Bulimia nervosa is a serious, potentially life-threatening eating disorder. People with bulimia (bu-LEE-me-uh) nervosa may binge and purge, eating large amounts of food and then trying to get rid of the extra calories in an unhealthy way. For example, someone with bulimia nervosa may force themselves to vomit or do excessive exercise.
If you have bulimia nervosa, you are probably preoccupied with your weight and body shape, and may judge yourself severely and harshly for your self-perceived flaws.
Because it's related to self-image — and not just about food — bulimia nervosa can be difficult to overcome. But effective bulimia nervosa treatment can help you feel better about yourself, adopt healthier eating patterns and reverse serious complications.
Bulimia symptoms may include:
When you have bulimia, you may regularly vomit or exercise excessively after binge eating. Sometimes, however, people with bulimia feel a need to purge after eating only a small snack or a normal-size meal.
A binge is considered eating a larger amount of food than most people would eat under similar situations. For instance, when you have bulimia, you may eat an entire cake, rather than just a slice or two. And you may continue eating until you're painfully full.
Binges often occur in private. Once the binge episode ends, the purging begins. This may mean heading to the bathroom to vomit, hitting the treadmill for hours of exercise, or not eating for long periods of time (fasting). Because most people with bulimia are of normal weight or even slightly overweight, it may not be readily apparent to others that something is wrong.
Bulimia may be categorized in two ways:
However, these behaviors often overlap, and the attempt to rid yourself of extra calories is usually referred to as purging, no matter what the method.
When to see a doctor
If you have a primary care doctor, talk to him or her about your bulimia symptoms and feelings. Or seek help directly from a mental health provider. If you're reluctant to seek treatment, try to work up the courage to confide in someone about what you're going through, whether it's a friend or loved one, a health care professional, a teacher, a faith leader, or someone else you trust. They can help you take the first steps to successful bulimia treatment.
Helping a loved one with bulimia symptoms
Red flags that family and friends may notice include:
The exact cause of bulimia is unknown. As with other mental illnesses, there are many possible factors that could play a role in the development of eating disorders, such as genes, certain behaviors, psychological disorders, and family and societal influences:
Certain situations and events might increase the risk of developing an eating disorder. These risk factors may include:
Bulimia may cause numerous serious and even life-threatening complications. Possible complications of bulimia include:
Preparing for your appointment
Treatment of bulimia nervosa is generally done using a team approach that includes medical providers, mental health providers and dietitians, all with experience in eating disorders.
Here's some information to help you get ready for your appointments, and what to expect from your doctor and other health providers.
What you can do
Some potential questions you might want to ask your doctor or other health care provider include:
In addition to the questions that you've prepared to ask, don't hesitate to ask questions of any of your providers anytime that you don't understand something.
What to expect from your doctor
Tests and diagnosis
When doctors suspect you have bulimia, they typically perform:
Additionally, your doctor may also request an X-ray to check for broken bones, pneumonia or heart problems, and an electrocardiogram may be done to look for heart irregularities.
Diagnostic criteria for bulimia
DSM criteria for bulimia include:
Some people may not meet all of these criteria but still have an eating disorder. Don't try to diagnose yourself — get professional help if you have any eating disorder symptoms.
Treatments and drugs
When you have bulimia, you may need several types of treatment, although combining psychotherapy with antidepressants may be the most effective for overcoming the disorder. Treatment is generally done using a team approach that includes you, your family, your primary care doctor or other medical provider, as well as mental health providers and dietitians experienced in treating eating disorders. You may have a case manager to coordinate all of your care.
Here's a look at bulimia treatment options and considerations:
A type of talk therapy called cognitive behavioral therapy may help people with bulimia. This type of therapy is based on the idea that your own thoughts — not other people or situations — determine how you behave. Cognitive behavioral therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. An important negative belief that cognitive behavioral therapy addresses is the idea that restrictive eating can help you stay thin, when in fact, the reality is that fasting can often trigger binge eating.
Family-based therapy can also be an effective treatment for children and adolescents with eating disorders. This type of therapy begins with the assumption that the person with the eating disorder is no longer capable of making sound decisions regarding his or her health and needs help from the family. An important part of family-based therapy is that the family is involved in making sure that healthy-eating patterns are followed and helping the person restore weight. This type of therapy can help resolve family conflicts and encourage support from concerned family members.
Weight restoration and nutrition education
Treatment challenges in bulimia
Lifestyle and home remedies
Although you can't treat bulimia on your own, you can do some things for yourself that will build on your treatment plan. In addition to professional treatment, follow these self-care tips for bulimia:
Usually, when people turn to alternative medicine it's to improve their health, but for people with eating disorders this isn't always the case. Alternative medicine treatments have both negative and positive consequences when it comes to eating disorders.
Coping and support
You may find it difficult to cope with bulimia when you're hit with mixed messages by the media, culture, and perhaps your own friends or peers. You may even have heard people joke that they wish they could throw up after overeating.
So how do you cope with a disease that can be deadly when you're also getting messages that being thin is a sign of success?
Coping advice for parents
Here are some suggestions for supporting your child:
It's also important to remember that eating disorders affect the whole family and that you need to take care of yourself too. If you feel that you aren't coping well with your teen's illness, you might benefit from professional counseling. Or, ask your child's doctor if he or she knows of any support groups in your area for parents of children with eating disorders.
While there's no sure way to prevent bulimia, there may be ways to help. For instance, pediatricians may be in a good position to identify early indicators of an eating disorder and help prevent its development. During routine well-child checks or medical appointments, they can ask children questions about their eating habits and satisfaction with their appearance. In addition, parents can cultivate and reinforce a healthy body image in their children no matter what their size or shape. Be sure not to tease or joke about a child's size, shape or appearance.
If you notice a family member or friend with low self-esteem, severe dieting, disordered eating behaviors and dissatisfaction with appearance, consider talking to her or him about these issues. Although you may not be able to prevent an eating disorder from developing, your encouragement can steer someone toward healthier behavior or professional treatment before the situation worsens.
Last Updated: 2010-02-23
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