General Overview

Bulimia nervosa is an eating disorder in which a person eats a large amount of food in a short period of time (binging) and then forces themselves to vomit or take medication that expels the food from the body (purging). This cycle of binging and purging is considered an extreme and dangerous eating behavior that can cause various long-term problems. Extreme eating disorders such as bulimia can lead to serious health problems, infertility and sometimes even death. A person with bulimia often has a low self esteem that is closely related to their body image. People with bulimia can be treated successfully with intense psychotherapy. This treatment often requires inpatient therapy initially, but also includes years of follow-up outpatient therapy.

Statistics

Women are much more likely to be affected by bulimia; up to 2% of women of all races and ethnicities in the U.S. have been diagnosed with this disease. This disorder used to be seen primarily in young women 17- 25 years of age, but in recent years women age 50 and up have frequently been found to have eating disorders. One study of extreme eating disorders estimated 13% of women over 50 to have signs of an eating disorder.

Signs and Symptoms

Unlike in patients with anorexia, a person with bulimia will often be normal weight. In addition, the binging and purging is done in private. These two factors combined make it hard to identify a loved one that has a problem. Therefore, a person may have the disorder for many years before it is noticed by family members or friends. Some signs of bulimia are:

• Swollen cheeks or jaw

• Calluses on the knuckles

• Broken blood vessels in the whites of the eyes

• Acid reflux, constipation and other intestinal problems

• Poor dentition (teeth look clear instead of white)

• Dehydration

Behavior changes often occur as well.  Some examples are:

• Getting up to go to the bathroom immediately after eating

• Extreme exercise, especially after a meal

• Food wrappers found in unusual places

• Difficulty expressing emotions

• Loss of interest in friends and activities once enjoyed

• Never happy with appearance

• Moodiness and sadness

It is common for people with eating disorders to have other mental health disorders such as anxiety, depression or substance abuse.

Effects of bulimia on the body

The act of purging food prevents a person from getting nutrients into the body. Over time this causes an overall decline in health. Some specific examples are:

• Electrolyte imbalances (sodium, calcium, potassium and magnesium)

  • These electrolytes being out of balance can affect critical systems and lead to heart and kidney failure as well as many other illnesses.

• Ulcerations of the esophagus and stomach

• Irregular periods (sometimes leading to infertility)

• Tooth decay (from vomiting)

• Intestinal problems (constipation can lead to blockages)

Diagnosis

Diagnosis can be complicated by a patient’s unwillingness to report their purging. It is usually quite difficult for the person to admit to their secret binging and purging. For this reason, many people with eating disorders go untreated until a health crisis of another kind occurs. If the person has chosen to be forthcoming about their purging and seeks medical help, diagnosis is made based on the patient’s medical history and physical assessment. The physician may order an EKG to make sure the heart is functioning normally, or a urine screen to check for protein levels. A blood test may also be ordered to check electrolytes.

Treatment

Treatment generally consists of many parts. A team of medical and nutritional professionals are needed in order to be successful. Together, this team can guide an individual through treatment. Parts of the treatment plan may include:

• Psychotherapy

• Monitoring

• Nutritional therapy

• Nutritional counseling

• Medication

• Support groups

If bulimia is not treated before complications appear, other methods of treatment may be required to address these complications.

Psychotherapy

Another name for psychotherapy is “talk therapy.” This type of therapy is one-on-one with a psychiatrist or psychologist and focuses on the importance of talking out their feelings and turning negative thoughts into positive ones, thereby eliminating the base desire to perform the harmful behaviors that cause bulimia.

Monitoring

In the early part of treatment a patient must be monitored. Because their behaviors have been done privately and successfully for so long, the patient must be supervised to ensure that they do not begin purging again. It is usually difficult for a family member to watch a patient’s every move, so this treatment plan often occurs inside a healthcare facility.

Nutritional Therapy

If the patient has been purging for a long time they may be very ill and require hospitalization for nutritional support, hydration and electrolyte replacement.

Nutritional Counseling

A registered dietitian or counselor can help the patient learn to make better food choices and learn to eat in a healthier way than binging and purging.

Medication

Prozac is the only drug approved by the FDA for treatment of bulimia. However, if the person has been diagnosed with other mental health disorders it is important that they are treated with medication appropriately prescribed by their physician.

Support groups

Support groups can be helpful as well. Support groups give the patient an opportunity to connect with others struggling with the same type of problems. Learning from peers who are managing their illness can be another key to helping them manage their own.

Prognosis

Most patients get better with treatment. They will usually return to normal eating habits, exercise in a healthy way and maintain a healthy weight. That being said, some patients do relapse and restart treatment many times before finding success. With continued support and encouragement treatment is usually successful.

References:

Eating Disorders: About More than Food. Retrieved from https://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml.

Rushing, Jona M., et. al. (2003). Bulimia Nervosa: A Primary Care Review. Prim Care Companion J Clin Psychiatry, 5 (5), 217-224. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC419300/.

Statistics. Retrieved from https://www.nimh.nih.gov/health/statistics/index.shtml.