Bulimia eating disorder

Bulimia Nervosa | Johns Hopkins Medicine

What is bulimia?

Bulimia is an eating disorder. It is characterized by uncontrolled episodes of overeating, called bingeing. This is followed by purging with methods such as vomiting or misuse of laxatives. Bingeing is eating much larger amounts of food than you would normally eat in a short period of time, usually less than 2 hours. You may feel like you can’t stop or control these episodes of binge eating.

The binge-purge cycles can happen from many times a day to several times a week.

Often, people with bulimia keep a normal or above normal body weight. This lets them hide their problem for years. Many people with bulimia don’t seek help until they reach the ages of 30 or 50. By this time, their eating behavior is deeply ingrained and harder to change.

There are 2 ways people with bulimia restrict calories:

Purging type. The person engages in self-induced vomiting or misuse of laxatives, diuretics, or enemas, or other medicines that clear the intestines.
Nonpurging type. The person uses other behaviors, such as fasting or excessive exercise, rather than purging behaviors.

Who is at risk for bulimia?

Bulimia most often affects females and starts during the teenage years. But, it can also affect males. People with bulimia are more likely to come from families with a history of eating disorders, physical illness, and other mental health problems. Other illnesses, such as substance use disorder, anxiety disorders, and mood disorders are common in people with bulimia.

What causes bulimia?

The cause of bulimia is not known. Society and cultural ideals that assign value based on body weight and shape play a role. There is also a genetic link as eating disorders tend to run in families.

What are the symptoms of bulimia?

These are the most common symptoms of bulimia:

Usually a normal or above average body weight
Recurrent episodes of binge eating and fear of not being able to stop eating
Self-induced vomiting (usually secretive)
Excessive exercise
Excessive fasting
Peculiar eating habits or rituals
Inappropriate use of laxatives or diuretics
Irregular or absence of menstruation
Anxiety
Discouraged feelings related to dissatisfaction with themselves and the way their body looks
Depression
Preoccupation with food, weight, and body shape
Throat is always inflamed or sore
Tiredness and decreased energy
Dental problems due to erosion of enamel from vomiting

Most people with eating disorders also share certain traits including:

Low self-esteem
Feelings of helplessness
Fear of getting fat
Intense unhappiness with their body shape and size

If you have bulimia, you may binge to reduce stress and ease anxiety.

With binge eating comes guilt, disgust, and depression.
Purging brings only short-term relief.
You may be impulsive and more likely to take part in risky behaviors, such as alcohol and drug use.

The symptoms of bulimia may look like other medical problems or mental health conditions. Always talk with a healthcare provider for a diagnosis.

How is bulimia diagnosed?

You likely keep your binging and purging secret. This is so family, friends, and healthcare providers won’t know about it. If you seek help from a healthcare professional for bulimia, he or she will want to gather a detailed history of your behaviors from you, your family, parents, and others. Sometimes, psychological testing is done.

Blood tests may be done to check overall health and nutritional status.

Early treatment can often prevent future problems. Bulimia, and the malnutrition that results, can affect nearly every organ system in the body. Bulimia can be deadly. If you suspect bulimia, talk with a healthcare provider for more information.

How is bulimia treated?

Bulimia is usually treated with both individual therapy and family therapy. The focus is on changing your behavior and correcting any nutritional problems.

Therapy looks at the link between your thoughts, feelings, and behaviors. The therapist will explore the patterns of thinking that lead to self –destructive actions and help change that thinking.

Medicine (usually anti-depressants or anti-anxiety medicines) may help if you are also anxious or depressed.

A healthcare provider and a nutritionist will be part of your care.

Your family can play a vital supportive role in any treatment process.

In some cases, a hospital stay may be needed to treat electrolyte problems.

What are the complications of bulimia?

Complications of bulimia include:

Stomach rupture
Heart problems due to loss of vital minerals and electrolytes, such as potassium and sodium
Dental problems, the acid in vomit wears down the outer layer of the teeth
Inflamed esophagus
Swollen glands near the cheeks
Irregular menstrual periods
Kidney problems
Diminished sex drive
Substance use disorder
Compulsive behavior
Depression, anxiety, obsessive-compulsive disorder, and other mental health problems
Suicidal behavior

Living with bulimia

It’s important to follow your healthcare provider’s advice for treating your bulimia. Support is necessary. Try to involve your family and friends in your care.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, tell your healthcare provider.

Key points about bulimia

Bulimia is an eating disorder. It is characterized by uncontrolled episodes of overeating (called bingeing). This is followed by purging by self-induced vomiting, misuse of laxatives, and other methods.
Bulimia typically affects females and starts during the teenage years. But, it can also affect males. Society and cultural ideals that assign value based on body weight and shape play a role in the cause. So does genetics.
People with bulimia keep it very private and hidden.
Bulimia is usually treated with a combination of individual therapy and family therapy. The focus is on changing behavior and correcting any nutritional deficits.
Complications may include heart and kidney problems, inflamed esophagus, dental problems, and others.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.

