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Bulimia nervosa

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 do 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, 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 can be difficult to overcome. But effective treatment can help you feel better about yourself, adopt healthier eating patterns and reverse serious complications.

Symptoms Causes Risk factors Complications Prevention

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
  • Misusing laxatives, diuretics or enemas after eating
  • Using dietary supplements or herbal products for weight loss

When to see a doctor

If you have any bulimia symptoms, seek medical help as soon as possible. If left untreated, it may get worse and take over your life.

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 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 of normal weight or even 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 high-fat or sweet foods
  • 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

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

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 or parents) 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.
  • Psychological and emotional issues. People with eating disorders may have psychological and emotional problems that contribute to the disorder. Examples include low self-esteem, perfectionism, impulsive behavior, anger management problems, depression, anxiety disorders or obsessive-compulsive disorder. In some cases, traumatic events may be a contributing factor.
  • Societal pressure. Peer pressure and what people see in the media may fuel a desire to be thin, particularly among young women. People who are in the public eye, such as actors, dancers and models, are at higher risk of eating disorders.
  • Performance pressure in sports. Eating disorders are particularly common among athletes, such as gymnasts, runners and wrestlers. Coaches and parents may unknowingly contribute to eating disorders by encouraging young athletes to lose weight, maintain a low weight and restrict eating for better performance.

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 and heart failure
  • Severe tooth decay and gum disease
  • Absence of a period in females
  • Digestive problems, and possibly a dependence on laxatives to have bowel movements
  • Anxiety and depression
  • Drug and alcohol abuse

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:

  • Cultivate 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.
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