Disordered eating has existed for hundreds of years and has been documented all over the world. Chronological evidence indicates that eating disorders have been present since the first century.

An eating disorder is exemplified by an atypical and detrimental relationship with food, along with erratic eating behaviors and significant apprehension related to weight, shape and overall appearance. Food intake can vacillate from insufficient amounts to extreme portions and negatively affect many aspects of a person’s life.  

Eating disorders can arise at any point during life, but these disorders most often occur during adolescence or early adulthood. Eating disorders can be remedied, but they can have a significant medical impact, quite possibly being fatal if ignored or untreated.  

Bulimia Nervosa is one of the most common eating disorders in the United States. Bulimia is a debilitating disease that can worsen without treatment.  

What is Bulimia?

Bulimia nervosa is characterized by a repetitive cycle of compulsive binge-eating and compensatory-purging behaviors. Binging occurs when a large amount of food is consumed within a short period of time, which could be long after a person is satisfied.  

The uncontrolled binging often occurs with unhealthy, high-calorie foods and leads to feelings of shame and discomfort. After binging, individuals might desperately seek to alleviate feelings of indignity and distress by attempting to undo what they have eaten.  

People with bulimia might engage in purging behaviors by:  

  • Inducing vomit
  • Exercising excessively
  • Fasting
  • Using laxatives, enemas or diuretics

Individuals often consider purging as a form of punishment for excessive caloric intake and may engage in any behavior to avoid weight gain. Paradoxically, most individuals with bulimia are within normal weight range and body mass index. Unlike anorexia, bulimia does not necessarily cause significant weight loss, which makes detecting and diagnosing the disorder more challenging. 

Compensating behaviors are usually performed in secret, leading to intense feelings of humiliation. This secrecy also makes detecting the disorder increasingly difficult.  

Bulimia arises from a person’s distorted perception, intense dissatisfaction and constant obsession over their body weight, shape or size. Individuals struggle between a commitment and desire to lose weight and an overpowering compulsion to eat excessively, which can prolong this vicious cycle.  

A binge-and-purge cycle can repeat on a daily or weekly basis, depending on severity. A person with bulimia concentrates heavily on their dieting habits and fears associated with body image.  

Purging Type of Bulimia

The purging type of bulimia is the more common form of the disorder and involves self-provoked vomiting and the abuse of diet pills, laxatives, diuretics or enemas. A person with bulimia often tries to induce vomit after a binging episode to lose weight.  

Someone with bulimia might use excessive amounts of laxatives and diuretics, assuming they will excrete food before it can be absorbed. This assumption is erroneous, as calories and nutrients have already been absorbed and processed by the time they are excreted.   

Non-purging type of Bulimia

Non-purging bulimia involves extreme exercising or abstaining from eating, but it does not include self-generated vomiting. These techniques are used to ward off potential weight gain after a binging episode.

Exercise Bulimia

Exercise bulimia was once categorized as a type of bulimia nervosa. However, this form of bulimia is no longer classified this way. Exercise bulimia involves excessively exercising with the intention of eliminating fat and calories.  

Exercise bulimia could be classified as a type of body dysmorphic disorder or be related to obsessive-compulsive behaviors, as a type of anxiety. A person with exercise bulimia worries excessively about their weight and often prioritizes exercise over everything else in their life. They often become apprehensive and feel ashamed if they miss an exercise session. They might also become irritated upon the insinuation that they are exercising too much.      

Symptoms of Bulimia

There are many physical, mental, and emotional symptoms of this eating disorder.  Some facts about bulimia include:

  • Physical symptoms can include gastrointestinal difficulties, cardiac issues and electrolyte and water imbalance.  
  • Psychological symptoms can include weight loss, compulsion, a loss of control and a preoccupation with body image.  
  • Emotional symptoms can consist of anger, apprehension and feelings of helplessness.  

Signs of Bulimia

Shame and culpability are the principal signs of bulimia, along with low self-esteem, lack of confidence and tendencies to criticize perceived flaws. Individuals with bulimia have a fixation and extremely distorted viewpoint of their physical appearance and body shape.  

A constant preoccupation with food, dieting or physical appearance may also be indicative of bulimia. The binging-and-purging cycle may be used as a negative coping mechanism for stress, anxiety and depression.

