Bulimia nervosa, often just called bulimia, is a disorder that is characterized by rapid,
out-of-control binge eating past the point of fullness or comfort, followed by purging
either by self-induced vomiting done manually or sometimes with ipecac syrup, by taking
laxatives, or by using diuretics.
To fit the diagnosis, these cycles of binging and purging must repeat consistently at least
once a week for a period of 3 months, but can happen as often as multiple times per
day.
The onset of bulimia typically happens around adolescence, usually in individuals with low
self-esteem who have a strong desire to have control over key aspects of their life including
their weight.
They are often fixated on food, which includes the amount that they consume as well as the
calorie and fat content.
The pattern of bulimia is often cyclical with someone setting unrealistic goals for themselves
(like getting a 100 percent on every exam they take), and when they don’t reach those
goals, they binge, and then they purge to try to ‘fix’ the binging.
Individuals with bulimia will also try to control their weight in other ways—by taking
stimulants, by going on extreme diets such as “water fasts” where they consume only
water, and by exercising excessively.
These symptoms of binging and purging with bulimia nervosa can be confused with another
eating disorder—anorexia nervosa, where they might also binge and purge, but the main
distinction between these two disorders doesn't have to do with this act of binging and purging,
but actually has to do with an individual's weight.
People with bulimia are usually normal weight or overweight, whereas people with anorexia
are underweight.
Because of this, people can more easily hide the fact that they suffer from bulimia, and
can also potentially start out with bulimia, and then develop to anorexia over time.
The binging and purging cycles associated with bulimia can result in a number of serious
side effects.
Repeated vomiting can lead to erosion of dental enamel, sialadenosis, which is swelling of
the parotid gland, and halitosis, or very bad breath.
The back of the knuckles can get calloused from using the hand to induce vomiting, which
is called Russell’s sign, and if the vomiting is forceful enough it can lead to tears of
the distal esophagus and stomach itself, which is called Mallory Weiss syndrome, which can
cause abdominal pain and blood to come up in the vomit, called hematemesis.
Over time, vomiting can cause dehydration and lead to hypotension—a blood pressure
below 90/50, as well as tachycardia or a fast heart rate over 100 heart beats per minute.
The purging involved in bulimia can also cause a depletion of electrolytes which leads to
a low level of sodium, chloride, magnesium, phosphate, and potassium, as well as a general
metabolic alkalosis.
The low potassium or hypokalemia is particularly worrisome because it can lead to muscle weakness
and even cardiac arrhythmias, the latter of which can lead to death.
Bulimia can also lead to endocrine changes, the most common of which is menstrual irregularities
in women, who might even develop amenorrhea, where either the normal menstrual cycle stops
or menstruation doesn’t start by age 15.
In addition, individuals with bulimia are at higher risk of developing diabetes mellitus,
which makes for a particularly dangerous combination.
And that’s because the purging part of the bulimia cycle is a form of food restriction
that causes a starvation state for the body’s cells, and on top of that diabetes makes it
more difficult for glucose to enter the body’s cells at a cellular level, which worsens that
starvation state.
As far as causes of bulimia go, it’s been shown to have a genetic component, based on
twin and adoption studies.
In addition, though, there is also evidence for a strong social component.
Bulimia typically begins in teen years or in young adulthood, which is a time when individuals
usually start to pay attention to the media, and rates of bulimia are higher for individuals
and in societies that have higher exposure to media.
Also, although bulimia is more common in women, it’s worth mentioning that men suffer from
bulimia as well, and in both genders it can often be seen among athletes and professionals
who are keenly focused on their body weight and percent body fat, like with dancers, models,
and wrestlers.
Finally, bulimia is also commonly associated with other conditions like obsessive-compulsive
disorder, depression, and anxiety, all of which have overlapping symptoms and risk factors.
Medical treatment with careful nutrition and weight management is important.
But it’s also important to use tools like psychotherapy and cognitive behavioral therapy
to help the individual and his or her family structure a new relationship around food.
For example, teaching a person to eat just a small amount of a ‘forbidden food’ and
then consciously noticing the absence of severe consequences.
Bulimia is sometimes also treated with antidepressant medications, like SSRIs or selective serotonin
reuptake inhibitors, and typically a combination of therapy with the medication works best
for severe cases.
Alright so as a quick recap, bulimia is when somebody goes through cycles of binging and
purging at least once a week for 3 months, but are typically still normal weight or overweight.
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