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Definition

Bulimia is an eating disorder. People with bulimia are overly worried about their weight and body image. They binge and purge their food. Bingeing is eating large amounts of food. Purging is using vomiting, laxatives, or diuretics to get it out of the body. Exercise may be used to replace purging, or it may be used with it. The cycle is done to stop weight gain.

Causes

The cause is not known. It may be due to a mix of genes and the environment.

Risk Factors

Bulimia is more common in young women. Other things that may raise the risk are:

  • Low self-esteem
  • Feelings of helplessness
  • Wanting to be perfect
  • Fear of gaining weight
  • Not being happy with weight and size
  • Pressure to be thin
  • Having other family members with the same problems
  • Emotional stress
  • Prior obesity or anorexia
  • Having other mental health problems, such as depression or anxiety
  • Substance use disorder
  • A way of life that highlights being thin as ideal

Symptoms

People with bulimia have a healthy weight. But, their habits are not healthy. Bulimia may cause:

  • Eating of large amounts of food at one time
  • Feeling like eating is not in one's control
  • Forced vomiting
  • Taking of laxatives, enemas, diuretics, or diet pills
  • Too much exercise
  • Mood swings
  • Problems with impulse control
  • Misuse of alcohol or other substances

Physical problems may be:

  • Belly pain
  • Heartburn
  • Menstrual problems
  • Swollen cheeks and jaw
  • Sore throat
  • Swollen glands in the mouth and throat
  • Bloating
  • Stained or chipped teeth—because of contact with stomach acid
  • Cuts or scars on back of hands—from scraping skin on teeth during forced vomiting

Diagnosis

The doctor will ask about symptoms, past health, and eating habits. A physical and mental health exam will be done. Other tests may be:

  • Blood tests to look for electrolyte imbalances
  • ECG to check heart function

ECG
Heart EKG

Bulimia can lead to severe heart problems.

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Treatment

The goal of treatment is to develop healthy habits and thought patterns. Treatment can include a combination of:

  • Nutrition counseling and support
  • Mental health counseling methods, such as individual or group cognitive-behavioral therapy
  • Vitamins and minerals
  • Antidepressants along with therapy

Prevention

There are no known guidelines to prevent bulimia.

RESOURCES:

Bulimia Nervosa Resource Guide for Family and Friends
https://bulimiaguide.org

National Eating Disorders Association
https://www.nationaleatingdisorders.org

CANADIAN RESOURCES:

Canadian Mental Health Association
https://cmha.ca

National Eating Disorder Information Center
http://www.nedic.ca

REFERENCES:

Bulimia nervosa. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/bulimia-nervosa. Accessed November 18, 2020.

Bulimia nervosa. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/psychiatric-disorders/eating-disorders/bulimia-nervosa. Accessed November 18, 2020.

Bulimia nervosa. Office on Women's Health website. Available at: https://www.womenshealth.gov/mental-health/mental-health-conditions/eating-disorders/bulimia-nervosa. Updated August 28, 2018. Accessed August 31, 2018.

Eating disorders. National Institute of Mental Health website. Available at: https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml. Updated February, 2016 Accessed August 31, 2018.

Harrington BC, Jimerson M, et al. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician. 2015 Jan 1;91(1):46-52.

Last reviewed January 2021 by EBSCO Medical Review Board Adrian Preda, MD  Last Updated: 04/14/2021