Overview

Bulimia (boo-LEE-me-uh) nervosa, commonly called bulimia, is a serious, potentially life-threatening eating disorder. People with bulimia may secretly binge — eating large amounts of food — and then purge, trying to get rid of the extra calories in an unhealthy way. For example, someone with bulimia may force vomiting or engage in excessive exercise. Sometimes people purge after eating only a small snack or a normal-size meal.

Bulimia can be categorized in two ways:

  • Purging bulimia. You regularly self-induce vomiting or misuse laxatives, diuretics or enemas after bingeing.
  • Nonpurging bulimia. You use other methods to rid yourself of calories and prevent weight gain, such as fasting, strict dieting or excessive exercise.

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.

If you have bulimia, you're probably preoccupied with your weight and body shape. You may judge yourself severely and harshly for self-perceived flaws. Because it's related to self-image — and not just about food — bulimia can be hard to overcome. But effective treatment can help you feel better about yourself, adopt healthier eating patterns and reverse serious complications.

Bulimia care at Mayo Clinic

Symptoms

Bulimia signs and symptoms may include:

  • Being preoccupied with your body shape and weight
  • Living in fear of gaining weight
  • Feeling that you can't control your eating behavior
  • Eating until the point of discomfort or pain
  • Eating much more food in a binge episode than in a normal meal or snack
  • Forcing yourself to vomit or exercise too much to keep from gaining weight after bingeing
  • Misusing laxatives, diuretics or enemas after eating
  • Restricting calories or avoiding certain foods between binges
  • Using dietary supplements or herbal products excessively for weight loss

When to see a doctor

If you have any bulimia symptoms, seek medical help as soon as possible. If left untreated, bulimia can severely impact your health.

Talk to your primary care provider or a mental health provider about your bulimia symptoms and feelings. If you're reluctant to seek treatment, confide in someone about what you're going through, whether it's a friend or loved one, a teacher, a faith leader, or someone else you trust. He or she can help you take the first steps to get successful bulimia treatment.

Helping a loved one with bulimia symptoms

If you think a loved one may have symptoms of bulimia, have an open and honest discussion about your concerns. You can't force someone to seek professional care, but you can offer encouragement and support. You can also help find a qualified doctor or mental health provider, make an appointment, and even offer to go along.

Because most people with bulimia are normal weight or slightly overweight, it may not be apparent to others that something is wrong. Red flags that family and friends may notice include:

  • Constantly worrying or complaining about being fat
  • Having a distorted, excessively negative body image
  • Repeatedly eating unusually large quantities of food in one sitting, especially foods the person would normally avoid
  • Not wanting to eat in public or in front of others
  • Going to the bathroom right after eating or during meals
  • Exercising too much
  • Having sores, scars or calluses on the knuckles or hands
  • Having damaged teeth and gums

Causes

The exact cause of bulimia is unknown. There are many factors that could play a role in the development of eating disorders, including biology, emotional health, societal expectations and other issues.

Risk factors

Factors that increase your risk of bulimia may include:

  • Being female. Girls and women are more likely to have bulimia than boys and men are.
  • Age. Bulimia often begins in the late teens or early adulthood.
  • Biology. People with first-degree relatives (siblings, parents or children) with an eating disorder may be more likely to develop an eating disorder, suggesting a possible genetic link. It's also possible that a deficiency in the brain chemical serotonin may play a role. And, being overweight as a child or teen may increase the risk.
  • Psychological and emotional issues. Psychological and emotional problems, such as anxiety disorder or low self-esteem, can contribute to eating disorders. Triggers for bingeing may include stress, poor body self-image, food, restrictive dieting or boredom. In some cases, traumatic events and environmental stress may be contributing factors.
  • Media and societal pressure. The media, such as TV and fashion magazines, frequently feature a parade of skinny models and actors. These images seem to equate thinness with success and popularity. But whether the media merely reflect social values or actually drive them isn't clear.
  • Sports, work or artistic pressures. Athletes, actors, dancers and models are at a higher risk of eating disorders. Coaches and parents may inadvertently raise the risk by encouraging young athletes to lose weight, maintain a low weight and restrict eating for better performance.

Complications

Bulimia may cause numerous serious and even life-threatening complications. Possible complications include:

  • Dehydration, which can lead to major medical problems, such as kidney failure
  • Heart problems, such as an irregular heartbeat or heart failure
  • Severe tooth decay and gum disease
  • Absent or irregular periods in females
  • Digestive problems, and possibly a dependence on laxatives to have bowel movements
  • Anxiety and depression
  • Misuse of alcohol or drugs
  • Suicide

Prevention

Although there's no sure way to prevent bulimia, you can steer someone toward healthier behavior or professional treatment before the situation worsens. Here's how you can help:

  • Foster and reinforce a healthy body image in your children, no matter what their size or shape.
  • Talk with your pediatrician. Pediatricians may be in a good position to identify early indicators of an eating disorder and help prevent its development.
  • If you notice a relative or friend who seems to have food issues that could lead to or indicate an eating disorder, consider supportively talking to the person about these issues and ask how you can help.

Bulimia nervosa care at Mayo Clinic

Aug. 23, 2017
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