What is Bulimia Nervosa?

Bulimia nervosa is an eating disorder characterized by periods of binge eating followed by purging behavior to prevent weight gain. Like anorexia, bulimia is associated with an obsession with weight and body image.

 

Both physical health complications and mental health problems accompany bulimia nervosa. The risk of death due to bulimia is lower than for anorexia, but both eating disorders can prove fatal. Unlike anorexics, bulimics are usually of average weight or slightly overweight, despite their concerns about weight gain.

Bulimia nervosa affects from one to three percent of women, with rates climbing as high as five percent among female college students. Women of Caucasian ethnicity who occupy middle to high socioeconomic ranges are most at risk of developing bulimia nervosa.

Bulimia is usually diagnosed in late adolescence, with most cases developing around age eighteen. The majority of bulimia diagnoses take place between the ages of ten and thirty.

Men can also develop bulimia, but the eating disorder is generally considered a woman's disease. Cases of bulimia nervosa in women are ten times the number associated with men. Men are less likely to seek help for eating disorders than women, however, so true incidence rates in men may actually be higher.

An exact cause for bulimia nervosa is unknown, although an obsession with weight loss, weight gain, and body image occurs in all bulimics.

 

Binge eating is not caused by hunger for most bulimics. Instead, binge eating seems to be a response to stress, depression, and feelings of worthlessness, often centered on weight gain and food. After binge eating, bulimics feel guilt and shame due to their uncontrolled food consumption, and purge (take inappropriate steps to void eaten food) to prevent weight gain.

Coexisting mental health disorders are common with bulimia nervosa, implying a psychological cause for the eating disorder. Anxiety and depression frequently occur in combination with bulimia.

 

In addition, borderline personality disorder, antisocial behavior, impulse control disorders, and obsessive compulsive disorder can all coexist with bulimia nervosa. Bulimics often have histories of sexual promiscuity or substance abuse, and the binge and purge cycle of the eating disorder has been compared to substance addiction.

Bulimics describe feeling out of control during an episode of binge eating. High calorie, high fat food is usually consumed during a binge. Due to feelings of shame at their out of control eating, bulimics usually binge in secrecy, although they may eat normally in social situations. Food is eaten at great speed during a binge, with little or no concern for the food's flavor.

 

Binge eating can cause a number of health complications, including gastrointestinal and nutritional disorders. Overeating can even rupture the stomach or esophageal lining.

Purging may take several forms, but self-induced vomiting and laxative abuse are especially common methods used to prevent weight gain. Self-induced vomiting causes dental health problems, eroding tooth enamel over time. Consistent vomiting also damages esophageal health.

 

Abusing laxatives to prevent weight gain causes serious health complications. Health complications of laxative abuse include bowel disorders, malnutrition problems, metabolic disorders, heart problems and death.

Successful treatment of bulimia nervosa is similar to successful substance abuse treatment. Patients learn to change eating habits and attitudes towards body image and weight gain to prevent future binge and purge behavior.

Changing a bulimic's attitudes about eating, weight gain, and body image takes time, and may never be completely successful. Fifty percent of people successfully treated for bulimia nervosa retain features of bulimia up to six years after treatment.

This section on eating disorders provides detailed articles associated with bulimia, such as bulimia symptoms and effects of bulimia, with each listed in the menu to the left. To research other mental health topics, please use the morefocus search tool, or see the related topics listed to the left.

Resources

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Behrman, R.E. & Kliegman, R.M. (ed). Nelson Essentials of Pediatrics, 3rd Edition. W.B. Saunders Company, Philadelphia, 1998.

Deshmukh, R. & Franco, K. (2003, January 21). Eating disorders: Differential diagnosis.

Eating Disorders Association. (updated 2004). What is bulimia nervosa?

Gowers, S. & Bryant-Waugh, R. (2004). Management of child and adolescent eating disorders: The current evidence base and future directions. Journal of Child Psychology and Psychiatry 45, 63-83.

Mehler, P.S. (2003, August 28). Bulimia nervosa. The New England Journal of Medicine 349(9), 875-881.

MedicineNet. (updated 2002, April 15). Bulimia nervosa.

Rome, E.S. & Ammerman, S. (2003, December). Medical complications of eating disorders: An update. Journal of Adolescent Health 33(6), 418-426.

Something Fishy Website on Eating Disorders. (nd). Bulimia nervosa.