What is Bulimia?

According to the National Eating Disorders Association, eating disorders are serious but treatable mental and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights. National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives. The most common eating disorders individuals experience are anorexia nervosa, bulimia nervosa, and binge eating disorder. In addition, individuals struggle with eating disorders such as Otherwise Specified Feeding and Eating Disorder (OSFED), Avoidant Restrictive Food Intake Disorder (ARFID), and Orthorexia.

Those who develop bulimia nervosa often have low self esteem, perfectionism, and are overly critical of not only their bodies but also themselves as a whole. Similarly to individuals who struggle with anorexia, individuals with bulimia are extremely harm avoidant. However, in comparison to those with anorexia, individuals with bulimia tend to be more impulsive, novelty seeking, struggle with emotional regulation, and have a higher incidence of substance use disorders.  It’s common to see that an individual living with an eating disorder may deny having a problem in its early stages; they may also continue to feel “fat” despite experiencing malnutrition, which may even be life-threatening.

Bulimia Nervosa and Binge Eating Episodes 

While Individuals with bulimia nervosa might vigorously exercise and diet often, they may be any size, often having weight fluctuations,  and generally are not as underweight as those suffering from anorexia nervosa, restricting type. This is because patients with bulimia nervosa often binge eat, and may consume an incredible amount of food in a short period of time. 

A binge session could lead to the consumption of thousands of calories that are often high in fat, carbohydrates, and sugars; sometimes, they eat incredibly fast, consuming food without so much as tasting it. An individual may feel out of control in the midst of an eating binge, and oftentimes their binge will only stop if they fall asleep, are interrupted by someone else, or their stomach begins to hurt because it is stretched far beyond its normal capacity. Someone with bulimia nervosa uses compensatory behaviors such as self-induced vomiting, laxative abuse, or excessive exercise to “undo” the binge episode. 

Diagnostic Criteria for Bulimia

According to the DSM-5, the official diagnostic criteria for bulimia nervosa are:

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
• Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
• A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of anorexia nervosa.

Signs of Bulimia Nervosa

People do not often know when a friend or family member is suffering from bulimia nervosa because they tend to hide their bingeing and purging behaviors. Due to society’s perception and stigma around what a person with an eating disorder looks like, individuals who struggle with bulimia often go unnoticed by even those who are closest to them because they appear to have a “normal” body size.

 A few of the numerous health consequences that may come with bulimia include:

• A sore throat that is chronically inflamed
• Teeth beginning to decay from exposure to stomach acids after their enamel wears off
• Gastroesophageal reflux disorder, caused by constant vomiting
• Intestinal issues caused by irritation from laxative abuse
• A puffy face and cheeks
• Severe dehydration from the purging of fluids
• Salivary glands below the jaw and in the neck become swollen
• Kidney problems caused by the use of diuretics, or water pills

While mortality rates are less known for bulimia nervosa compared to anorexia nervosa, bulimia has life-threatening and elevated mortality risks due to the myriad health complications that can affect every organ system. Individuals with bulimia have severe psychological consequences and have a high rates of suicide. 

Can Bulimia Nervosa Be Prevented?

According to the Mayo Clinic, there is no definitive way to prevent the development of bulimia nervosa, and factors that may increase one’s risk of developing the disease include one’s biology, dieting, and emotional and physical issues. Bulimia nervosa is more common in girls and women than in boys and men; it tends to begin in one’s late teens or even early adulthood. Some ways to help steer an individual (or yourself) towards a healthier relationship with food include:

• Having regular, enjoyable family meals
• Discouraging dieting, especially iterations that involve fasting, the use of weight-loss supplements, or laxatives
• Avoiding talking about weight at home
• Fostering and reinforcing a healthy body image in one’s children, no matter what shape or size they may be; this can be coupled with helping them build confidence in ways that do not hinge upon their appearance.
• Talk to your primary care provider about what early indicators to look out for

If you or a loved one is experiencing bulimia nervosa or otherwise disordered eating, we are here to help at Eating Disorder Recovery Specialists. You may contact us via phone (866-525-2766), email, or by filling out our contact form.