Social isolation and other behaviors around mealtimes can also be suggestive of bulimia. Individuals with bulimia often consume an excessive amount of food within a short period of time, often excusing themselves shortly thereafter to engage in compensatory behaviors.  

A consistent pattern of withdrawing and going to the bathroom immediately following meals can indicate the presence of bulimia. Eating alone, hoarding sweets and snacks, or excessive fluid intake after eating can also signify the onset of purging behaviors.

Physical Symptoms of Bulimia

Bulimia has an immense and significant physical impact on various body systems. The severity of physical symptoms and the effect on body systems is related to the overall intensity of the disorder.  

Individuals with bulimia often experience disrupted gastrointestinal functioning, including:

  • Bloating
  • Diarrhea
  • Constipation
  • Abnormal bowel movements
  • Acid reflux
  • Heartburn
  • Stomach pain  

Consistent vomiting can have detrimental and lasting effects on the mouth, as excessive vomiting can significantly damage teeth. Vomit comprises stomach acids, which is caustic to teeth enamel and can potentially cause cavities and holes in the teeth.  

Corrosion to the enamel can alter the color, strength and consistency of the teeth and can cause them to turn yellow, look tattered and appear flat. The teeth can weaken, thus putting them at risk for chipping. Teeth can become painful, as the inner portion thins and becomes sensitive to temperature changes.

Vomiting can have damaging effects to the inner cheeks, as acids serve to chafe the salivary glands. If the salivary glands are impacted, a swelling around the cheek and jaw can occur. A lack of saliva can cause dry mouth or the constant sensation of being thirsty.  

Dry mouth can alter the flavor of food and further damage the teeth, as saliva is unable to handle bacteria causing tooth decay. Although damage to the teeth is mostly irreparable, swelling in the salivary glands can be reversible and inflammation should subside once vomiting is discontinued.    

Corrosive stomach acid that frequently invades the mouth can have a negative impact on the throat and skin on the roof and sides of the mouth, leaving painful sores. Moreover, the acid can aggravate or tear the esophagus, which can cause an individual to vomit blood.    

The circulatory system is affected in that recurrent vomiting, which can cause dehydration, weak muscles or fatigue. The weakened heart muscles can cause an erratic heartbeat, leading to heart failure in severe cases. Frequent vomiting can also cause an imbalance in electrolytes–namely potassium, magnesium, and sodium—and considerably strain the heart.

Bulimia impacts the reproductive system via hormonal imbalances, low sex drive and interference with menstruation. The discontinuing of menstruation, also called amenorrhea, can cause women to have trouble getting pregnant. Bulimic women that manage to get pregnant and who continue binging and purging during pregnancy face dire consequences for themselves and their babies, including:

  • High blood pressure
  • Gestational diabetes
  • Miscarriage or stillbirth
  • Premature birth
  • Breech birth or risk of cesarean delivery
  • Low birth weight babies and birth defects
  • Postpartum depression.  

Bulimia also affects the hair, skin and nails. Excessive self-provoked vomiting can cause calluses on the knuckles, which occurs when knuckles interact with incisor teeth during instigation of the gag reflex. Damage to knuckles has not been a common symptom of bulimia in recent years, as individuals today typically use objects instead of their hands to precipitate vomiting.

Hair thinning and hair loss occurs when an individual does not have the appropriate nutrition to sustain healthy hair growth. This symptom of bulimia can be caused by long-term emotional and physical stress. Hair may become dry and frizzy resulting from dehydration because the body does not have an ample supply of water to keep hair hydrated.  

Long-Term Effects of Bulimia  

Bulimia can lead to short- and long-term health problems. Long-term repercussions can affect both an individual’s physical and emotional health and should not be underestimated or minimized.  

Many short-term effects of bulimia — like amenorrhea, dehydration and cavities— will usual dispel once appropriate medical care is received. However, an extended period of poor nutrition can have long-term complications, with the overall severity depending on the longevity and intensity of the disorder.  

Diabetes can be a potential long-term effect, as individuals often have a propensity to binge on foods with high sugar and fat content. Despite purging, elevated amounts of sugar can remain in the bloodstream, thus triggering diabetes onset.  

