If you or someone you love has bulimia nervosa, that person probably eats a lot of food at one sitting (binge eat), then works to get rid of that food or purge. People use various ways to purge. Some make themselves vomit, others use laxatives or enemas, and some people fast or exercise excessively. If you have bulimia nervosa, you may often feel out of control and may take extreme measures to prevent weight gain.

Bulimia usually begins in late adolescence or early adulthood. About one to three percent of adolescents and young adults develop bulimia nervosa, roughly two-thirds are female. As with other eating disorders, people who have bulimia nervosa suffer from concerns with body image. The difference is that they are often in a healthy weight range. Doctors only use the term bulimia nervosa for people who binge eat and purge at least once a week for three months. 

Researchers suggest that certain personality traits can make you more likely to develop bulimia. People with bulimia are often unhappy with their body size and shape and have low self-esteem. Bulimia may go along with anxiety or depression. The condition may also run in families.

Common symptoms

It can sometimes be difficult to tell if you or a loved one has bulimia. If you are concerned, you should seek medical help. Symptoms can be emotional and behavioral or physical.

Emotional and behavioral symptoms include:

• Appearing uncomfortable eating around others
• Depression or mood swings
• Drinking excessive amounts of water or non-caloric drinks
• Eating uncontrollably
• Excessive exercise
• Extreme mood swings
• Fear of gaining weight
• Food rituals, such as excessive chewing or eating only certain types of foods
• Intermittent fasting
• Irregular periods
• Laxative and diuretic misuse
• Preoccupation with body weight and image
• Self-induced vomiting
• Shame over bingeing
• Skipping meals or taking very small portions
• Stealing or hoarding food
• Using excessive amounts of mouthwash, mints, and gum
• Wearing baggy clothing to hide body
• Withdrawing from usual friends and activities
• Evidence of binge eating may include, large amounts of food disappearing in a short period of time or the presence of numerous empty wrappers and containers
• Evidence of purging may include, frequent trips to the bathroom after meals, smells of vomiting, the appearance of food wrappers or packages of laxatives or diuretics—usually purging gives a sense of relief

Physical signs include:

• Body covered with fine hair
• Cuts and calluses on top of finger joints (as a result of inducing vomiting)
• Difficulty concentrating
• Dizziness or fainting
• Dry skin
• Dry, brittle nails
• Feeling cold all the time
• Poor wound healing
• Repeatedly gaining and losing weight
• Sore throat or swollen glands in the neck and face
• Stomach cramps and other tummy complaints
• Teeth are stained or discolored
• Weakness, exhaustion, or bloodshot eyes

Complications

Bulimia nervosa can be hard on the body. It can cause a variety of medical complications that can be severe. They are reversible with appropriate treatment. These complications include:

• Erosion of tooth enamel and cavities
• Damage to the esophagus
• Dehydration
• Gastrointestinal disturbances such as reflux
• Gum disease and dental problems
• Heart disease
• Hormonal problems
• Kidney disease
• Low libido or sex drive
• Menstrual irregularities
• Osteoporosis
• Rupture of the stomach or esophagus
• Seizures
• Stomach ulcers
• Swollen salivary glands

Some research suggests there is a link between type I diabetes, disturbed stomach hormones, and bulimia.

In addition to these physical problems, many bulimia nervosa patients also suffer from a variety of psychological problems. These can include anxiety and depression, cutting and other forms of self-harm, substance abuse, risky behaviors (such as sexual or criminal), or intentional misuse of insulin (diabulimia).

Diagnosis

To diagnose bulimia, your doctor will talk to you about your eating habits and how you attempt to control your weight or shape. You may get questions about your medical history and any family members with eating disorders. We may do a physical exam, request blood and urine tests, and schedule a psychological evaluation. In addition, your doctor may order additional tests to make sure there are no other reasons for your fluctuating weight. This includes determining whether you have anorexia nervosa.

There is no single test that determines if you have bulimia. According to the DSM-5, bulimia patients experience the following at least once a week for three months:

• Frequent binge eating, with a sense that you are out of control
• Frequent, drastic behavior with the intent to lose weight, including vomiting, misuse of laxatives or diuretics, excessive exercise, or fasting

Treatment

To help someone with bulimia, we need to address their physical and psychological needs. Usually, this means both psychotherapy and medication.

At Mount Sinai, we generally use cognitive behavioral therapy to help. If you are also depressed/anxious or impulsive, we may use fluoxetine (Prozac) or other medications to help.

In addition, we often have people with bulimia work with a dietician to help you develop healthy eating habits. The goal is to avoid hunger and cravings while also having good nutrition. Eating regularly is very important to treating bulimia.

The outcomes of treatment for bulimia nervosa vary. Some individuals have the illness for a long time, while others alternate between recovery and intermittent binge eating and purging. Symptoms often emerge in adolescence, but most do not seek treatment for their eating disorder until adulthood. 

Bulimia vs. Anorexia

Bulimia and anorexia are the most common eating disorders. They both involve a distorted body image and are similar in many ways. There is one major difference. If you have bulimia, your weight is probably at a normal level or even above. Patients with anorexia are generally at a very low body weight. Those with bulimia are often able to keep their weight at a normal level, or even above.