Signs bulimia nervosa
Bulimia Nervosa – Signs, Symptoms & Treatment
Nationwide Children’s Hospital
Overview
Signs & Symptoms
Causes
Diagnosis
Treatment
Complications
Seeking Help
What is Bulimia Nervosa?
An eating disorder is a mental health illness that causes unhealthy eating behaviors.
Bulimia nervosa is one type of eating disorder in which a person regularly eats excessive amounts of food (binge eats) and then attempts to eliminate (purge) the consequences of overeating by vomiting, taking laxatives or diuretics, fasting or exercising excessively. This is often referred to as “binge and purge.
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Though bulimia is more common in teenage girls and women in their early 20s, all young people are at risk.
Because bulimia is a serious illness that can lead to dangerous, life-threatening health complications, it is very important to take any warning signs or symptoms of the disorder seriously.
What Are The Signs and Symptoms?
It can be hard to tell if a child has bulimia. This is because people with the disorder are often at a healthy weight and binge and purge when family and friends are not around.
However, it may be possible to find signs of a binge and purge episode. Large amounts of food missing from the kitchen, several empty food containers or wrappers found in unexpected places, boxes of laxatives or diuretics, or the smell of vomit are all signs.
A child with bulimia may:
- Disappear after meals.
- Hoard food.
- Skip meals or eat small amounts of food at regular meals.
- Have a distorted body image and low self-esteem.
- Exercise excessively.
- Be sad or anxious.
- Withdraw from friends and social activities.
Other signs and symptoms of bulimia include:
- Swollen salivary glands
- Cut or callused knuckles from self-induced vomiting
- Tooth enamel erosion from contact with stomach acid during self-induced vomiting
- Gastrointestinal problems such as stomach cramps, acid reflux and constipation
Substance abuse, impulsivity and self-harm are also common in people with bulimia.
What Causes Bulimia?
Researchers are still studying the causes of bulimia and other eating disorders. It is currently thought that eating disorders might be caused by a combination of biological, genetic, psychological and social factors.
How is Bulimia Diagnosed?
The doctor talks to the child and parent about eating behaviors and other related topics and evaluates the child’s symptoms and medical history.
A physical exam and blood and urine tests are also performed to make sure another condition isn’t causing the child’s symptoms.
In some cases, additional tests are done to check for complications related to bulimia.
How is Bulimia Treated?
Proper treatment for bulimia requires professional help from a multidisciplinary team of specialists. Parents must also educate themselves and play an active role in the treatment process.
Treatment may include:
- Nutrition therapy. A dietitian creates an eating plan to restore healthy eating habits and treat dehydration and electrolyte imbalance.
- Counseling. A therapist or psychiatrist who specializes in eating disorders talks to the child about his or her thoughts and feelings in an effort to change the child’s behavior. Counseling may take place with the child’s parent there or one-on-one.
- Medicine. A psychiatrist may prescribe an antidepressant if the child is also diagnosed with depression or anxiety.
- Hospitalization. Severe complications of bulimia may require hospitalization.
Recovery from an eating disorder takes time and full support from loved ones. Relapse is possible. But with love and thoughtful guidance from parents, a child can recover.
Are There Any Complications Associated With Bulimia?
Potential health complications of bulimia include:
- Loss of menstrual period (amenorrhea) and infertility in girls
- Severe dehydration, which can lead to seizures or kidney failure
- Electrolyte imbalance, which can lead to irregular heartbeat, heart failure, stroke or seizures
- Stomach damage
- Esophagus damage
- Insulin resistance, which can cause Type 2 diabetes
Many of the complications of bulimia can become life-threatening if left untreated. The mental and emotional factors related to bulimia can also lead to suicide.
When Should You Seek Help For Your Child?
Bulimia is easier to treat before it causes severe health problems.
Don’t ignore the signs and symptoms.
If you find signs of binging and purging coupled with other signs and symptoms of bulimia, make an appointment with your family doctor or pediatrician to discuss your concerns.
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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 abuse, 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 abuse.
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
- Addictions, substance abuse, and/or 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.
symptoms and treatment by specialists of the TsIRPP in Moscow
Description of the disease:
- Constant preoccupation with food and irresistible craving for food; the patient periodically cannot resist overeating when a large amount of food is taken in a short time.
- The patient attempts to counteract the effect of obesity from food intake by one or more of the following:
- Self-induced vomiting;
- Misuse of laxatives; nine0006
- Alternative periods of fasting;
- Use of drugs, in particular appetite suppressants.
- If bulimia develops in diabetic patients, they may neglect insulin therapy.
- The patient develops a morbid fear of obesity and sets a clearly defined body weight limit for himself, which is much lower than what the doctor sees as optimal or normal weight.
