What is Bulimia?

Bulimia is an eating disorder categorized by a cycle of binge eating an abnormally large amount of food in a short period of time, followed by a compensatory behavior.¹ Compensatory behaviors may consist of self-induced vomiting, excessive exercising, fasting, or laxative use to avoid gaining weight from binge eating.¹ Individuals with bulimia may participate in compensatory behavior due to overwhelming feelings of guilt after eating. Bulimia affects people of all ages, races, genders, and sexual orientations.

Diagnostics and Statistical Manual 5 Categorization

The Diagnostic and Statistical Manual 5 (DSM-5) categorizes bulimia as a psychiatric eating disorder.  In order to be diagnosed with bulimia, a person must meet the following diagnostic criteria:¹

• An individual must engage in recurrent episodes of binge eating characterized by eating an abnormally large amount of food in less than two hours and a sense of lack of control while eating. The individual may feel unable to stop eating or may be unaware of how much food they actually consumed.
• An individual must engage in recurrent episodes of compensatory behavior to prevent weight gain behavior after binge eating. Compensatory behavior may include self-induced vomiting, laxative use, diuretics or other medications, fasting, or over-exercising.
• An individual must engage in binge/purge behaviors at least once a week for a period of at least three months and not during periods of anorexia.
• An individual’s self worth is dependent upon their body’s shape and weight.

An individual who does not meet all of the criteria for bulimia may still be suffering from an eating disorder. Eating disorders are unique to each individual. If a person meets some of the criteria alone or mixed with criteria of another disorder, they may be suffering from an eating disorder not otherwise specified and should still seek medical attention.¹

Major Types of Bulimia

There are two main types of bulimia: purge type and non-purge type.² Both types of bulimia are serious, potentially life-threatening disorders. Purge type is the most common type of bulimia and is characterized by regularly self-induced vomiting, laxative use, or diuretic use. Individuals with non-purge-type bulimia will use other compensatory behaviors to avoid gaining weight such as fasting or excessive exercising. People suffering from non-purge types may still engage in purge behaviors but not as frequently.²

Causes

Bulimia may be caused by a combination of genetic, psychological, cultural, and environmental factors.² People with a family history of eating disorders are at an increased risk of developing an eating disorder like bulimia. Psychological factors like a negative body image, poor self-esteem, or a history of abuse also may increase a person’s risk for developing bulimia.² Cultural factors like societal beauty standards greatly increase a person’s risk for developing bulimia. The media idolizes thin women and influences how many people view themselves. Environmental factors like a person’s career can influence their risk for developing an eating disorder like bulimia. For example, models, dancers, and athletes must maintain a certain body type and are at an increased risk for developing this eating disorder.²

Signs and Symptoms

Secrecy is a key aspect of bulimia; however, there are many symptoms and signs that a person may be suffering from bulimia. Physical signs of bulimia include the following:³

• An individual with bulimia may exhibit fluctuations in weight.
• A person with bulimia may have physical signs on their body from self-induced vomiting such as scars or marks on their knuckles, broken blood vessels in their eyes, enlarged glands in their neck, and dental issues. They may smell like vomit and frequently experience sore throats and an inflamed esophagus.
•  An individual suffering from bulimia may have chronic dehydration, anemia, an electrolyte imbalance, or other laboratory abnormalities.
• Bulimia may also cause dry and brittle skin, thinning of hair, cold skin, and muscle weakness.
• A person with bulimia may experience sleep problems, dizziness, fainting, and difficulty concentrating.

Non-physical, emotional, and behavioral signs of bulimia include the following:³

• A person with bulimia may be obsessed with their weight, dieting, and controlling what and how much they eat while maintaining an average or slightly above average body weight .
• An individual with bulimia may have an intense fear of eating in public, may skip meals, or may only eat small portions at meal times.
• A person with bulimia may eat in secrecy, steal or hoard food, drink excessive amounts of water, and frequently use the bathroom after eating to purge.
• An individual with bulimia may develop food rituals like excessive chewing, pushing their food around, or cutting their food into small pieces. They may also cut out entire food groups or try new diets like vegetarianism or veganism.
• A person with bulimia may organize their life around binge-purge episodes, maintain a strict exercise regime, or avoid social situations.
• Bulimia may also cause a person to exhibit extreme mood swings and have severe concerns about bodyweight and shape.

A person with bulimia may experience some or all of these symptoms. Each eating disorder is unique and every person may experience different symptoms. No matter the symptoms a person experiences, bulimia is still a serious and dangerous mental illness.

