It is estimated that between one and four percent of women in the United States (1.5 million to over 6 million women) will suffer from bulimia nervosa at some point in their lives. While mostly women are affected, men also bear a significant burden, with estimates showing between 100,000 and 1.5 million men suffer from the disease as well. The disorder primarily affects adolescent girls and young women, particularly those who are involved in activities or pursuits where a thin body type is idealized, such as modeling, dance, acting, and cheerleading among others.
Bulimia nervosa (usually referred to as bulimia) is an eating disorder where the affected individual will binge on food (consume a large amount of food in a short period of time) and then immediately try to purge the food from the body in an attempt to prevent weight gain. Purging is most often accomplished by vomiting, but can also be accompanied by laxative and diuretic abuse and excessive exercise.
Symptoms of bulimia may be difficult for friends and family to detect, as many patients with bulimia are high functioning and may not appear to be overweight and are often a healthy weight. However these patients often hide the bulimic behavior.
Those suffering from bulimia nervosa will binge on a large amount of food and feel shame which results in the need to purge the food to prevent weight gain. They will force themselves to vomit, exercise excessively, or use diet pills and laxatives. The cycle can repeat several times a week, and in severe cases, several times a day.
What are signs of bulimia?
A person with bulimia may be thin, overweight, or have a normal weight. Also, bulimic behavior, such as throwing up, is often done in private because the person with bulimia feels shame or disgust. This makes it hard to know if someone has bulimia. But there are warning signs to look out for:
Someone with bulimia may use extreme measures to lose weight by:
- Using diet pills, or taking pills to urinate or have a bowel movement
- Going to the bathroom all the time after eating (to throw up)
- Exercising a lot, even in bad weather or when hurt or tired
Someone with bulimia may show signs of throwing up, such as:
- Swollen cheeks or jaw area
- Calluses or scrapes on the knuckles (if using fingers to induce vomiting)
- Teeth that look clear
- Broken blood vessels in the eyes
Treatment for bulimia nervosa often involves a combination of options and depends upon the needs of the individual. To reduce or eliminate binge-eating and purging behaviors, a patient may undergo nutritional counseling and psychotherapy, especially cognitive behavioral therapy (CBT), or be prescribed medication.
Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on the important role of thinking in how we feel and what we do. CBT that has been tailored to treat bulimia has shown to be effective in changing binging and purging behavior, and eating attitudes. Therapy for a person with bulimia may be one-on-one with a therapist or group-based.
Some antidepressants, such as fluoxetine (Prozac), which is the only medication approved by the U.S. Food and Drug Administration (FDA) for treating bulimia, may help patients who also have depression and/or anxiety. It also appears to help reduce binge-eating and purging behavior, reduces the chance of relapse, and improves eating attitudes. (“Relapse” means to get sick again, after feeling well for a while.)
There is no single cause for bulimia, and a large amount of environmental and social factors are thought to interplay with possible genetic predispositions. The “thin ideal” presented in many western cultures has been demonstrated to be a primary cause. Bulimia can run in families. Traumatic events such as sexual abuse or life stressors have been shown to increase the risk of developing bulimia.
There is no single known cause of bulimia, but there are some factors that may play a part.
- Culture: Women in many Western cultures are under constant pressure to fit a certain ideal of beauty. Seeing images of flawless, thin females everywhere makes it hard for some women to feel good about their bodies.
- Families: If you have a mother or sister with bulimia, you are more likely to also have bulimia. Parents who think looks are important, diet themselves, or criticize their children's bodies are more likely to have a child with bulimia.
- Life changes or stressful events: Traumatic events (like rape), as well as stressful things (like starting a new job), can lead to bulimia.
- Personality traits: A person with bulimia may not like herself, hate the way she looks, or feel hopeless. She may be very moody, have problems expressing anger, or have a hard time controlling impulsive behaviors.
- Biology: Genes, hormones, and chemicals in the brain may be factors in developing bulimia.
What should I do if I think someone I know has bulimia?
- If someone you know is showing signs of bulimia, you may be able to help.
- Set a time to talk. Set aside a time to talk privately with your friend. Make sure you talk in a quiet place where you won’t be distracted.
- Tell your friend about your concerns. Be honest. Tell your friend about your worries about his or her eating or exercising habits. Tell your friend you are concerned and that you think these things may be a sign of a problem that needs professional help.
- Ask your friend to talk to a professional. Your friend can talk to a counselor or doctor who knows about eating issues. Offer to help your friend find a counselor or doctor and make an appointment, and offer to go with him or her to the appointment.
- Avoid conflicts. If your friend won’t admit that he or she has a problem, don’t push. Be sure to tell your friend you are always there to listen if he or she wants to talk.
- Don’t place shame, blame, or guilt on your friend. Don’t say, “You just need to eat.” Instead, say things like, “I’m concerned about you because you won’t eat breakfast or lunch.” Or, “It makes me afraid to hear you throwing up.”
- Don’t give simple solutions. Don’t say, "If you'd just stop, then things would be fine!"
- Let your friend know that you will always be there no matter what.
Untreated bulimia can lead to several other health problems from the repeated vomiting, included chronic gastric reflux, inflammation of the esophagus, dehydration and low potassium, ruptures in the wall of the esophagus, as well as trauma to the back of the throat from trying to trigger the gag reflex. The teeth can have severe dental erosion from the acid from the stomach. Constant vomiting and laxative use can cause severe electrolyte imbalances which may sometimes lead to heart arrhythmias and even cardiac arrest. Patients with bulimia frequently suffer from mental disorders such as depression and anxiety disorders, and sometimes have anorexia as well.
People with bulimia often have other mental health conditions, including:
- Substance abuse problems
Someone with bulimia may also have a distorted body image, shown by thinking she or he is fat, hating her or his body, and fearing weight gain.
Bulimia can also cause someone to not act like her or himself. She or he may be moody or sad, or may not want to go out with friends.
Can someone with bulimia get better?
Yes. Someone with bulimia can get better. A health care team of doctors, nutritionists, and therapists will help the patient recover. They will help the person learn healthy eating patterns and cope with their thoughts and feelings. However, bulimia is a long-term illness that requires vigilance on the part of the patient, and patients may have symptoms even with treatment. People with fewer medical complications of bulimia, and those who are willing and able to take part in therapy have the best chance of recovery.