Eating disorders have existed for many hundreds of years. The ancient Romans at Caesar’s banquets would reportedly overeat, purge, and then return to the feast to consume more.
However, bulimia nervosa as a diagnosis has only been around since 1979 when a British psychiatrist observed and coined the condition. Forty years later, much of the world is still learning about the condition. Grow Therapy hopes to increase understanding of bulimia today and point people toward recovery.
What Is Bulimia Nervosa?
Bulimia nervosa is a serious eating disorder characterized by cycles of binging — eating large amounts of food in short periods of time — and then unhealthy compensatory behaviors to expel the food consumed. In the mind of someone caught in this cycle, expelling the food “undoes” the binge’s effects.
We often associate bulimia with self-induced vomiting. But this is just one of several purging behaviors that therapists observe in clients with bulimia, notes Julia Preamplume, a licensed clinical social worker with Grow Therapy.
“It can be laxative misuse. It can be over-exercising,” she says. Extreme fasting, misusing enemas, and misusing diuretics also count as purging behaviors.
Johns Hopkins Medicine’s bulimia resource page explains that the disorder has two types:
- Purging type: The individual engages in self-induced vomiting or misuses laxatives, diuretics, enemas, or other intestine-emptying medicines
- Non-purging type: The individual engages in non-purging behaviors to “compensate” for overeating, such as fasting, excessive exercise, or prolonged periods of starvation
This binge-and-compensate cycle may occur multiple times a day or several times a week, according to the DSM-V’s diagnostic criteria. But Preamplume emphasizes that any amount of disordered behaviors is concerning and worthy of care.
“Even if you’re not purging as frequently as what the criteria says, it’s still really valid even if you’re purging once a month,” says Preamplume. “It shows that there’s a struggle in your relationship with food.”
Signs and Symptoms of Bulimia
Both purging and non-purging bulimia follow the same pattern. The individual eats until painfully or uncomfortably full, usually feeling out of control while the binge is happening. Then there’s “an urge to expel everything,” as Preamplume puts it. “Now that there’s food in my body, I need to get rid of it.”
This binge-and-compensate cycle wears the body down and taxes the brain. NEDA’s information page on bulimia nervosa covers symptoms and warning signs of bulimia, including:
Behavioral Symptoms and Signs of Bulimia
- Developing attitudes that suggest losing weight, dieting, and controlling food have become primary concerns
- Leaving evidence of binge eating, such as excessive empty wrappers and containers
- Showing signs of purging behaviors, including the smell of vomit, packages of laxatives, or frequent bathroom trips after eating
- Appearing uncomfortable eating around others and/or in public
- Developing unusual eating habits
- Skipping meals or having only a small amount of food at mealtimes
- Stealing or hoarding food in unusual places
- Drinking excessive amounts of low-calorie beverages or water
- Using excessive amounts of mouthwash, gum, or mints
- Doing excessive exercise regardless of weather, illness, or injury
- Withdrawing from usual activities and friends
Physical Symptoms and Signs of Bulimia
- Discolored or stained teeth
- Unusual swelling of cheeks, salivary glands, or jaw area
- Cuts or calluses on the back of the hands and/or knuckles
- Bloating from fluid retention
- Extreme mood swings
- Noticeable weight fluctuations, both up and down
- Difficulty concentrating
- Stomach cramps and other gastrointestinal complaints
- Abnormal lab results (e.g., anemia, low potassium, slow heart rate, etc)
- Fainting
- Trouble sleeping
- Dry skin and brittle nails
- Fine or thinning hair
- Irregular menstrual cycles
What’s Happening Mentally in Those Suffering From Bulimia?
People experiencing any eating disorder tend to also struggle with allowing themselves to experience difficult thoughts or feelings. Disordered behaviors are a way of dealing with unpleasantness.
“They use them as a way to cope, and it’s a way to numb without even really recognizing it,” says Preamplume.
Bulimia’s binge-and-compensate cycle is a way of avoiding inner turmoil, and the rhythm can become an almost soothing distraction — even as it harms the body. People with bulimia may fear gaining weight, feel unhappy with their body weight and shape, or desperately want to lose weight, according to the National Institute on Mental Health’s eating disorders research.
The causes of bulimia are as diverse as the people who develop the condition. Family history is considered a risk factor; more than 50% of the risk of developing an eating disorder is based on genetics, according to the Eating Recovery Center (ERC). ERC also notes that certain personality traits are commonly found among those at high risk for bulimia, such as:
- High impulsiveness
- Unstable moods
- Emotional intensity
- Trouble seeing the “big picture”
- Cognitive rigidity
Another of the possible bulimia risk factors is social media and the comparison game it fuels. Seeing a constant feed of others’ appearance often drives people to feel unhappy with their own body shape, size, or weight — and may compel them to use unhealthy methods of altering it.
