What Is Bulimia Nervosa?

Overview

Bulimia nervosa is a condition that affects both physical and mental health. It is an eating disorder characterised by periods of binge eating followed by self-induced vomiting, fasting, excessive exercise, or medicine misuse to counteract the over-eating. Sufferers become fixated on losing weight and having trouble accepting their bodies. 

Bulimia nervosa is most common in adolescents, particularly in those who are assigned female at birth (AFAB). For diagnosis, episodes have to happen at least once every week for three months. Early intervention leads to a better chance of recovery, therefore it is advised to see a GP as soon as possible. The doctor will look into your history and might refer you further if they feel it is required. It may be hard to ask for help or open up to someone about these issues, therefore having someone in a clinical setting to support you could be helpful.

This article will highlight the causes of bulimia as well as signs and symptoms to look out for, potential risk factors and treatment options for the condition.

Causes of bulimia nervosa

The exact cause of bulimia nervosa is unclear. The condition is multifactorial and although there is evidence that it is associated with neuronal pathway abnormalities responsible for appetite regulation and taste reward, it is often put down to modern external factors.¹

Blame is often placed on the media and fashion industry, which have normalised and popularised a slim body to be the normal standard and caused low self-esteem in younger generations.

Bulimia is also associated with other psychological problems as part of a broader mental health condition. These can include anxiety disorders, obsessive-compulsive disorder, depression and post-traumatic stress disorder (PTSD).

Signs and symptoms of bulimia nervosa

People suffering from weight issues and body image problems over a long period of time should consider seeking help from a medical professional. To help you understand this condition better, here are some signs and symptoms:^{1, 2}

• Binge eating; uncontrollably eating large amounts of food in a short time
• Purging: Emptying the stomach or bowels or working to remove food from the body by self-induced vomiting, laxative misuse, excessive exercise or extreme fasting
• Phobia of putting on weight
• Being hypercritical of weight and body image
• Mood changes

Some signs to watch out for are:

• Tiredness
• Callouses on the back of the hands
• Erosion of teeth from excessive vomiting
• Dry skin
• Swelling on the side of the cheeks

Management and treatment of bulimia nervosa

Bulimia requires a multidisciplinary team (MDT) to help sufferers get on a path to recovery. A management plan might incorporate addressing issues with bingeing and purging, broader mental health issues and physical health.

Types of treatment offered may be:³

• Guided self-help programme: Involves working through a self-help book and attending sessions with a therapist. The self-help book will help with monitoring eating, making meal plans, learning about triggers and learning coping mechanisms for feelings
• Cognitive behavioural therapy (CBT): To explore emotions and thoughts that could be contributing to the eating disorder and to help adopt healthy eating habits
• Family-based therapy (FBT): Offered to young children and their families to help the family learn how to offer support
• Medicine: Antidepressants are not recommended for children and adolescents due to a lack of evidence to prove they are helpful. Antidepressants may be for adults, where the most common medication for bulimia nervosa treatment is a class called Selective Serotonin Reuptake Inhibitors (SSRIs) such as fluoxetine
• Dietician: To specifically address food-related habits

In emergency cases, sufferers may require correction of electrolyte balance and dehydration which would require hospital admission. 

Diagnosis

As bulimia nervosa is a psychological and physical condition, diagnosis can be complex. During diagnosis, your doctor may:

• Ask several questions about thoughts, feelings and eating habits
• Ask about physical symptoms such as a sore throat, irregular menstruation, constipation, headache, fatigue, lethargy, abdominal pain and bloating
• Conduct a physical exam to check weight, height and other vital signs
• Carry out blood and urine tests to assess the impact on the body including blood cell levels, vitamin B levels, electrolytes, liver function, kidney function and calcium levels

Risk factors

It is difficult to identify causes of bulimia. Risk factors that might increase susceptibility to an eating disorder are:

• Family history of eating disorders, depression, alcohol or drug addiction
• Being subject to unwanted attention and/or critique about one’s weight and eating habits
• An inclination towards worrying about what societal expectations are
• Anxiety, low self-esteem or an obsessive personality
• Being subject to sexual abuse

Complications

Bulimia can lead to potentially critical complications. The complications associated with this disorder and their severity are determined based on the frequency and method of purging, thus different from anorexia nervosa, which is dependent on patients’ weight. Complications related to bulimia are as follows:¹

• Mallory Weiss syndrome: Tears in the food pipe mucosa, near the stomach border, which can lead to bleeding and then rupture. This can become an emergency if gastric acid gets into the sterile area of the abdomen
• Barretts Oesophagus: A condition in which abnormal mucosal cells replace the normal lining of the oesophagus, thus increasing the risk of developing oesophageal cancer
• Gastro-oesophageal reflux disease (GORD): Reflux disease, which consists of multiple episodes of retching, which in turn can also increase the risk of Barretts Oesophagus
• Irregular heartbeats: This can be caused due to hypokalemia (decreased potassium in the blood) due to self-induced vomiting, which in turn can lead to fainting and decreased oxygen supply to the heart and brain
• Constipation: Chronic abuse of laxatives can lead to cathartic colon syndrome, subjecting the patient to constant aches and inability to eat
• Dental erosion: This can happen due to the gastric content which is acidic in nature coming into contact with teeth due to excessive vomiting. It can affect the ease of daily life activities, like eating and can also have psychological effects since teeth are part of a person’s smile and first impression
• Pancreatitis: Inflammation of the pancreas. It has been found in several cases of bulimia nervosa although the reason is still unknown. Pancreatitis on its own is very harmful because it is a condition that starts breaking down the body from the inside

FAQs

How can I prevent bulimia nervosa?

As there is no specific cause of bulimia, it is difficult to ‘prevent’ it. As modern media is a large factor in building a distorted image of the ‘perfect’ body, you should focus on building a positive body image for you and your children outside of social media. 

How common is bulimia nervosa?

The number of patients with bulimia nervosa has remained stable over the last decade but there has been an increase in the percentage of younger people suffering. In Western countries, 3%  of people assigned female at birth (AFAB) and more than 1% of those assigned male at birth (AMAB) suffer from bulimia nervosa.⁴

When should I see a doctor?

You should see a doctor if you feel like your weight and its management has taken over a major portion of your life. Even if you feel you are doing it in a healthy manner, it is not good to spend long periods of time focusing on your body. 

Summary

Bulimia is characterised by periods of binge eating followed by self-induced vomiting, or other methods to remove food from the body. Even though the relative amount of people suffering from bulimia is generally small, the burden of living with it is great. It can affect anyone but usually is seen in adolescents aged between 13 and 17. Bulimia comes with a great psychological burden, making the path to recovery difficult. Getting help is important and will involve people working with you and your family to get to the foundation of your thoughts and triggers. They will help you manage your emotions, and get you to be a better version of yourself. The process of recovery can be a long one, but recovery is possible.