What is Bulimia Nervosa?

By The Fix staff 07/30/14

Characterized by an obsession with weight control and dieting, bulimia is an eating disorder that affects as much as 5% of the U.S. population. 

Most people suffering with bulimia nervosa have difficulty managing their need to binge eat, consuming as many as 5,000 calories in at least one uncontrolled setting a week. Feeling guilty about their loss of control and worried about the weight they could gain from the binge eating episode, bulimics then feel compelled to purge the food from their system as quickly as possible to avoid weight gain. 

Studies estimate 90% of bulimics are women, though some statistics indicate that up to 15% of bulimia sufferers may be male. Women are more susceptible to bulimia – and eating disorders in general – because they tend to be more concerned with their body image than men. Women are also more likely than men to seek treatment for an eating disorder. 

Similar to those with anorexia, people suffering from bulimia obsess about their weight but still maintain an average or slightly over average weight. This is one of the major differences between bulimia and anorexia. In fact, while weight is a determining factor in diagnosing anorexia, it is not as important in cases of bulimia. It’s the disordered eating behaviors that determine bulimia. 

What Behaviors/Factors Define Bulimia? 

When people use food to meet an emotional and psychological need rather than hunger, chances are they’re either on the verge of developing an eating disorder or already have one. They use food to escape reality, avoid stressful situations and alleviate anxiety, grief, low self esteem or loneliness. Food also becomes a distraction from traumatic memories or tense situations and can serve as a punishment or reward. All of these conditions apply to bulimia. Binge-eating bulimics consume food until they are uncomfortably full, eat large amounts when not hungry, devour food faster than normal and even isolate themselves when they eat so they don’t attract unwanted attention. 

The characteristics that distinguish bulimia from simple BED (binge eating disorder) are the frequency and the preoccupation with body image and weight that leads to purging, most commonly (some 70% of bulimics) with self-induced vomitingThey also use laxatives or enemas after eating and take diuretics to flush water weight from their bodies. Some bulimics exercise excessively to burn calories instead of purging.  

How Does Bulimia Affect the Body? 

Looks can be deceiving when it comes to bulimia because, unlike anorexics, those afflicted most often have average weight. 

Jennifer Gaudiani, associate professor of medicine and assistant medical director for the Acute Center for Eating Disorders at Denver Health, said bulimia and binge eating disorder can be especially difficult to diagnose. “People can have devastating eating disorders in every size and every shape. And you can have a severe, life-altering eating disorder in every size and shape,” she said. 

Warning Signs 

Most people with bulimia attempt to conceal their disease from friends and family members and are often successful because they’re able to manage a healthy weight. Apart from binge eating and purging, warning signs include eating in secret or changing eating habits around friends and family, showing no change in weight despite heavy food consumption and making food runs by themselves. 

Other visible signs include: 

• Food disappearance. 

• Stashing of junk food. 

• Excess food wrappers or containers thrown in the trash. 

Bulimics who purge (rather than the relative handful who compulsively exercise off the weight) exhibit even more symptoms: 

• Weight fluctuations by 10 pounds or more. 

• Bumps or scars on the hands and knuckles from sticking fingers down the throat to induce vomiting. 

• Tooth discoloration and enamel erosion. 

• Puffy cheeks or tears in the esophagus from excessive vomiting. 

• Constipation. 

• Multiple trips to the restroom, particularly immediately after meals. 

Long-Term Effects 

Due to the constant physical abuse bulimics inflict on their bodies, they tend to suffer from a number of long-term effects. Complications from bulimia include diabetes, high blood pressure and heart disease, as well as osteoarthritis, joint and muscle pain, and polycystic ovary syndrome.

Add purging to the list of symptoms, and the number of long-term health issues surges for someone with bulimia: 

• Tooth cavities or other dental problems. 

• Electrolyte imbalances caused by dehydration and loss of essential nutrients. 

• Rupturing of the stomach due to binge eating. 

• Chronic bowel issues. 

Coexisting Medical Conditions

Both bulimics and people with binge eating disorder usually suffer from anxiety, depression and substance abuse as they struggle to control their binge eating, but bulimics use purging as a means to alleviate anxiety and shed unwanted calories. 


Since bulimia coexists with anxiety-related mental health conditions, the most popular method of treatment usually involves cognitive behavior therapy. By addressing thoughts and feelings with a psychotherapist, patients learn to change their unhealthy habits and eliminate behaviors that fuel them. 

Doctors also may prescribe mood-stabilizing medications that relieve anxiety. By increasing levels of serotonin to the brain, selective serotonin reuptake inhibitors alleviate depression, panic attacks and behaviors associated with obsessive-compulsive disorders. Examples include FDA-approved medications with fluoxetine such as Prozac, Zoloft and Sarafem. Physicians who treat binge eating have also shown positive results by prescribing the anti-seizure mood-stabilizing drug topiramate, also known as Topamax. Some patients, however, have experienced such side effects as fatigue, dizziness and tingling sensations, so it is not as widely prescribed. 

Many psychotherapists also recommend that patients work with a nutritionist to manage harmful eating habits. 

Finally, self-care techniques such as stress management have been shown to help reduce anxiety and decrease the frequency of binge eating or excessive dieting episodes. Many methods can be practiced at home and are recommended in addition to professional therapy. Adrenaline from moderate exercise, when performed to reduce stress and not as a means to affect body image, often helps patients control their disordered thinking. Bulimics and binge eaters have also had success with writing down thoughts and feelings as a way to ease stress.

Additional stress management techniques include: 

• Engaging in a creative activity such as a hobby or craft that stimulates the brain and focuses attention away from thoughts that trigger unhealthy behaviors. 

• Taking up relaxing activities such as breathing exercises, muscle relaxation, massage therapy, yoga or tai chi. 

• Releasing emotions through talking, laughing, crying or expressing anger to unleash pent-up anxiety that usually feeds negative behaviors. 


There are a number of blood and urine tests that identify when someone suffers from an eating disorder. 

A complete blood count (or CBC) checks for low iron, infections, inflammations and the health of the immune system by determining the white blood cell, red blood cell and platelet counts. An electrolyte test will identify dehydration, self-induced vomiting and laxative/diuretic abuse. People who complain of leg cramps, heart palpitations and swelling in the legs or feet should have this test run. 

B12 and Folic Acid tests reveal difficulty metabolizing proteins, carbohydrates and fat, as well as the body’s ability to absorb nutrients, while a cholesterol test determines when someone’s at risk for a heart attack. Testing for a perfectly functioning thyroid is important as well, particularly for people with eating disorders, because the thyroid controls the body’s metabolism. People with an overactive thyroid will have problems gaining weight, where those with an underactive thyroid have issues losing weight.

A urinalysis includes a series of tests that rates the functioning of the kidneys, urine sugar and ketone levels. Ketone is an organic compound that develops in the blood when food and nutrients are withheld, and a high level of ketones reveals the potential that the body could be “eating its own fat” for energy. An electrocardiogram detects irregularities in heartbeat for people exhibiting symptoms such as heart palpitations, trouble breathing or chest pain. These warning signs are especially prevalent among bulimics who purge. 

Finally, running a bone density test is vital because bone loss will be revealed through deficiencies in calcium, vitamin D or hormonal imbalances.

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