Commonly Asked Questions: Bulimia Nervosa

What are the Symptoms?

If you are wondering whether someone you know may have bulimia, here are some critical characteristics to look for:

Frequent Binge Eating

Binge eating means eating a much larger amount of food than normal (usually thousands of calories) over a short period of time (usually less than two hours). Eating a large meal during a holiday or celebration, or snacking all day are not considered eating binges.

People with bulimia often binge on sugary foods with a lot of calories, such as chocolate, cookies, cake, or ice cream. However, they can also binge on other types of foods such as fried chicken, hamburgers, or pizza.

People diagnosed with bulimia often say that they feel as though they are "losing control" when they binge-eat. They have a feeling that they can't stop eating, even when it causes them physical pain or upsets them emotionally.

Drastic Attempts to Prevent Gaining Weight

People with bulimia often try to prevent gaining weight through two basic patterns.

• Purging Patterns -- These individuals regularly attempt to eliminate food from their system by making themselves vomit, using medicines that make them urinate frequently (diuretics), or misusing laxatives or enemas. Approximately 80 to 90 percent of people who are treated for bulimia regularly attempt to make themselves vomit. It appears that vomiting helps them calm their worries about gaining weight and relieves the physical discomfort of overeating.

   

• Non-purging Patterns -- These individuals try to limit any weight gain by going on "crash" or starvation diets and/or exercising excessively. Like people who attempt to purge their food, these individuals are trying to correct for their binge-eating.

   

Many people with bulimia don't fit neatly into one category or another. They may combine vomiting with crash diets or the use of laxatives with exercising three times a day.

Frequent Binge-Eating and Inappropriate Attempts to Keep Weight Down

People who have eaten or exercised a lot more than usual over the past few weeks don't necessarily have bulimia. Bulimia is a lasting condition. It is generally accepted that people must be binging and compensating at least twice a week for three months before the diagnosis of bulimia nervosa can be considered.

Self-esteem Is Tied to Body Image

For most of us, our self-esteem is partly related to our thoughts about how we look. It's natural to feel better about yourself when you think that you look pretty good. However, the self-esteem of people with bulimia hinges almost completely on their thoughts about how they look, and specifically, whether they are overweight.

Do People Have Bulimia Forever?

In most cases the answer is "no." Some people are successfully treated while others seem to "grow out" of the problem. However, researchers are not yet sure of the long-term course of bulimia.

Part of the problem is that bulimia has only been frequently diagnosed in the past 20 to 30 years. In many cases it can take several years before the bulimic behaviors are reduced or eliminated.

Sometimes the binging and compensating activities may disappear for months or even years only to come back. Other times they may disappear and never return. And yet other times they continue, especially if left untreated, without ever stopping.

Are There Any Medical Complications?

Unfortunately, yes. As with anorexia nervosa, women with bulimia may menstruate (have their periods) irregularly. These problems may be due to malnutrition, emotional stress, or rapid changes in weight.

Also, the extreme changes in diet often seen with bulimia may cause cardiac (heart) or gastrointestinal (stomach and intestines) problems. Frequent vomiting may cause tooth decay or chipping of teeth.

What are the Psychological Factors?

There is no set "personality" that describes people with bulimia. However, people with bulimia often feel ashamed about their eating problems. They may attempt to hide their binge-eating while others are around. Food may be hidden away in closets or at work for times when no one can see them.

Most people with bulimia are afraid of gaining weight. They may become very nervous about any changes in their body shape.

People with bulimia are more likely to be depressed or have problems with anxiety as compared to others. These emotional difficulties may have been part of the reason they developed bulimia, or they may be in response to their eating problems.

Also, people with bulimia are more likely to abuse alcohol and drugs (especially stimulants) to cope with depression and anxiety or to lose weight.

Can Bulimia be Treated?

Fortunately health care professionals are having increasing success in treating bulimia. Typically, treatment is coordinated among a physician, psychologist or other mental health professional, and a registered dietitian.

The first step in getting help for people with bulimia nervosa is to have them seen by a doctor. A physician can assess their general health and provide more information about their current and expected weights.

Long-term nutritional counseling may also be indicated. This counseling can best be accomplished by a registered dietitian who can assess the individual's current dietary practices and establish an eating plan that meets their individual needs.

Mental health professionals often provide psychotherapy designed to help these individuals understand their perception and expectations for themselves, family members and significant others, or the world in general. Individual or family therapy is often used to address the person's perceptions of food and body image, as well as help to resolve family issues.

References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (text revision). Washington, DC: Author.

Florida Dietetic Association. (1997). Handbook of medical nutrition therapy (2nd ed.).