What Causes Bulimia Nervosa? - Center For Discovery

Written by Ben Mahoney
Categorized Bulimia Nervosa

Bulimia nervosa is an eating disorder that impacts an individual’s mental and physical health. Though we often visualize someone suffering with bulimia to be a young white woman, anyone of any gender, race, ethnicity, or background can struggle with the disorder. Those battling this disorder most often experience intense bingeing episodes, followed by compensatory behaviors such as purging or over-exercising. Though the causes of bulimia are extremely complex, they can be broken down into four categories: biological factors, including traits we inherit via our genes; developmental factors, including our personalities and childhood trauma; psychological factors, including undiagnosed mutually-occurring mental illness; and sociocultural factors, such as diet culture and the thin ideal.

Biological factors associated with bulimia nervosa

Bulimia can be ingrained in your brain or genes; meaning that developing this disorder is not your fault. Genes are heritable traits that we pass down to our offspring and include hair color, eye color, personality traits and an increased prevalence for developing medical and mental health disorders. Although there is no specific gene associated with bulimia nervosa, a familial component appears to be present in the development of eating disorders. First-degree relatives (parents, siblings, and children) of individuals with an eating disorder are more likely to develop an eating disorder than the general public. Neurotransmitters are chemicals in the brain responsible for brain cell communication and mood regulation and serotonin, norepinephrine and dopamine are neurotransmitters that are associated with bulimia nervosa and other eating disorders. Additionally, these specific neurotransmitters are associated with depression, which can lead to the development of bulimia nervosa. Hormones are natural biological chemicals in the body that regulate every physiological process including digestion and studies have shown that hormonal levels can be abnormal in untreated bulimia nervosa and can return back to baseline once the individual undergoes successful treatment.

Developmental factors associated with bulimia nervosa

Our personalities, habits, thought patterns and behaviors become ingrained during childhood and therefore both positive and negative experiences during our developing years can have an everlasting impact on us through adulthood. Childhood abuse and trauma are strongly associated with the development of bulimia nervosa later on in life. Divorce, the loss of parents, emotional, physical, mental, sexual and verbal abuse, bullying and neglect are all strongly linked with the development of a mental health disorder or low-self-esteem resulting in harmful eating disorders such as bulimia.

Psychological factors associated with bulimia

Studies have shown that approximately 30% of individuals who partake in binge and purge behaviors also practice self-harm behaviors such as cutting; thereby a direct link has been associated with bulimia nervosa and self-harm. Depression, anxiety and borderline personality disorder are also closely linked with bulimia nervosa. Treating these underlying psychological disorders is necessary in order to treat bulimia nervosa.

Sociocultural factors associated with bulimia

Peer pressure, media influences and trending diet fads are all associated with the development of bulimia. We live in a society where our image is measured by our body shape and physical appearance. Emotional stress, substance abuse, and the influence of social media are sociocultural factors known to contribute to the development of bulimia nervosa.

Recognizing the causes and understanding that this disorder is not related to one individual cause is necessary to develop the proper treatment plan where all underlying triggers can be addressed. These causes and triggers associated with bulimia nervosa can vary among each individual. For example, some individual may just have the biological components whereas other individuals may have deep-rooted emotional trauma or mental health disorders resulting in their bulimia nervosa.

binging, body image, bulimia, bulimia nervosa, causes, developmental, diet trends, disortion, eating disorder, factors, media, peer pressure, psychological, purging, trigger

signs, symptoms, causes, diagnosis and treatment of the disease

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This disease is treated by a Psychotherapist

The information provided on this page should not be used for self-treatment or self-diagnosis. If you suspect a disease, you should seek help from a qualified specialist. Only your doctor can diagnose and prescribe treatment.

Causes
Symptoms of bulimia
Classification
Diagnostics
Treatment of bulimia
Prophylaxis

What is bulimia?

Bulimia is an eating disorder. The main signs of bulimia are bouts of uncontrolled consumption of large amounts of food, followed by emptying of the stomach by artificial induction of vomiting.

The patient constantly overeats, after which he begins to feel guilty and tries to quickly cleanse the body in various ways (enemas, inducing vomiting, taking diuretics and laxatives). To reduce weight, people begin to torture themselves with heavy physical exertion and go on strict diets.

Most often, the disease occurs in young girls aged 15-24 years, whose weight is in the normal range or slightly higher. Most patients are associated with areas that require weight control (gymnasts, runners, dancers, models).

