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Bulimia Nervosa Fast Facts

Eating disorders like bulimia and anorexia nervosa primarily affect young women. Most individuals with eating disorders have a distorted and negative body image. Those who struggle with binge eating and bulimia focus on their body size, weight and shape in unhealthy ways. They also tend to have obsessive and intrusive thoughts about food and eating.

Many people with bulimia think they look fat, even when their body shape and size actually appear normal. Two to three of every 100 American women experience bulimia at some point in their lives. Treatment is vital because bulimia can cause serious health and dental problems over time. About 2% of young women with bulimia die every decade. Around a fifth of those deaths are due to suicide.

More than 5% of college women suffer from bulimia. About 1-4% of American women experience bulimia at some point in life.

What is Bulimia Nervosa?

Binge eating disorder is eating an excessive amount of food in a relatively short period of time, but without purging. Bulimia nervosa is diagnosed when binge eating is followed by behaviors like self-induced vomiting, misuse of laxatives, diuretics (water pills), and enemas.

Many people who binge eat and purge also suffer from anxiety disorders or obsessive-compulsive disorder (OCD). Bulimia affects an estimated 5% of people who suffer from depression or bipolar disorder. Alcohol abuse, drug use, and other addictions are also common in people with bulimia.

Many people deal with feelings of low self-worth or perfectionism by binge eating in secret. Some mask their unhealthy behaviors with excessive exercise to prevent weight gain. People with the eating disorder only feel good about themselves when they are thin and begin purging when they think they look fat.

People with bulimia:

  • Binge at least once a week for three months or longer.
  • Purge (or exercise excessively) after they eat.
  • Blame and shame themselves if they gain weight.

Every system in the body is dependent on nutrition and healthy eating habits to function properly. An individual’s health is at risk when body rhythms are disrupted by binging and purging.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

What Causes Bulimia Nervosa?

Scientists continue to explore the behavioral, psychological, and social aspects of eating disorders. While the exact causes of binge eating and bulimia remain unknown, researchers suspect that genetics often plays a role [see Heritability].

To avoid gaining weight after overeating, people:

  • Force themselves to vomit.
  • Exercise too much.
  • Use over-the-counter medications to make themselves vomit, urinate, or have bowel movements.
  • Focus their attention on weight and food.

People with binge eating disorder and bulimia often deny that they have a problem. They try to hide their eating disorders from family, friends, and doctors.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

Is Bulimia Nervosa Hereditary?

A new understanding of the role of genetics in eating disorders is bringing insights into how heredity influences people with bulimia. Many genes contribute to the development of an eating disorder. Research suggests that an individual’s vulnerability to the disorder results from a complex interplay of environment and genetics.

Certain personality traits are seen in bulimia — perfectionism, anxiety, and obsessive tendencies — may be influenced by genetics. Studies have pinpointed particular genetic variants on several chromosomes that may add up to greater risk for binge eating and vomiting. Family history suggests that inherited traits may influence the likelihood of using self-induced vomiting as a coping mechanism.

Although eating disorders have long been considered to be largely sociocultural in origin, scientists think that people with bulimia are likely to come from families where the disorder is common. Research shows that self-induced vomiting tends to run in families.

Scientists suspect that abnormal levels of a key neurotransmitter, serotonin, increase susceptibility to bulimia. Researchers at the University of California San Diego Eating Disorder Center have linked bulimia to reduced serotonin levels. Even after recovery from bulimia, low serotonin levels persist. Bingeing on high-carbohydrate foods can raise serotonin levels in the brain and stimulate feelings of pleasure. Scientists think that bulimia probably results from a genetic predisposition, triggered by life events and family environment.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

How Is Bulimia Nervosa Detected?

Bulimia nervosa usually appears in adolescence or the early adult years. Peer pressure, identity issues, and family stresses often seem overwhelming as teens move from childhood into adolescence. Cultural stereotypes about beauty and body shape influence young people in not-so-subtle ways.

The most common signs of bulimia include overeating, excessive exercise, preoccupation with body weight, and an irrational fear of becoming fat.

Common warning signs of bulimia include:

  • Rapid heartbeat
  • Low blood pressure
  • Blood-tinged vomit
  • Dry skin
  • Swelling of the salivary glands in front of both ears
  • Irregular or missed menstrual periods.
  • Acid reflux disease (GERD)
  • Erosion of dental enamel

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

How Is Bulimia Nervosa Diagnosed?

Although overeating and inactivity can account for weight gain, a substantial group of obese people also suffers from binge eating. During binges, people overeat and feel guilty, ashamed, and out of control.

Bulimia nervosa is diagnosed when binge eating is accompanied by unhealthy purging behaviors and excessive exercise. People with bulimia follow episodes of binge eating with laxatives, diuretics, self-induced vomiting, fasting, diet pills, and excessive exercise to prevent weight gain.

