Bulimia nervosa (bull-EE-me-uh ner-VO-zuh—often called simply “bulimia”), sometimes referred to as the “binge-purge” disorder, involves repeated episodes of excessive eating (bingeing) followed by attempts to rid the body of the food by vomiting, using laxatives or enemas * (purging), or exercising excessively.
Binge eating is excessive, out-of-control eating. A person with binge eating disorder exhibits a repetitive pattern of eating significantly more food in a limited time (usually one to two hours) than most people typically would eat. Doing so often results in overweight or obesity * .
To her friends and family, Marlene had a perfectly fine figure, and she seemed confident and self-assured. But privately, Marlene suffered from bulimia and could not seem to stop bingeing and purging. Several times per week, she would eat whole batches of cookies, packages of candies, and as much bread and as many muffins as she could find. Her guilt and fear of becoming overweight always led her to make herself vomit. Marlene stayed at a healthy weight for her size, but she was obsessed with her weight and body shape.
Eating disorders are habits or patterns of eating that are out of balance and may involve major health and emotional problems. Bulimia is a type of eating disorder in which a person binges, or consumes large quantities of food, and then purges, or attempts to rid the body of the food. When bingeing, people with bulimia often feel as if they have little control over their behavior. After a binge, they feel guilty and fearful of becoming fat, so they try to rid, or purge, their body of the food by vomiting or using laxatives or enemas. They may use diet pills or take diuretics, which are drugs to reduce the volume of fluids in the body. Some people with bulimia also exercise excessively in order to burn some of the calories eaten during binges. People with bulimia have a distorted body image * . Even though many people with bulimia stay at a fairly healthy weight, they are fixated on body shape and weight and feel as if they are fat.
Most people who develop bulimia are girls and young women of European ancestry, although males and people of all ethnic groups can have it. Bulimia affects at least 1 to 3 percent of middle and high school girls and up to 5 percent of college-age women in the United States. Individuals in certain occupations and those who train for athletic events where body weight is scrutinized such as wrestlers, competitive bodybuilders, dancers, divers, cyclists, and gymnasts are more likely to develop eating disorders such as bulimia nervosa and binge eating.
Bulimia often starts with a cycle of bingeing and dieting that eventually leads to compulsive purging. Once the purging begins, the situation worsens. A person eats too much, feels guilty about it, and purges. The purging provides some immediate relief but is followed by shame and guilt. People with bulimia begin to believe that the only way to control their weight is to purge. They often feel intense social and cultural pressure to be thin. Family problems, conflict, and poor self-esteem are present in the lives of people with bulimia. People with bulimia overemphasize the importance of body shape and size in their overall self-image.
A person with bulimia often hides it well. A young woman with bulimia is usually near a healthy weight but is preoccupied with eating and dieting. Bulimia and other eating disorders share many symptoms, such as fatigue, low blood pressure, dehydration * , preoccupation with food, and secretiveness about eating. Because of the purging, bulimia can be associated with serious symptoms that include:
Like Marlene, people often keep their bulimia hidden from family, friends, and healthcare professionals. The shame and embarrassment about purging can be profound. Sometimes a dentist will notice damage to the tooth enamel. A healthcare professional might ask about a person's weight, diet, nutrition, and body image, and the responses may reveal an eating disorder. If concerned, a physician might order lab tests to study a person's nutritional and medical status. A mental health professional may uncover bulimia when a person is treated for a different symptom, such as anxiety * or depression.
Bulimia, like other eating disorders, is treated most effectively with a combination of therapies. The main treatment for bulimia is psychotherapy * . The focus of treatment is on changing eating behaviors and thinking patterns. To help a person overcome bulimia, a therapist also addresses the person's distorted body image and fear of being fat. Sometimes a physician prescribes an antidepressant medication * to relieve anxiety or depressive symptoms. Nutritional counseling, dental care, support groups, and family counseling are also components of the interdisciplinary approach * used to treat bulimia.
People who eat uncontrollably on a regular basis (at least twice a week for at least three months) are binge eaters. These people eat abnormally large quantities of food in one sitting—often as much as four times their daily calorie needs (1,200 to 2,000 calories, depending on body weight). Binge eating is sometimes referred to as compulsive overeating.
Binge eaters tend to eat much faster than other people usually do and continue eating even when they are no longer hungry. During a binge, they may eat until they feel uncomfortably full because they feel out of control and unable to stop eating even when they want to quit.
Binge eaters often develop the habit of eating alone so that others do not see them gorging themselves, hiding empty food containers to disguise how much they eat, and hoarding food in preparation for another binge. After bingeing, compulsive eaters often feel guilty, upset, disgusted, and/or depressed about how much they have eaten. They may vow to themselves never to binge again, but they are not able to keep this promise.
About 2 percent of Americans are binge eaters, and estimates are that between 30 and 50 percent of obese individuals binge. Women who binge outnumber men in a ratio of 3:2; however, binge eating is the most common male eating disorder. Unlike anorexia nervosa or bulimia, both of which usually start in the teenage years, binge eating disorder is more likely to develop in adults between the ages of 45 and 55.