The diagnosis is made by a psychotherapist by interviewing and examining the patient, using psychodiagnostic questionnaires.

How to cure bulimia? The therapy of the disease is complex and includes diet therapy, antidepressants, psychotherapy Source:
Anorexia and bulimia nervosa: from history to the present. Barylnik Yu.B., Filippova N.V., Deeva M.A. Guseva M.A. Russian Psychiatric Journal No. 3, 2016. p. 36-45.

Causes

This mental disorder usually develops under the influence of social factors, which include:

imposition of artificial beauty standards on the Internet, on television, in advertising;
interpersonal contacts;
excessive self-criticism resulting from the negative influence of someone from close people;
low self-esteem, self-doubt;
desire for ideal forms, excessive pedantry.

Bulimia nervosa is especially prevalent in the EU and the USA, where the fashion industry is well developed and the population is highly exposed to advertising, TV and the Internet. In recent decades, bulimia is increasingly common in Russia.

But in the countries of Latin America or India, where beauty standards are different and "girls in the body" are valued, the number of patients with bulimia is extremely small.

There are a number of other factors that can trigger the development of the disease:

hereditary predisposition;
lack of serotonin in the body;
depression;
chronic stress;
increased anxiety Source:
Modern ideas of young people about eating disorders (bulimia). E. M. Solodovnik, L. A. Nepovinnykh. International Journal of Humanities and Natural Sciences №42, 2020. p. 159-163.

Symptoms of bulimia

The main signs of the disease are:

constant weight control, perception of oneself as a fat person, although in fact it is not, fear of gaining weight;
uncontrollable, obsessive desire to eat;
constant overeating - it happens objective when the patient really eats too much food at a time, and subjective when little food is eaten, but the person thinks that he overeats, the frequency of such episodes in bulimia is at least twice a week in for three months or more, after eating, the patient feels guilt, despair, anger;
getting rid of food eaten artificially to avoid weight gain (taking appetite suppressants, laxatives, inducing vomiting, cleansing enemas).

To confirm the diagnosis of bulimia , the patient must have all 4 of the above symptoms. The diagnosis is made by a psychiatrist after examination and detailed questioning of the patient.

In addition to the above signs, a person with bulimia feels loneliness, helplessness in front of his problem, he develops depression. As a result, in search of support, many people, instead of contacting a specialist, find thematic communities about bulimia and anorexia on the Internet and try to solve their problems on their own, which rarely gives a result. If bulimia is started, then over time this leads to metabolic disorders and the development of diseases of internal organs Source:
Overeating as a way to regulate the emotional sphere of people with cleansing bulimia nervosa syndrome. Svitkevich Yu.V. North Caucasian Psychological Bulletin No. 1, 2021. p. 5-20.

Classification

There are two types of bulimia:

cleansing - after episodes of overeating, the patient tries to get rid of food by causing attacks of vomiting, enemas, laxatives and diuretics;
uncleaning - less common, in this case the patient tries to compensate for overeating with intense sports, fasting.

According to the nature of attacks, three types of disease are distinguished:

paroxysmal - periods of overeating occur suddenly;
nocturnal - attacks of gluttony and hunger occur exclusively at night, during the day the appetite is normal or reduced;
constant - overeating is replaced by body cleansing, after which the patient soon begins to feel hungry again.

Diagnosis

Diagnosis is made by a psychotherapist based on anamnesis, questioning and examination of the patient, results of laboratory and instrumental studies. To determine the degree of metabolic disturbance, a blood test for biochemistry may be prescribed.

If there are indications for diagnosing disorders in the functioning of internal organs, the doctor may prescribe such examinations as ECG, CT, ultrasound and a number of others.

Bulimia treatment

1. Psychotherapy . Bulimia needs to be treated comprehensively. After all, this pathology leads not only to organic and functional disorders, but also to psychopathological consequences for health. Therefore, for those who are looking for ways to get rid of bulimia on their own, it is better not to waste time and immediately seek help from specialists. The main treatment for bulimia today is Cognitive Behavioral Therapy . In addition, interpersonal therapy and cognitive-emotional therapy show good results. Children and adolescents are treated with systemic family therapy.
2. Medical treatment . To correct this pathological condition, the patient is prescribed antidepressants . This helps to quickly normalize the emotional background, reduce the strength and frequency of seizures, which, in combination with psychotherapy, gives good results. With properly selected treatment and patient compliance with all the recommendations of the attending physician, the prognosis is favorable.
3. Food . Patients need to eat varied, wholesome, do not overeat, do not starve, do not go on diets, refuse to take medications for weight loss.