Severely bulimic patients may need tests to check levels of key electrolytes like calcium, magnesium, and phosphorus. Electrolyte imbalances commonly result from frequent purging.

The following tests are used to diagnose bulimia:

  • Blood and urine tests can show abnormal nutrient levels and dehydration (a severe drop in water levels in the body).
  • Liver function and kidney tests reveal potential damage to organ systems.
  • An electrocardiogram (EKG) records the electrical activity in the heart and measures heart rate and rhythm.
  • A psychiatric exam focuses on the individual’s attitude about body weight and shape, self-esteem, and any mental health disorders that could affect treatment.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

How Is Bulimia Nervosa Treated?

Because of the secrecy and shame around eating disorders, only about one in 10 people with bulimia nervosa receive treatment. Even with treatment, relapse is common. Although males account for only about 10-15% of people with bulimia, eating disorders among male athletes are the rise, especially in sports where weight is restricted.

Since many people with bulimia struggle with obsessive thoughts, therapy is vital to the process of recovery from eating disorders. Treatment for bulimia focuses on understanding the behavioral, psychological, cultural, and treatment needs of individual binge eaters and bulimics. Obese or overweight people often benefit from a medically supervised behavioral weight-loss program. Those with a substance abuse disorder may need counseling, medications, and self-help support groups.

Many people with bulimia work with an eating disorders team that includes a mental health clinician, nutritionist, and medical support. Antidepressants have been shown to improve symptoms of bulimia, especially in people who also suffer from depression.

A mental health clinician may coordinate care in an outpatient setting or an eating disorder treatment center. Since people with bulimia often struggle with perfectionism and low self-esteem, long-term therapy leads to better outcomes. Psychological treatment to tackle flawed thinking and poor self-image often integrates a number of different therapies:

  • Acceptance and Commitment Therapy (ACT) is a type of psychotherapy that helps people accept things that are largely out of their control. ACT helps individuals give up harmful or self-destructive bulimic behaviors by encouraging flexibility and new ways of thinking.
  • Individual, group, and family psychotherapy. The multifaceted approach focuses on thinking and behaviors. A psychotherapist works one-on-one to support the individual. Family therapy helps parents and adolescents work through relationship problems or interpersonal issues related to bulimia. Some therapists use additional treatment modalities for children or those with a history of trauma.
  • Cognitive-behavioral therapy (CBT) is the leading evidence-based treatment for adults with eating disorders. CBT is considered the “gold standard” treatment for bulimia. The treatment addresses cognitive factors like negative body image, core beliefs about self-worth, and perfectionism. CBT also helps people with binge eating disorder. Mindfulness-Based Cognitive Behavior Therapy integrates concepts of mindfulness into the treatment approach.
  • Dialectical behavioral therapy (DBT) combines mindfulness with techniques for healthy emotional regulation. The focus is on acceptance (rather than change) and learning to cope with difficult emotions.
  • Pharmacotherapy. Antidepressant medication is prescribed for bulimia. Prozac® (fluoxetine) is the only medication approved by the Food and Drug Administration (FDA) to treat bulimia. The usual dose is 60 mg of Prozac to help control symptoms. Additional medications may be prescribed for co-occurring mental health problems, such as bipolar disorder or obsessive-compulsive disorder.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

How Does Bulimia Nervosa Progress?

While symptoms vary widely, people with bulimia nervosa are at risk for medical complications. Shortness of breath, chest pain, joint pain, gastrointestinal problems, menstrual problems, and headaches occur more often in individuals with either bulimia nervosa or binge eating disorder than those without a psychiatric disorder.

People with bulimia often suffer from other  mental health disorders:

  • Depression. Some depressed people try to make themselves feel better by binge eating and purging. Depression causes disruptions in sleep, appetite, energy levels, and memory. Treatment is urgently needed if someone with bulimia and depression becomes suicidal.
  • Anxiety disorders. People try to handle worry or obsessive thoughts by binge eating and/or purging. Mood disorders are common in people with bulimia.
  • Alcohol or drug abuse. Many research studies have linked substance abuse and other addictive behaviors with eating disorders. Nearly one in 10 people with bulimia also have a substance abuse disorder, usually alcohol use.

Over time, bulimia causes a range of worsening medical problems:

  • Fatigue and tiredness
  • Irregular menstrual cycles and missed periods
  • Belly pain, bloating, and constipation
  • Damage to the esophagus (the tube that runs from the throat to the stomach)
  • Severe tooth decay and gum disease

Bulimia often has lasting effects on reproductive health. The danger is greatest when women get pregnant during episodes of active bulimia. Pregnant women are at greater risk for miscarriage, stillbirth, diabetes, and high blood pressure, as well as birth complications and birth defects.