Binge eating is thought to be caused by a combination of social, psychological, and genetic factors. For many binge eaters, stress is the factor that triggers a binge. Social factors that encourage binge eating include the easy availability of inexpensive food in developed countries that makes it possible to binge eat and to hide this activity. Societies that value thinness can also promote depression and guilt among binge eaters, especially when the media send mixed messages that place food at the center of social events but also present thinness as necessary to be socially acceptable.
Psychologically, binge eaters share the following traits:
Research has suggested that there is a genetic component to binge eating. The appetite control system is complex and involves the interaction of multiple genes, hormones, and neurotransmitters. The way appetite is controlled is not completely understood. Researchers have found that some obese people have a mutation, or change, in a gene that suppresses the urge to eat once a person has eaten enough calories. Although researchers found that while only about 5 percent of obese people have mutations in this gene (meaning that this mutation is not the only cause of obesity), all the people with this mutated gene were binge eaters.
Symptoms of binge eating may be difficult to detect because binge eaters tend to hide their behavior. Although many people are obese, not all obese people are binge eaters. Secretive eating, constant dieting without losing weight, obsessive concern about weight, and depression suggest that a person may be a binge eater, but none of these patterns proves binge eating. People who are obese and fail to lose weight may seek help from a healthcare professional due to concern about health problems related to obesity. An evaluation that involves questions about family and personal history, physical health, eating and dieting habits, psychological concerns, and personality issues may reveal binge eating behavior. However, people with binge eating disorder often lie about their eating habits.
Medical professionals agree that the earlier binge eating is detected and treated, the easier it is to break the pattern and control of binge eating behaviors. Lisdexamfetamine dimesylate (Vyvanse) was the first medication approved by the U.S. Food and Drug Administration for use in adults with moderate to severe binge eating disorder. Antidepressant medications may also be helpful, but they may cause weight gain in some individuals. The antiobesity drug sibutramine (Meridia) may also be prescribed. This drug enhances the sensation of fullness and helps to suppress hunger.
Binge eating cannot always be prevented, but there are ways of reducing the likelihood that it will develop. These include:
See also Anorexia Nervosa • Anxiety and Anxiety Disorders: Overview • Body Image • Depressive Disorders: Overview • Eating Disorders: Overview • Fluid and Electrolyte Disorders • Menstruation and Menstrual Disorders • Substance Abuse • Suicide
Schmidt, Ulrike, Janet Treasure, and June Alexander. Getting Better Bite by Bite: A Survival Kit for Sufferers of Bulimia Nervosa and Binge Eating Disorders. 2nd ed. New York: Routledge, 2016.
National Institute of Mental Health. “Eating Disorders among Adults—Binge Eating Disorder.” NIMH.NIH.gov . http://www.nimh.nih.gov/health/statistics/prevalence/eating-disorders-among-adultsbinge-eating-disorder.shtml (accessed March 20, 2016).
National Institute of Mental Health. “Eating Disorders among Adults—Bulimia Nervosa.” NIMH.NIH.gov . http://www.nimh.nih.gov/health/statistics/prevalence/eating-disorders-among-adults-bulimianervosa.shtml (accessed March 20, 2016).
National Eating Disorders Association. 165 W 46th St., Suite 402, New York, NY 10036. Toll-free: 800-931-2237. Website: http://www.nationaleatingdisorders.org (accessed March 20, 2016).
National Women's Health Resource Center. PO Box 430, Red Bank, NJ 07701. Toll-free: 877-986-9472. Website: http://www.healthywomen.org (accessed March 20, 2016).
Overeaters Anonymous. 6075 Zenith Ct. NE, Rio Rancho, NM 87144-6424. Telephone: 505-891-2664. Website: https://oa.org (accessed March 20, 2016).
* enemas (EH-nuh-muhz) are procedures in which liquid is injected through the anus into the intestine, usually to flush out the intestines.
* obesity (o-BEE-si-tee) is an excess of body fat. People are considered obese if they weigh more than 30 percent above what is healthy for their height.
* body image is a person's impressions, thoughts, feelings, and opinions about his or her body.
* dehydration (dee-hi-DRAY-shun) is a condition in which the body is depleted of water, usually caused by excessive and unre-placed loss of body fluids, such as through sweating, vomiting, or diarrhea.
* depression (de-PRESH-un) is a mental state characterized by feelings of sadness, despair, and discouragement.
* anxiety (ang-ZY-e-tee) can be experienced as a troubled feeling, a sense of dread, fear of the future, or distress over a possible threat to a person's physical or mental well-being.
* psychotherapy (sy-ko-THER-uh-pee) is the treatment of mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personality growth.
* antidepressant medications are used for the treatment and prevention of depression.
* interdisciplinary approach is when a coordinated group of experts from different specialties or fields work together in a team approach toward a common goal for patient care.