Prevention

To prevent new attacks, the following preventive measures should be observed:

improve the patient's self-esteem;
create a healthy psychological environment in the family;
set a person up for positive thinking;
create a stable and safe environment in the environment. Source:
Transactional analysis of bulimia in a passive-aggressive personality. Dmitrieva N.V., Krasovskaya N.R. Medical psychology in Russia No. 6, 2018. pp. 1-16.

It is necessary that the patient is clearly aware of his problems and understands that the struggle with them must continue until complete recovery. The most important preventive measure is the observance of the principles of rational and healthy nutrition.

Patients with a confirmed eating disorder (EDD) need to see a psychotherapist periodically. The specialists of our clinic will help to cure the disease and avoid the severe consequences of bulimia.

You can make an appointment with a doctor right now by calling the indicated numbers or filling out the feedback form on the website.

Anorexia nervosa and bulimia nervosa: from history to the present. Barylnik Yu.B., Filippova N.V., Deeva M.A. Guseva M.A. Russian Psychiatric Journal No. 3, 2016. p. 36-45
Modern ideas of young people about eating disorders (bulimia). E. M. Solodovnik, L. A. Nepovinnykh. International Journal of Humanities and Natural Sciences №42, 2020. p. 159-163
Overeating as a way to regulate the emotional sphere of people with purgative bulimia nervosa syndrome. Svitkevich Yu.V. North Caucasian Psychological Bulletin No. 1, 2021. p. 5-20
Transactional analysis of bulimia in a passive-aggressive personality. Dmitrieva N.V., Krasovskaya N.R. Medical psychology in Russia No. 6, 2018. p.1-16

Article published : 10/12/2016
Last updated : 11/06/2022

Eating disorders | Tervisliku toitumise informatsioon

Eating disorders are psychiatric illnesses that damage a person's physical and mental health and overall quality of life - relationships, work and personal development suffer.

Eating disorders disrupt the connection with one's own body, resulting in highly problematic eating behavior. Weight and body shape are overemphasized, underweight is idealized, and various methods are used to lose weight or prevent weight gain.

Approximately 8% of women and 2% of men will develop an eating disorder during their lifetime. Eating disorders occur in any population, regardless of gender, age, ethnicity, or socioeconomic status. However, they are most common in girls and young women.

Eating disorders are a group of diseases that are distributed differently in different classifications. The most common eating disorders are anorexia ( anorexia nervosa ), bulimia ( bulimia nervosa ) and compulsive overeating ( binge-eating disorder ).

The term "eating disorder" is often erroneously used as a synonym for selective eating disorder, as both are associated with eating disorders. However, the reasons for them are different: an eating disorder is caused by a desire to control weight, while in a selective eating disorder, eating certain foods causes anxiety or fear.

Other eating disorders

Anorexia, bulimia and binge eating disorders are the three most common and well-known eating disorders. However, often not all of the symptoms of a person with an eating disorder correspond to one specific disorder. In such cases, these disorders are referred to as "atypical" or "other eating disorders". A common myth is that in such cases the course of the disease is milder and treatment is treated more lightly. However, this is erroneous, since the name of the disease indicates only its diagnostic criteria, and not the severity or course.

All eating disorders, no matter how they are called or classified, are dangerous conditions that impair quality of life and require treatment.

Causes of Eating Disorders

There is never one single cause of an eating disorder. These are complex diseases, in the development of which a combination of many factors plays an important role. Genetic, biological and environmental factors always play a role. Modern social representations, including the culture of diets and the cult of slimness, contribute to the development of psychological vulnerability, which can become a fertile environment for the formation of eating disorders. Probably for the same reasons, a higher incidence of eating disorders is observed in sports in which weight is of great importance, and among representatives of professions focused on appearance. However, it should be emphasized that browsing social networks or playing a certain sport does not contribute to the development of the disease. There are many factors involved in the development of the disease that are usually beyond the control of the individual. However, it is often more practical and even more important to identify the factors that support the disease, since changing them is associated with better treatment outcomes.

Treatment Options for Eating Disorders

Eating disorders can be life-threatening illnesses with a long and chronic course; they have one of the highest mortality rates of any psychiatric illness. Treating eating disorders is often a lengthy and complex process. However, early intervention is paramount to achieve a good treatment outcome.
Diagnosis and treatment of an eating disorder usually begins with a family doctor. Family sisters can provide advice on healthy eating. Psychiatrists are specialists in the diagnosis and treatment of eating disorders as a psychiatric illness. The participation of a clinical psychologist or psychotherapist is also important.

There are two centers in Estonia that specialize in the treatment of eating disorders: the Department of Eating Disorders of the Mental Health Center of the Tallinn Children's Hospital treats children and adolescents, and the Department of Eating Disorders of the Psychiatric Clinic of the Tartu University Hospital treats adolescents and adults.

Learn more