Bulimia: Symptoms, diagnosis and treatments

Bulimia nervosa, often called bulimia, is an eating disorder. Individuals with bulimia eat large amounts of food in a relatively short time, often even when they aren't hungry. People with bulimia tend to feel out of control when eating and can't stop eating.

People with bulimia can eat huge quantities of food, sometimes up to 20,000 calories at a time. Binge foods tend to be comfort foods that are sweet, salty, soft, or smooth, and generally high in calories. People with bulimia may binge a few times a week or as frequently as several times a day.

Most people with bulimia are female (85% to 90%) and the disorder usually begins between ages 15 and 20.

There are two types of bulimia:

• purging bulimia. A person with this type makes herself or himself vomit after binging.
• nonpurging bulimia. A person with this type uses laxatives, suppositories, enemas, or diuretics to get rid of the food; may go on an extended fast; or may exercise strenuously to burn it off.

Bulimia nervosa and anorexia nervosa can be quite similar, since those with bulimia may restrict food intake (a characteristic of anorexia) and people with anorexia may binge and purge.

Bulimia can lead to dehydration. Repeated vomiting can cause stomach acids to dissolve protective tooth enamel, making teeth much more vulnerable to decay. Overuse of laxatives can cause chronic gastrointestinal problems. Severe bulimia can lead to heart problems, and sometimes can be deadly.

Some individuals have bulimia for a short time, such as during a stressful a stage of life. Others have it for many years.

Symptoms

Symptoms of bulimia include:

• extreme concern over body weight or body shape.
• eating large quantities of food over a short period, often in secret.
• binge eating followed by self-induced vomiting; use of laxatives, diuretics, enemas or suppositories; fasting or severe dieting; or excessive exercise.

Bulimia can cause a number of physical symptoms including:

• poor concentration
• tooth erosion and decay
• constant sore throat
• muscle weakness
• bone pain with exercise
• low blood pressure
• irregular heartbeat
• swollen salivary glands
• constipation or other bowel problems
• gastrointestinal problems, such as bloating, heartburn or acid reflux
• fertility problems

Diagnosing bulimia

An important element for diagnosing bulimia is the individual's story of how she or he is feeling. A health care professional will also do a physical exam and may recommend blood tests to check for problems associated with vomiting or laxative use. The exam will also explore whether there are any other areas of mental distress, such as obsessive-compulsive disorder, an anxiety or mood disorder, or problems with substance use.

Treating bulimia

Eating disorders such as bulimia tend to be caused by a mix of physical and emotional problems. Treatment usually aims to address all of these problems by:

• reducing or eliminating binge eating and purging
• treating physical complications caused by bulimia
• helping the individual understand and change harmful thought patterns related to bulimia
• identifying and treat any associated mental health disorders such as depression or anxiety
• encouraging and developing family support

Nutritional counseling helps the individual develop a structured meal plan and learn to recognize, and resist, body cues and urges to binge and purge.

Cognitive behavior therapy can help an individual with bulimia improve her or his body image, understand and deal with emotions, modify obsessive thinking and compulsive behaviors related to food, and create healthy eating behaviors. Family and group psychotherapy can also be helpful.

Medications such as antidepressants can sometimes reduce the urge to binge and purge, particularly in the short term. But medication generally doesn't work alone, and is best when combined with psychotherapy and other kinds of support.

About a quarter of individuals with bulimia get better without treatment. With treatment, more than half improve.

But even after successful treatment, bulimia can return, which is why experts often recommend maintenance treatment.