The Facts About Bulimia Nervosa

Bulimia nervosa is an eating disorder characterized by binge-eating episodes. People who experience bulimia feel as if they lack control over their eating during these binges. Additionally, they often experiment with unhealthy methods of losing weight, such as vomiting, fasting, enemas, excessive use of laxatives and exercising compulsively, according to Mayo Clinic.

According to the National Institute of Mental Health, bulimia nervosa typically develops in late adolescence or early adulthood. People with bulimia frequently binge and purge in secret. People with bulimia usually weigh within the normal range for their height, but often face an intense fear of gaining weight, experience a desire to consistently lose weight, and/or feel unsatisfied with their current weight and body.

The exact cause of bulimia is unknown. Multiple factors, including biology, genetics, mental health and societal expectations, could play into the development of the eating disorder. Up to 3 percent of females and more than 1 percent of males suffer from bulimia nervosa during their lifetime.

While epidemiological studies in the past mainly focused on young females from Western countries, bulimia is reported globally among all sexes and ages. Bulimia nervosa may carry a five or more times increased mortality risk.

Females are more likely to have bulimia than males. Factors that increase your risk of bulimia include:

• Biology. People with first-degree relatives—siblings and/or parents—who have bulimia nervosa may be more likely to develop the disorder, which suggests a genetic link. Being overweight as a teen can also increase risk.
• Dieting. People who go on diets are at greater risk of developing eating disorders. Many people with bulimia strictly limit calories between binge episodes, which may lead to an urge to binge and purge. Other triggers include stress, poor body image and boredom.
• Psychological issues. Emotional problems, such as anxiety, depression and substance use disorders, are linked to bulimia. People with the disorder may have negative feelings about themselves. In some instances, past trauma can prove a contributing factor.

Bulimia can be hard to spot. People with the disorder often binge and purge in private. However, behavioral symptoms of bulimia nervosa may include:

• Anxiety
• Depression
• Excessive exercising
• Feeling guilty about eating
• Feeling out of control
• Frequent visits to the bathroom, especially after meals
• Intense fear of gaining weight
• Obsession with body image
• Social isolation
• Excessive use of substances such as drugs and alcohol

Dental issues are some of the most common physical symptoms of bulimia. Self-induced vomiting can cause erosion of the tooth enamel. The teeth may appear clear and be more sensitive.

Other common physical symptoms of bulimia nervosa include:

• Acid reflux
• Bloodshot eyes
• Constipation
• Dehydration
• Fainting
• Irregular menstrual periods
• Muscle weakness
• Scars, scrapes or calluses on the knuckles from forced vomiting
• Swollen cheeks

When diagnosing bulimia, a doctor can conduct several tests to help eliminate other medical causes for weight loss or gain and check for related complications.

Common diagnostic tools for bulimia include:

• Lab tests. These may include a complete blood count and tests that check electrolytes and protein, as well as kidney, thyroid and liver functions. A urinalysis may also be performed.
• Physical exam. This involves measuring height and weight, checking vital signs (heart rate, blood pressure and temperature), checking skin and nails, and listening to heart and lungs.
• Psychological evaluation. A mental health provider may inquire about your thoughts, feelings and eating habits. They may ask you to complete a psychological questionnaire.

The goal of treatment is to reduce symptoms of bulimia nervosa and improve quality of life. It's vital to treat other associated health problems, too. Bulimia treatment is not "one size fits all" and varies from person to person. Treatment may involve a team of providers, such as a mental health provider, a nutritionist and primary care doctor.

Different forms of psychotherapy can be helpful in treating bulimia. Cognitive behavioral therapy (CBT) helps people alter the negative thoughts they may have about their appearance and eating behaviors. Interpersonal psychotherapy helps people with bulimia improve the quality of their relationships and learn how to address interpersonal conflict.

Medications can also be used to treat bulimia nervosa. These medications include a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). Fluoxetine (brand name: Prozac) has been approved by the Food and Drug Administration (FDA) for treating bulimia in adults. If Prozac doesn't improve symptoms, a doctor may prescribe the SSRIs sertraline (Zoloft) or escitalopram (Lexapro). Tricyclic antidepressants such as desipramine (Norpramin) and imipramine (Tofranil) may also be considered, along with mood stabilizers such as topiramate (Topamax).

Learning how to date while suffering from bulimia can be challenging. You may not be ready to share your struggles with someone you are involved with, in which case you should make sure you discuss your situation with your support system.

Dating can be triggering for some people, and you don't want to take part in something that might exacerbate your condition. Still, many people successfully date with bulimia nervosa.

You cannot care for another person in a relationship unless you make self-care a priority. It's important to take care of yourself and be healthy. Have an idea of what you're looking for in a potential date and be unwilling to compromise for anything less than you deserve.

