
  • Nausea, bloating, constipation, or other gastrointestinal problems
  • Death

Some of the other mental health issues that people suffering from bulimia could have include:


  • Anxiety disorders
  • Alcohol abuse
  • Drug abuse
  • Self-injury behaviors
  • Depression
  • Excessive stress
  • Suicide


Even though combining psychotherapy with antidepressants is the most effective treatment for overcoming bulimia, someone may need several types of treatment as well. In treatment for bulimia, usually a team approach is used including dietitians, mental health providers and the patient's primary care doctor or other medical provider, all of which have experience in eating disorders. In order to coordinate all of the patient's care, the patient could also have a case manager.

Depending on the severity of the symptoms, personal preferences, affordability, treatment side effects and other factors, the best treatment option for a person will be decided. The patient should be an active participant in their bulimia treatment. In some cases, a doctor, a guardian or a loved one may need to guide the patient's care until they get well enough to participate in decision making, in case the bulimia is very severe.

Some of the treatment options for bulimia are:

In case the patient has a dietitian on their team, he/she could teach about eating a healthy diet and meeting all nutritional needs. In order to help the patient achieve their weight and nutrition goals, the dietitian can design a customized eating plan.

Also known as therapy, counseling, talk therapy or psychosocial therapy, psychotherapy involves treating bulimia by talking about the condition and related issues with a mental health provider.
Studies have shown that the most beneficial type of therapy used in treating bulimia is the cognitive behavioral therapy. This type of therapy helps a person replace unhealthy and negative beliefs and behaviors with healthy and positive ones. Cognitive behavioral therapy believes that someone's behavior is determined by their own thoughts and not the thoughts of other people or situations.
Bulimia could also be treated with interpersonal therapy, which concentrates on the current relationship of the patient with other people. With this type of therapy the patient learns how to evaluate the way they interact with others and develop strategies in order to deal with communication and relationship problems. The major goal of interpersonal therapy is improving interpersonal skills, including how the patient relates to others; family, friends and colleagues.

Any complication caused by bulimia should be treated, such as anemia. In case someone's complications are serious, they may be hospitalized until their health is stabilized. In order to ensure that the condition isn’t getting worse, the patient will need frequent monitoring of vital signs, hydration level and electrolytes.

Treatment for bulimia could include antidepressants. Although doctors can prescribe some antidepressants and medications to treat bulimia, the only antidepressant approved to treat bulimia by the Food and Drug Administration is fluoxetine, which is a type of SSRI (selective serotonin reuptake inhibitor). Other mental disorders associated with bulimia, including depression and anxiety, could also be treated with antidepressants. It has been suggested that antidepressants could reduce the frequency of bingeing and purging.

Bulimia can usually be treated outside of the hospital, but if the patient have a severe form of bulimia and serious health complications, they may need treatment in a hospital. Hospitalization could be on a medical or psychiatric ward. Rather than full inpatient hospitalization, some clinics or eating disorder programs offer day treatment. Specialized eating disorder clinics offer intensive treatment, usually for several weeks or months.
Bulimia could be quite difficult to manage or overcome, just like other eating disorders. In some cases, bulimia symptoms don’t go away entirely despite the fact that the majority of people with bulimia do recover. Like a chronic condition, bulimia could require long-term care. Through the years, depending on the person's life circumstances, periods of bingeing and purging could come and go. For example someone may return to their familiar and unhealthy eating behavior during times of high distress. In order to prevent a relapse, they should learn positive ways to cope, create healthy relationships and manage stress. However, if they find themselves back in the binge-purge cycle, “booster” sessions with their health care providers usually help in overcoming the crisis before their eating disorder gets out of control again.


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