Long-Term Effects

There are many negative health concerns associated with bulimia that can have lasting effects. Several body systems are affected by bulimia, such as the gastrointestinal system, cardiovascular system, neurological system, and endocrine system. Below are the side effects of bulimia on several body systems.⁴

Gastrointestinal System

Purge type bulimia can seriously affect the gastrointestinal system by disrupting the digestion of food. Disrupted digestion can cause stomach pain, nausea and vomiting, bacterial infections, blocked intestines, and a full feeling after consuming a small amount of food. Purging may also lead to pancreatitis. Bulimia can also cause constipation due to not digesting enough calories or being dependent upon laxative use. Bulimia can lead to life-threatening conditions like a stomach or esophagus rupture.⁴

Cardiovascular System

Consuming an inadequate amount of food negatively affects the heart and the cardiovascular system. Bulimia causes your heart rate and blood pressure to decrease to dangerous levels. The risk for heart failure increases with malnutrition. Purging may cause an electrolyte imbalance which could cause an irregular heartbeat, heart failure, or even death.⁴

Neurological System

Bulimia can have several negative effects on the neurological system. Not consuming enough calories can lead to dizziness, difficulty concentrating, and difficulty falling and staying asleep. Chemical signals in the brain can also be disrupted, leading to seizures, muscle cramps, and tingling in the extremities. Binge eating can also cause sleep apnea.⁴

Endocrine System

Bulimia can decrease the level of hormones present in the body. Testosterone, estrogen, and thyroid hormones are some of the first hormones depleted in the body due to bulimia. Reduced hormone levels can lead to amenorrhea, osteoporosis, and a reduced metabolic rate. Binge eating can also lead to type 2 diabetes.⁴

Treatment

Bulimia is a potentially life-threatening disorder and it is imperative that a person seeks treatment as soon as possible. Treatment will first try to eliminate binge-purge behaviors and attempt to understand what triggers the individual to engage in these behaviors.² Treatment will then include establishing healthy eating patterns and may include help from a dietician or nutritionist. Negative body image and low self-esteem are at the root of bulimia and require therapy in order to fully recover.² The therapist will try to eliminate negative thoughts and help the person improve their body image. Therapy will try to recognize the underlying issues of bulimia and help the patient establish healthier coping methods. Addressing the underlying emotional issues is important to achieve a full recovery. This part of treatment may include cognitive behavioral therapy or another form of behavioral therapy.² Relapse is a normal part of eating disorder recovery. Almost half of people in recovery from bulimia will experience at least one relapse.² It is important to remember that relapse does not indicate failure and is a normal part of the recovery process.

Statistics

Bulimia affects people all over the world regardless of age, race, gender, or sexuality. The following are statistics gathered from the United States, the UK, and Europe:⁵

• Approximately 4% of women and .1% of men develop bulimia during their lifetime.
• Over 30% of people diagnosed with bulimia also have an addictive disorder. For example, a person may practice self-harm, substance abuse, or drug addiction in addition to having bulimia.
• Only 10% of people suffering from bulimia will seek treatment.
• About 30-50% of people with bulimia will relapse.
• Bulimia has a mortality rate of about 4%, commonly due to heart issues or suicide.

Bulimia and Intimacy

Bulimia can affect many aspects of a person’s life, including their personal relationships. Because poor body image and low self-esteem are often at the root of bulimia, an individual suffering from bulimia may be self-conscious in their intimate relationships.⁶ They may prefer to keep their clothes on or the lights on while engaging in sexual activity. They also may prefer sexual positions that do not give their partner a full view of their body, or they may have a decreased libido. Bulimia has also been shown to be linked to a higher sex drive and the tendency to have more sexual partners.⁶ Whichever the case, if you are dating someone with bulimia, it is important to respect your partner’s wishes in order to help them on the road to recovery.

Resources

If you or someone you know is suffering from bulimia, there are many resources available to help. Doctors can provide more information on local resource. If there is a medical emergency, always call 911. Below are a list of U.S. helplines and emails:¹

• National Eating Disorders Association (NEDA) helpline: +1(800)931-2237
• NEDA Crisis Text Line: text “NEDA” to 741741 to connect with a trained volunteer
• Eating Disorders Victoria Helpline Phone Number: +1(300)550-236
• Support group finder: suportgroups@anad.org

Concluding Remarks

Bulimia is a serious mental disorder that can have life threatening health consequences. It is extremely important to seek treatment if you think you may be suffering from bulimia or another eating disorder. If you are suffering from bulimia, you are not alone. Approximately 1.5% of American women suffer from bulimia during their lifetime and over 30 million people of all backgrounds suffer from an eating disorder in America.⁵ Seeking early treatment will help increase one’s chance of achieving and maintaining a full recovery.

References

1. “Overview and Statistics.” National Eating Disorders Association
2. “About Bulimia: Symptoms, Signs, Causes & Articles For Treatment Help.” Eating Disorder Hope
3. “Warning Signs and Symptoms.” National Eating Disorders Association.
4. “Health Consequences.” National Eating Disorders Association.
5. “Eating Disorder Statistics for Anorexia, Bulimia, Binge Eating.” Eating Disorder Hope
6. “Intimacy Issues and Eating Disorders in Women.” Eating Disorder Hope, 16 Aug. 2017.

Last Updated: 6 February 2018.