Studies on the incidence of bulimia during pregnancy are limited. Also, the results of studies may be skewed because many pregnant women are reluctant to admit they have bulimia nervosa. A study published in the British Journal of Obstetrics and Gynecology indicated eating disorders affect 5 percent to 8 percent of pregnant women. Many women with bulimia have irregular menstrual periods, but fertility does not appear to be a major problem.

When bingeing and purging, an expectant mother may fail to consume an adequate amount of calcium, and the baby takes calcium from the mother's body to develop its own bones. This lack of calcium could increase the risk of osteoporosis as the woman ages. Fortunately, some bulimic women are able to stop bingeing and purging entirely during pregnancy.

Bulimia nervosa during pregnancy can also produce babies who develop cerebral palsy, cleft palate, liver disorders, blindness and other disabilities. The lack of nutrition places a baby at a greater risk of having learning disabilities and mood disorders.

People with bulimia may struggle to experience joy in their relationships. They may struggle with sexual arousal, pleasure and intimacy during the active and early recovery phases of their disorder.

As with any eating disorder recovery, awakening and reconnecting patients to their bodies and sexual lives takes time and attention. It is vital for a patient beginning recovery to feel safe, both emotionally and physically, as they navigate initial intimacy with their partner. This process includes open communication and tolerance for going at an acceptable pace to support the patient and their recovery.

It is definitely possible to overcome bulimia and experience fulfilling intimacy at the same time. However, it is crucial to understand eating disorders have an influence on a person's physical and emotional well-being. An eating disorder is a complicated mental health issue, and recovery may require patience and perseverance. All parties involved must have patience during the healing process.

A person's sexual function may be affected in one way or another by the complex array of psychological neuroses that lead to eating disorders.

Erectile dysfunction (ED)—the consistent inability to achieve and sustain an erection strong enough for sexual activity—can be a cause of anxiety. Bulimia nervosa and other eating problems frequently occur together with anxiety. Bulimia and ED can also be influenced by perfectionism, having high standards, and being concerned with looks and the body.

Bulimia nervosa can wreak havoc on the body, depriving it of essential calories and nutrients. This can contribute to a host of physical ailments, such as hypertension and diabetes.

Biologically, if men experience nutritional deficits and the body does not have enough calories to function, a reproductive function such as an erection is one of the first to fail.

If you are concerned about a friend or loved one who has bulimia, it's important to encourage them to seek treatment as soon as possible to give them the best chance at recovery.

In addition to treatment, there are other ways you can play an important role in helping them recover: being a good listener, going to the grocery store with them and supporting them by walking the dog or doing some housework.

No two people with bulimia nervosa are exactly alike, so each individual needs to be approached with a different strategy.

Here are some tips to help you support someone with bulimia:

• Acknowledge that they are not to blame.
• Ask them how they are feeling and what they are thinking.
• Don't discuss weight, food and dieting in front of them.
• Educate yourself about bulimia.
• Realize how distressing the eating disorder is for them.
• Reassure them that recovery is possible.
• Try to model a balanced relationship with your own eating habits and fitness regimen.

What do the words "bulimia nervosa" mean?

"Bulimia" comes from the Greek word for "ravenous hunger," and "nervosa" is the Latin word for "nervous." Bulimia nervosa literally translates to "nervous ravenous hunger" in English.

What damage does bulimia nervosa do to your body?

Bingeing and purging take a toll on the body and can cause damage to the cardiovascular and digestive systems, as well as the teeth and gums.

Bulimia can cause other problems, including:

• Acid reflux. When the esophagus is damaged, stomach acid can come back up through it, leading to heartburn.
• Damage to your esophagus. Vomiting can lead to tears in the lining of the esophagus. If the esophagus tears, it can cause severe bleeding.
• Dehydration. The body loses fluids when you vomit or abuse diuretics.
• Difficulty regulating body temperature. When you do not eat enough to give your body the energy it needs, your body temperature may drop.
• Electrolyte imbalances. Dehydration leads to a loss of electrolytes, which are chemicals such as sodium and potassium. Electrolytes help the body keep the right amount of fluid in the blood vessels and organs. A severe electrolyte imbalance could lead to cardiovascular issues, seizures and even death.
• Heart problems. Bulimia can lead to a rapid or fluttering heart rate as well as arrhythmia (irregular heartbeat).
• Low blood pressure. Blood pressure may drop so low that you are at risk of fainting.

Does bulimia nervosa ever go away?

Recovery from bulimia is possible but requires time and effort. Recovery looks different for everyone. The main goal is to have a healthy weight and a healthy relationship with food

Your treatment plan should be customized to you and should consider any other support you may need, such as help with anxiety and depression. About half of women recover from bulimia within a decade of their diagnosis. However, an estimated 30 percent of these women relapse.