Dangers of Bulimia
Our bodies are resilient and can cope with the stress of disordered eating behaviors, according to NEDA’s information about the health consequences of eating disorders. Lab tests can appear normal even when someone is at high risk of death due to electrolyte imbalances or cardiac arrest.
Bulimia in particular affects three key body systems: cardiovascular, gastrointestinal, and neurological.
Cardiovascular
People with eating disorders may have weakened hearts due to reduced blood volume and negative energy supply,” according to Eating Disorder Hope’s article on bulimia and cardiovascular risk. With bulimia, the individual’s body is routinely depleted of electrolytes and fluids. As the article highlights, this deficit can create a host of problems including a heightened risk of arrhythmias, congestive heart failure, and sudden cardiac arrest.
A longitudinal study published in 2020 found that women who were hospitalized for bulimia nervosa had a “significantly increased risk” of hospitalization for cardiovascular disease and death, up to eight years after the initial hospitalization.
Patients with bulimia will typically have several heart health evaluations, including an electrocardiogram (EKG), a physical exam, electrolyte monitoring, and frequent assessments of vital signs.
Gastrointestinal
Self-induced vomiting can lead to gastroparesis, which is slowed or stopped muscle movement in the stomach. Gastroparesis causes problems including stomach pain, bloating, nausea, blocked intestines, bacterial infections, and more. Someone struggling with bulimia may also experience constipation, stomach ruptures, intestinal problems (such as obstructions, perforations, or infections), or a ruptured esophagus.
Neurological
Bulimia’s symptoms can create multiple problems in the neurological system. For example, unhealthy eating patterns — such as dieting, fasting, and erratic eating — can prevent the brain from getting the energy it needs for daily functioning. The binge-purge cycle creates electrolyte imbalances, which in turn, can cause fatigue, muscle weakness, and seizures.
Other Systems
In the endocrine system, binge eating may increase the chance that the body will become insulin-resistant; this can lead to Type 2 Diabetes, according to NEDA. Severe and extended dehydration can lead to kidney failure, and anemia can develop when there isn’t enough iron in a person’s diet. Depending on the type of purging involved, dental issues can also be very common due to contact with stomach acids when vomiting.
How to Get Help For Bulimia
Recovering from bulimia is a marathon, not a sprint, as Eating Recovery Centers’ bulimia resource puts it. Binging and purging behaviors are often ingrained, and medical support may be necessary to safely stop them. Preamplume shares advice for anyone dealing with bulimia below.
Open Up to a Trusted Loved One
Speaking up about your struggles can be intimidating, especially if your concerns have been ignored or dismissed in the past. But remember how much your eating disorder has taken from your life; you could even make a list to motivate yourself to open up and stay open.
“It affects your ability to enjoy your own company. It makes it hard to have any content in your life as long as you have an eating disorder that’s telling you you’re not enough, no matter what you do,” says Preamplume.
Try to identify someone likely to respond with compassion and support, even if they aren’t as close as other key figures in your life. The goal is to have help getting support, now that you’ve recognized you need it.
Seek Specialized Providers and Be Boldly Honest About Your Symptoms
Bulimia treatment requires a team approach, which usually includes a registered dietitian, a mental health therapist, and a primary care provider, at minimum. Overeaters Anonymous is also a 12 step program catered to helping to address unhealthy eating habits. When building your team, look for health professionals with specific expertise in bulimia or at least eating disorders. Together your team will evaluate you and recommend the level of treatment you need.
“Depending on the severity, it might be better to be referred to an intensive outpatient program or an inpatient treatment center,” Preamplume explains. “Self-help, it’s possible but very, very unlikely to be successful depending on the severity of the concern.”
Cognitive behavioral therapy is very often used to address negative self talk and irrational thoughts that are connected with the behavioral aspects of bulimia.
Expect Discomfort as You Break Old Habits and Build New Ones
Learning to have a healthy relationship with food, movement, and your body again can feel awkward and deeply uncomfortable. You can expect that your treatment team will set goals for you and support you in taking small steps toward them.
For example, the overarching goal may be to build a better relationship with exercise. Depending on your health status, your providers may recommend that you pause exercising at first. “But the goal could be to build it back in, in a way that’s more sustainable,” Preamplume says.
Recovering From Bulimia Is Possible
Recovering from bulimia takes time, dedication, and discipline. But making a full recovery is absolutely possible, especially when you can find a mental health provider you can trust.
If you’re looking for support, you can search for a therapist that specializes in eating disorders with Grow Therapy.