Bulimia can also decrease a person’s bone density. Weakened bones occur when an individual does not ingest enough Vitamin D, phosphorus or calcium. Weakened bones can then give rise to osteoporosis, an irreversible state where the bones become frail and breakable.

Impaired kidney functioning is another long-term effect, as poor nutrition prevents the kidneys from working properly. If the kidneys malfunction, toxins cannot effectively leave the body, which can increase the susceptibility to kidney infections or failure.

Long-term implications also occur to the ovaries, thus negatively affecting fertility. Menstruation ceases when there is a depletion of nutrients and the body goes into survival mode. When this occurs, there is no guarantee that menstruation will ever begin again.

Causes of Bulimia

Like most psychological disorders, it is believed that bulimia is multifaceted and precipitated by many factors, including:

  • Biology, chemical imbalances, heredity or early onset puberty
  • Social and environmental factors, like trauma history, abuse or a history of malnutrition.  
  • Emotional and psychological concerns, like anxiety, depression, poor body image and low self-worth
  • Participation in certain sports
  • Employment in specific occupations
  • Substance abuse  

How is Bulimia Diagnosed?

To diagnose bulimia, a physician usually conducts a physical exam and order laboratory tests, including a blood panel, urine test and electrocardiogram. Electrolytes, or minerals in the blood, work to sustain a regular heart rhythm and assist the muscles in pumping blood to the heart.  

When these chemicals are depleted, cardiac and kidney function are compromised, which can lead to cardiac arrest and sudden death. Due to this fact, blood tests are not only used for diagnosis, but they are critical in the assessment and monitoring of electrolyte levels.

A physician may also order additional tests to rule out physical or medical causes for weight changes and to verify that no other complications are present. A physician might attempt to assess eating habits, physical indicators and weight loss attempts in addition to referring a patient for a psychological evaluation.  

To obtain a bulimia diagnosis, an individual must meet all criterions in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. At least once weekly for three months, a person should engage in continual incidents of binge eating and utilize improper behaviors to evade weight gain. In addition, weight and body shape need to have ample impact on how a person apprises themselves.

Who is at Risk for Bulimia?

There are several risk factors that make individuals more susceptible to developing bulimia:

  • Females have an increased risk for the disorder
  • A mental health diagnosis or other emotional difficulties
  • Cognitive distortions and those who look to satisfy social norms
  • Having a first-degree relative with an eating disorder or a mental health condition
  • Anxiety, rigidity and perfectionist tendencies
  • Bullying and mockery, especially related to someone’s weight

Bulimia Statistics

The National Eating Disorder Association estimates that up to 30 million individuals in the United States suffer from some type of eating disorder and estimate that between 4.1 and 4.2 percent of women are afflicted with bulimia at some point in their lives.   

The National Association of Anorexia Nervosa and Associated Disorders (ANAD) states that nearly half of the bulimic population has an accompanying mood disorder. In addition, more than half has a supplemental anxiety disorder and almost 1 in 10 has an additional substance use disorder, most often alcoholism.  

The National Eating Disorder Association reported that substance abuse and alcoholism are four times more prevalent among people with eating disorders when compared with the general population.

Treatment Options for Bulimia Nervosa

Treatment for bulimia comprises psychotherapy, psychotropic medication and nutritional counseling. Each of these components can be sought through different practitioners or can be found in a primary-eating-disorder setting. Psychotherapy can be delivered in an individual, family or group modality. Behavioral and cognitive therapies are both used to assist individuals in changing thoughts and behavior patterns.  

Psychotropic medications, specifically antidepressants, are used in tandem with psychotherapy and nutritional counseling serves to educate individuals about healthy eating habits and proper nutrition.  

Other alternative treatments can include

  • Yoga
  • Tai Chi
  • Qigong
  • Hypnotherapy

Eating disorders can afflict individuals of all ages, races and cultures. The course of treatment for eating disorders has come a long way, but the long-term ramifications of eating disorders are dire, if not fatal, when not treated properly.

If you are simultaneously experiencing an eating and substance use disorder, inpatient or outpatient treatment may be needed. Contact the Recovery Village to learn how addiction treatment can help you learn ways to manage, improve your confidence and live a healthier life.

Bulimia
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