Bulimia (Binge eating disorder): Symptoms, Causes, Diagnosis & Treatment

Bulimia/Bulimia nervosa is a serious eating disorder characterized by frequent episodes of binge eating followed by extreme efforts to avoid gaining weight, often by vomiting or exercising excessively. This repetitious binge-and-purge cycle can cause damage to your digestive system and create chemical imbalances in the body that harm the functioning of major organs, including the heart. It can even be fatal.

While it is most common among young women, bulimia can affect women and men of all ages. Research indicates that roughly 1.5 percent of women and 0.5 percent of men experience bulimia at some point during their life. It is most common in women, and especially common during the teenage and early adult years. Up to 20 percent of college-age women report symptoms of bulimia. Performers are also at greater risk for eating disorders, as are athletes whose bodies and weights are closely monitored. Dancers, models, and actors may also be at a higher risk.

Self-diagnosis of bulimia: People with this condition binge eat. They then take steps to avoid weight gain. Most commonly, this means vomiting (purging). But it can also mean excessive exercising or fasting.

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How Does Bulimia Affect Your Body?

The most dangerous side effect of bulimia is dehydration due to purging. Vomiting, laxatives, and diuretics can cause electrolyte imbalances in the body, most commonly in the form of low potassium levels. Low potassium levels trigger a wide range of symptoms ranging from lethargy and cloudy thinking to irregular heartbeat and death. Chronically low levels of potassium can also result in kidney failure. Using ipecac syrup is also very dangerous, and can cause sudden death.

What Are The Causes of Bulimia?

There is no single cause of bulimia. While low self-esteem and concerns about weight and body image play major roles, there are many other contributing factors. One may have trouble managing emotions in a healthy way and use eating as an emotional release, binging and purging when feeling angry, depressed, stressed, or anxious.

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What Are The Risk Factors of Bulimia?

Risk factors of bulimia include the following:

  • Poor body image, particularly when paired with strict dieting.
  • Low self-esteem, often stemming from depression, perfectionism, or a critical home environment.
  • Stressful life changes, such as a breakup, going away to college, starting a new job, or going through puberty.
  • History of trauma or abuse, which includes things such as sexual assault, childhood neglect or abuse, troubled family relationships, or the death of a loved one.
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What Are The Symptoms of Bulimia?

Symptoms of bulimia include:

  • Lack of control over eating and being unable to stop eating until the point of physical discomfort and pain.
  • The secrecy surrounding eating by going to the kitchen after everyone else has gone to bed or going out alone on unexpected food runs.
  • Eating unusually large amounts of food with no obvious change in weight.
  • The disappearance of food, numerous empty wrappers or food containers in the garbage, or hidden stashes of junk food.
  • Alternating between overeating and fasting by rarely eating normal meals.
  • Going to the bathroom after meals to throw up.
  • Using laxatives, diuretics, or enemas after eating, or taking diet pills or using the sauna to “sweat out” water weight.
  • The odor of vomit from the bathroom or even the person. They may try to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.
  • Excessive exercising after eating, typically high-intensity calorie burners such as running or aerobics.
  • Calluses or scars on knuckles or hands from sticking fingers down their throat to induce vomiting.
  • Puffy “chipmunk” cheeks caused by repeated vomiting.
  • Discolored teeth (may look yellow, ragged, or clear) from exposure to stomach acid when throwing up.
  • Not underweight since men and women with bulimia are usually normal weight or slightly overweight. Being underweight while purging might indicate a purging type of anorexia.
  • Frequent fluctuations in weight, by 10 pounds or more due to alternating bingeing and purging.

How is Bulimia Diagnosed?

The doctor will conduct a variety of tests for diagnosis of bulimia. These would include physical examination, blood or urine tests, psychological evaluation etc.

The doctor will also use criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which is a diagnostic tool that uses standard language and criteria to diagnose mental disorders. The criteria used to diagnose bulimia includes:

  • Recurrent binge eating
  • Regular purging through vomiting
  • Persistent purging behaviors, like excessive exercising, misuse of laxatives, and fasting
  • Deriving self-worth from weight and body shape
  • Bingeing, purging, and purging behaviors that happen at least once a week for three months on average

The severity of bulimia can be determined by how often, on average, one exhibits binging, or purging behaviors. The DSM-5 categorizes bulimia from mild to an extreme:

  • Mild: 1 to 3 episodes per week
  • Moderate: 4 to 7 episodes per week
  • Severe: 8 to 13 episodes per week
  • Extreme: 14 or more episodes per week

How to Prevent And Control Bulimia?