As the disorder progresses, bulimia can cause various medical issues, ranging from irregular heartbeat to high blood pressure, severe headaches, and seizures. Heart failure is among the leading fatal effects of bulimia. In very severe cases, dehydration can lead to kidney failure.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

How Is Bulimia Nervosa Prevented?

While it’s difficult to prevent bulimia nervosa, professional treatment can make all the difference before the situation worsens. Early intervention can teach people better ways to cope with their feelings. Studies show that professional help — and even self-help cognitive behavioral therapy techniques — help individuals who are motivated to stop bingeing and purging. Unresolved personal trauma can contribute to binge eating and bulimia. Examples of common “triggers” for binge eating include:

  • Grief. The loss of an important person.
  • Interpersonal role disputes. Conflicts with a spouse, parent, or coworker.
  • Role transition. A major change in someone’s life circumstances or relationships.
  • Interpersonal problems. Social isolation or difficulty maintaining relationships.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

Bulimia Nervosa Caregiver Tips

The most important thing you can do for a loved one with bulimia nervosa is to be supportive. Try these helpful strategies:

  • Get an accurate diagnosis.
  • Look into a treatment center that specializes in eating disorders.
  • Watch for missing food, such as bags of chips, cartons of ice cream, or other signs of binge eating.
  • Set a good example by not overeating or dieting. Keep only healthy food in the house.
  • Be alert to signs of purging, such as vomit-stained towels.
  • Find therapists who can understand bulimia and can help individuals learn new coping skills.
  • Create a strong support system. The free recovery group Overeaters Anonymous welcomes people with bulimia as well as other eating disorders. Find a local group at [www.oa.org].
  • Connect with others for support. Support groups can be very helpful for people who are struggling to help someone recover from binge eating or bulimia.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

Bulimia Nervosa Brain Science

Scientists continue to investigate the neurobiology of binge eating and bulimia nervosa. Neurotransmitters that carry signals from the brain to the rest of the body play an important role in regulating mood and appetite. Researchers suspect that eating disorders may be caused by an imbalance in levels of the neurotransmitter serotonin.

Serotonin has been shown to be a factor in other brain disorders, including anxiety and depression. Serotonin changes how efficiently neurons communicate with each other.  Brain scans show disruptions in cellular signaling in people with bulimia. As a result of depletion of serotonin, people get too little of this vital neurotransmitter.

The antidepressant Prozac® (fluoxetine) is a SSRI (selective serotonin reuptake inhibitor) that blocks the reabsorption of the chemical to keep levels of serotonin high. Serotonin receptors are not just found in the brain, but throughout the body. In fact, about 80-90% of the human body’s total serotonin is found in specialized cells in the gut, not in the brain. Bulimia damages the nerves that tell the brain that the stomach is full.

Although the exact mechanism of the neurotransmitter is not completely understood, serotonin is known to help regulate mood, social behavior, appetite, digestion, memory, and more. Although research is more limited, researchers believe that people with binge eating disorder also have chronically low levels of serotonin.

Research shows that bulimia is associated with lower levels of another key neurotransmitter, dopamine. Often thought of as the “pleasure” chemical, dopamine has been linked with the brain’s reward system. In fact, alcoholism and other addictions — known to be related to dopamine levels — are particularly common in people with bulimia.  People with bulimia also often have difficulty with impulse control.

Eating is more rewarding and pleasurable for people with binge eating disorder than for healthy people. People with binge eating disorder use food as a reward to compensate for negative emotional states. Brain reward mechanisms drive people to consume large amounts of food during episodes of bingeing.

Binge eating is associated with the release of dopamine in certain regions of the brain. Eating is more rewarding and pleasurable for people with binge eating disorder than for healthy people.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

Bulimia Nervosa Research

Scientists are working on several research projects to expand on what is known about Bulimia Nervosa.  The research will improve knowledge about the factors that increase the risk for Bulimia, as well as the causes, and best treatments, and will aid people living with Bulimia and their caregivers.

We are currently gathering the information required to support projects such as Outpatient Research Study Examining Stress and Eating and Advances from Neuroimaging Studies in Eating Disorders.

*The medical information we gather and publish is vetted and intended to be up to date, accurate and express a spectrum of recognized scientific and medical points of view. The information comes from a nucleus of informed scientists, medical doctors, peer-reviewed scientific journals and the National Institute of Health. Please note, differing points of view among scientists and physicians are common. Every effort is employed to ensure the accuracy of these different points of view. That notwithstanding, it is incumbent on persons using this information to consult with his/her physician before reaching any conclusions. Our medical information and publications are not intended to be a substitute for consultation with one’s physician.

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