Also called bulimia nervosa, this binge-purge eating disorder is characterized by episodes of secretive excessive eating (binge-eating) followed by extreme methods of weight control. Self-induced vomiting (purging), abuse of laxatives and diuretics, or excessive exercise are all ways by which the bulimic compensates for binges.

2Depending on the type of compensatory behavior to burn calories, bulimia may also be called exercise bulimia. A binge involves a large amount of food, for example, several boxes of cookies, a loaf of bread, a half gallon of ice cream, and a bucket of fried chicken, eaten in a short and well-defined time period. Specific behaviors associated with bulimia include: 1) eating high-calorie junk food (candy bars, cookies, ice cream, etc.); 2) eating surreptitiously; 3) eating until stopped by stomach pain, drowsiness from the food, or external interruption; 4) a tendency to go on crash diets; and 5) weight that varies over a 10-pound range. Often bulimics describe themselves as addicted to both binging and purging. Both parts of the cycle can be equally compelling.

Unlike anorexia, people with bulimia often fall within the normal range of weight for their age and build. They may be slightly above their average weight as a result of absorbing calories during binges. Like people with anorexia, bulimics fear gaining weight, may want desperately to lose weight, and are intensely unhappy with their body size and shape. The anorexic may be able to shut down appetites altogether by starvation. The bulimic, however, has a dysregulated appetite. She may also have a more impulse-driven personality than the anorexic. A bulimic patient may experience trouble regulating other areas of life that involve appetite, such as spending, drinking, or sexual activity. Bulimic behavior is often highly secretive; patients report stealing food, using money beyond their means to buy food, eating out of the trash, or vomiting at work or school. Feelings of disgust or shame often torment the bulimic. The binging and purging cycle can repeat several times per week or three to five times per day.

Effects of bulimia on the body

Effects of bulimia on the body

SOURCE: National Women's Health Information Center, Office on Women's Health, U.S. Department of Health and Human Services

Like anorexia, people with bulimia often have coexisting psychological illnesses, such as depression, anxiety, a history of childhood abuse, and/or substance abuse problems. The causes of bulimia are many. Some bulimics begin as anorexics. Research shows that many bulimic patients are children of alcoholics. The bulimic, like the anorexic, may have a parent with a personality disorder who was unpredictable and intrusive. Bulimia can serve as a way to control intense feelings, good and bad, for someone raised in a difficult atmosphere. Bulimia also is understood as a coping strategy that serves to express intense unmet needs and deny them as well. Athletes who have an injury and are unable to eat and exercise as before are vulnerable to developing bulimia.

Physical problems result from the purging aspect of the illness, including electrolyte imbalances, gastrointestinal refluex, ulcers, bleeding, swollen glands in the face, and oral and tooth-related problems. Long-term effects of bulimia include chronic digestive problems. Unlike anorexics who often can be identified by their low weight, it is more difficult to identify bulimics. Dramatic shifts in weight may be an indicator that someone has an eating disorder. Scrapes on the knuckle of the index finger used for vomiting, puffy cheeks, and frequent use of the bathroom or shower immediately after eating may be signs someone is bulimic.

Like anorexia, bulimia is a serious psychological eating disorder. It is an eating disorder that goes beyond out-of-control dieting. The cycle of overeating and purging quickly can become an obsession similar to an addiction to drugs or other substances. Although bulimia has been widely considered to be psychological and sociocultural in origin, not everyone is susceptible to developing bulimia. The onset of the disorder commonly occurs in the late teens or early twenties and can begin after a period of dieting or weight loss. Risk factors for the disorder involve a pattern of excessive dieting in an attempt to weigh less, a history of depression or alcoholism, low self-esteem, obese parents or siblings, and a history of anorexia nervosa. Some research suggests that bulimia may have physiological causes, including a defective satiety mechanism.

According to the National Institute of Mental Health, eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. Researchers are using the latest in technology and science, PET scans, and neuroimaging to better understand eating disorders. One approach involves the study of human genes. As of 2015, research revealed that bulimia is strongly familial and that the pronounced familial nature of bulimia is due largely to the additive effects of a number of genes. Researchers studied various combinations of genes to determine if any DNA variations are linked to the risk of developing eating disorders. Neuroimaging studies provided more understanding of eating disorders and possible treatments. Psychotherapy interventions have been studied and most clinicians used a treatment team of doctor, nutritionist, and therapist. Adolescents often recover receiving Maudsley model family-based treatment. Dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT) were widely used for the treatment of impulse disorders and proved helpful for the treatment of bulimia.

The American Anorexia/Bulimia Association estimates that up to 5% of college-age women are bulimic and more than 90% of all bulimics are women. Ideally, to reduce the risks of developing an eating disorder, cultural attitudes associating thinness and beauty with personal worth and happiness would have to change. Healthier attitudes and eating behaviors in early childhood can be taught by parents and in schools. Peer attitudes rejecting the tyranny of thinness can help girls develop normally. Individuals can learn to value themselves and others for intrinsic rather than extrinsic qualities.

Bulimia is a serious illness with severe medical consequences, including abdominal pain, vomiting blood, electrolyte imbalance possibly leading to weakness or cardiac arrest, muscle weakness, and intestinal damage. Bulimics and anorexics rarely cure themselves and the longer the behavior continues, the more difficult it is to create lasting change. The most effective treatment usually consists of a team approach: medical evaluation, individual and/or group psychotherapy, nutritional counseling, psychotropic medication, and possible hospitalization or day treatment stays. Commonly recommended medications include selective serotonin reuptake inhibitor (SSRI) medication to address the anxiety that may trigger a binge or the depression that underlies the need for copious amounts of food. Long after the actual behavior ceases, a person with a history of a clinical eating disorder remains vulnerable to a lapse or a relapse under sufficient stress. The idea that a formal eating disorder can be completely cured has been debated. Many psychologists in the eating disorders field believe that total cure is not possible.

See also Anorexia ; Body image ; Food addiction .



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Sandoz, Emily K., et al. Acceptance and Commitment Therapy for Eating Disorders: A Process-Focused Guide to Treating Anorexia and Bulimia. Oakland, CA: New Harbinger, 2010.


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American Anorexia/Bulimia Association (AABA), 418 E. 76th St., New York, New York, 10021, (212) 734-1114.

American Dietetic Association (ADA) NCND-Eating Disorders, 216 W. Jackson Blvd., Chicago, Illinois, 60606, (800) 366-1655.

National Anorexic Aid Society, 445 E. Dublin-Granville Rd., Worthington, Ohio, 43229, (614) 436-1112.

National Association of Anorexia Nervosa and Associated Disorders (ANAD), PO Box 7, Highland Park, Illinois, 60035, (708) 831-3438.