Often, but not always, there are previous episodes of anorexia nervosa with remission between the two disorders of several months to several years.
The previous episode may be fully expressed or mildly latent with moderate weight loss and / or a transient period of amenorrhea (menstrual irregularities). Bulimia nervosa is usually a stage or variant of anorexia nervosa, but it can be a syndrome in some other mental illnesses. Inadequate compensatory behavior, with which the patient tries to avoid weight gain after an overeating attack, leads to various complications: heart rhythm disturbance (due to potassium loss), impaired functioning of the kidneys and intestines, inflammation of the esophagus, destruction of tooth enamel, enlarged salivary glands. nine0023
Treatment:
- Complex of measures for psychodiagnostics/somatodiagnostics
- Medical treatment
- Diet therapy
- Psychotherapy
Symptoms and signs: Emotional and behavioral signs of bulimia:
- The person becomes very preoccupied with the problem of weight loss, diets and in general with what he eats.
- The sudden disappearance of a large amount of food, a lot of empty packages and containers is a formal sign that a person constantly overeats. nine0006
- Frequent trips to the toilet or bathroom after meals, vomit smell, empty laxative or diuretic packs.
- The person is embarrassed to eat in public.
- The emergence of peculiar food rituals: for example, a person eats only one dish or eats food belonging to only one food group (for example, seasonings), chews food for a long time, does not allow others to touch what he eats, and so on .
- The person may skip meals or eat less than usual. nine0006
- A person can go to the toilet all the time after eating.
- The transition to all kinds of radical diets, including those where entire food groups are excluded from the diet (no sugar, no carbohydrates, no dairy products, vegetarianism, veganism).
- Fear of eating with other people.
- A person may steal food or hide it in unexpected places.
- Excessive consumption of water or other non-caloric fluids. nine0006
- Very frequent use of mouthwash, mints or gum.
- Wearing baggy clothing to hide figure.
- Excessively frequent sports that a person does not refuse regardless of the weather, fatigue or even injury.
- Swelling may occur in the cheeks and jaws.
- Cuts or hardening of the skin on the tips of the fingers (due to frequent vomiting).
- Discoloration of teeth, appearance of plaque. nine0006
- A person deliberately changes his regimen in such a way as to free up time for a long and plentiful intake of food and subsequent attempts to "cleanse" the body from food.
- Removal from the usual affairs and the usual social circle.
- Swollen appearance from excessive fluid intake.
- Frequent diets.
- Excessive preoccupation with one's weight and figure.
- A person constantly looks in the mirror to check if there are any flaws in his appearance.
nine0006 - A person has already secretly subjected himself to compulsive overeating several times (that is, he ate much more in a certain period of time than other people eat under the same conditions). At the same time, a person does not have enough control over himself to stop eating.
- Frequent episodes of eating large amounts of food, followed by attempts to "cleanse" the body of food (vomiting, using laxatives, diuretics, various dietary drugs or through exhausting sports, fasting, etc.)
- The weight of a person remains within the normal range (but sometimes it can be more than normal).
- Noticeable changes in weight, both weight loss and weight gain.
- Stomach cramps and other problems with the gastrointestinal tract (constipation, acid reflux, etc.).
- Violation of the menstrual cycle - the absence of menstruation or menstruation only when taking hormonal contraceptives (such menstruation is not considered to be "real").
nine0006 - Difficulty concentrating.
- Marked abnormalities in the results of laboratory tests (anemia, low levels of thyroid hormones, potassium, low red blood cells, hemoglobin, etc., low heart rate).
- Vertigo.
- Fainting.
- A person is constantly cold.
- Sleep disturbance.
- Cuts or hardening of the skin on the knuckles (due to frequent vomiting). nine0006
- Dry skin.
- Dry and brittle nails.
- Swelling in the region of the salivary glands.
- The appearance of fluffy hair in different places on the body (lanugo).
- Thinning hair on head, dry and brittle hair.
- Caries, discoloration of teeth due to vomiting.
- Weakness in the muscles.
- Yellow skin tone (when eating large amounts of carrots). nine0005 Cold, mottled hands or feet, also swollen feet.
- Wounds heal worse than usual.
- Violation of the immune system.
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- Causes
- Symptoms of bulimia
- Classification
- Diagnostics
- Bulimia Treatment
- 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. nine0023
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; nine0006
- 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. nine0023
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 reality 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; nine0006
- 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 symptoms, 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 bouts of vomiting, enemas, taking 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 cleansing of the body, after which the patient soon begins to feel hungry again. nine0006
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. nine0006 - 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. nine0006
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 to 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. nine0006
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. nine0218
- 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 on : 10/12/2016
Last updated : 11/06/2022
See also
Panic attacks
Apathy
Anxiety
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