Prevention of Bulimia includes the following healthy attitudes:

Modeling Behavior – A parent must model healthy eating and exercise behaviors for the kids. Eating healthy and exercising in moderation is important to live a balanced life.

Avoid Negative Image Comments – Never talk about being too thin or too fat. Never link weight or body image with being accepted in society.

Treatment of Bulimia

Treatment of bulimia is done by the following methods:

  • Antidepressants, like fluoxetine (Prozac), is the only antidepressant approved by the U.S. Food and Drug Administration (FDA) to treat bulimia.
  • Psychotherapy, also called talk therapy, can include cognitive behavioral therapy, family-based therapy, and interpersonal psychotherapy.
  • Dietitian support and nutrition education, which means learning about healthy eating habits, forming a nutritious meal plan, and possibly a controlled weight loss program
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Bulimia – Lifestyle Tips

People with bulimia should make the following lifestyle changes:

  • Eat Healthy Meals on a Normal Schedule – Choose healthy foods and eat at regular times throughout the day.
  • Start Walking After Meals – After each mealtime, take a short walk to relax and burn just a few calories to replace any vigorous exercising.
  • Learn to Talk About Things – Don’t keep worries and any reasons behind botheration inside. Talk to a trusted friend, family member, or counselor. Issues with food are often the result of emotional distress that is not shared.
  • Think Positive – Indulge in regular “self-talk.” Practice positive mantras each day like, “I am beautiful for who I am”. Write down positive and encouraging words and put them around the house.

What Are The Recommended Exercises For a Person With Bulimia?

Any of the following types of exercises can be done, depending on personal choices:

  • Dancing
  • Walking
  • Canoeing
  • Snowshoeing
  • Yoga
  • Pilates

Bulimia And Pregnancy – Things to Know

With repeated binging and purging, severe electrolyte abnormalities or heart impediments may put additional stress or pressure on a woman’s body. The combination of medical complications and nutritional deficiencies can increase a woman’s chance of:

  • Preterm labor
  • Placenta previa
  • Pregnancy-induced hypertension
  • Small for gestation sized baby
  • Increased chance for a cesarean delivery

Common Complications Related to Bulimia

Complications from bulimia can include:

  • Kidney failure
  • Heart problems
  • Gum disease
  • Tooth decay
  • Digestive issues or constipation
  • Dehydration
  • Nutrient deficiencies
  • Electrolyte or chemical imbalances

Other FAQs About Bulimia

Q. Are there other health complications one might experience if they have bulimia?

A. Yes, some of these complications may be life-threatening. Severe tooth decay and gum disease is one side effect. Repeated vomiting damages the teeth due to toxic stomach acids which erode the enamel and damage the gums. Repeated purging can also cause dehydration, which can eventually lead to kidney failure, as well as other health complications. Those with bulimia may also suffer from heart and digestive problems. There are also many mental health side effects, including anxiety, depression, and even suicide.

Q. How does a person know if they require inpatient treatment?

A. If symptoms related to an eating disorder are observed or have worsened despite attempts during outpatient treatment, following up with the physician immediately regarding inpatient treatment is reccomended. The patient will be referred to a psychiatrist where the history and symptoms will be reviewed and further medical testing will be required. It is helpful to attend a consultation with a close family member or significant other since it is believed that family support and involvement are very important while struggling with an eating disorder.

Q. How is bulimia different from anorexia nervosa?

A. Both disorders are characterized by an overwhelming drive for thinness and a disturbance in eating behavior. The main difference between diagnoses is that anorexia nervosa is a syndrome of self-starvation involving significant weight loss of 15 percent or more of ideal body weight, whereas patients with bulimia nervosa are, by definition, at normal weight or above.

Bulimia is characterized by a cycle of dieting, binge-eating and compensatory purging behavior to prevent weight gain. Purging behavior includes vomiting, diuretic or laxative abuse. When underweight individuals with anorexia nervosa also engage in binging and purging behavior, the diagnosis of anorexia nervosa supersedes that of bulimia.

The excessive exercise aimed at weight loss or at preventing weight gain is common in both anorexia nervosa and in bulimia.

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