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Do I have bulimia? How to recognize the symptoms and get proper treatment

September 8, 2020
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Dr. Harry Brandt provides insight into how to recognize bulimia, the potential medical complications and why seeking treatment is so important.

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Bulimia nervosa is an eating disorder characterized by cycles of binge eating and purging through methods like self-induced vomiting or taking laxatives. In the US, it will affect 1.5% of women and up to 0.5% of men at some point in their lives.

If left untreated, bulimia can cause long-term health issues like kidney damage and rupturing of the esophagus and stomach. Here's what you need to know about bulimia, its symptoms, and how to get a diagnosis. 

What is bulimia nervosa? 

Bulimia is a mental health disorder that can cause physical complications. "Bulimia nervosa involves excessive concern about body shape and weight, with a chronic fear of gaining weight," says Patricia Celan, MD, a psychiatry resident at Dalhousie University in Canada.

"Compared to anorexia, in which weight anxiety is managed by restrictive eating, bulimia involves episodes of – binge eating — eating excessively and with limited self-control — and then avoiding weight gain by inducing vomiting, diarrhea, or excessive exercise," Celan says.

According to the DSM-5, the three essential features of bulimia nervosa are: 

  1. Recurrent episodes of binge eating
  2. Recurrent behaviors to compensate and prevent weight gain like self-induced vomiting or over-exercising
  3. Self-evaluation that is excessively influenced by body shape and weight

Bulimia generally appears in adolescents and young adults between 15 and 20 years of age, and it's more common in women. In fact, roughly 85% to 90% of people who have the condition are female.

Bulimia is a progressive disorder, meaning that people who live with it present with behavior patterns that may result in dealing with more intense health complications as time goes on. This progression can also make it harder for people to recover mentally the longer they go without treatment. 

Noticing the signs of an eating disorder early on can be helpful in terms of seeking treatment and preventing the condition from becoming more serious.

"Early intervention and access to treatment can help ensure positive recovery outcomes and decrease short and long-term medical consequences," says Harry Brandt, MD, Regional Medical Director of the Eating Recovery Center

Signs of bulimia nervosa 

Bulimia is defined by a pattern of repetitive binge eating and engaging in compensatory behaviors to prevent weight gain. Some common behavioral, emotional and physical symptoms of bulimia include:

These symptoms vary from person to person. For example, not everyone with bulimia vomits to purge — some people will use laxatives or intense exercise. Other bulimia-related behaviors could include using diet pills and/or diuretics, misusing insulin injections, and chewing food and then spitting it out. 

Risk factors for bulimia nervosa 

Women are much more likely to develop bulimia than men. Other risk factors that might be linked to developing bulimia include:

  • Stressful life events like parents divorcing or the death of family members
  • Living with family members who struggle with obesity or have an eating disorder
  • Suffering from poor body image
  • Participating in a sport that emphasizes a particular body type or small size, such as gymnastics or ballet

A 2016 study published in European Eating Disorders Review compared 60 women with bulimia to 60 people who did not have the disorder. Developing bulimia was linked to high expectations from mothers, holding negative attitudes about parents' weight,  struggling with obesity as children or teens, a history of self‐harm, and family conflicts like divorce. 

Bulimia is also linked to other conditions, including:

  • Post-traumatic stress disorder (PTSD). A 1999 study published in the International Journal of Eating Disorders assessed 24,041 women and 466,590 men hospitalized in Veteran Affairs medical centers. Researchers found that 0.30% of the female veterans suffered from an eating disorder like bulimia or anorexia and that women with bulimia had high rates of PTSD. 
  • Mental health or substance abuse disorders. A 2018 study published in Cureus assessed 3,319 people who went through inpatient treatment for bulimia. Researchers found that 52.4% of the patients suffered from psychosis, 23.5% suffered from depression, 21.5% abused drugs, and 17.1% abused alcohol. 

Health complications of bulimia nervosa 

Bulimia can contribute to health issues such as tooth decay, chronic gastrointestinal problems, and dehydration, all of which are linked to induced vomiting. 

Purging is also linked to osteoporosis (due to bone mineral deficiency) and kidney disease (due to electrolyte imbalances). Extreme cases can lead to cardiovascular complications like arrhythmia and congestive heart failure

A 2015 study published in Heart Views assessed 45 female patients who were referred from eating disorder treatment centers to cardiovascular treatment. Five of the bulimia patients were diagnosed with bradycardia, a condition causing a slower than normal heart rate of fewer than 60 beats a minute. 

When to see a doctor 

If you are worried you or a loved one may have bulimia, do not wait for significant weight loss to seek treatment. "It's important to note many patients suffering from bulimia are a normal weight and may not be showing any physical signs of illness but could still be very sick," Brandt says. 

Brandt says that any type of binge eating or purging can be harmful to both physical and mental health, so it's best to speak to a doctor as soon as it starts happening. 

According to Brandt, bulimia treatment is multifaceted. Clinicians aim to:

  • Help patients stabilize their mental health and physical health
  • Enhance their coping strategies through therapy 
  • Help them back to healthy eating patterns with nutritional counseling 
  • Address body image issues and improve patients' self-esteem
  • Treat underlying trauma experiences, depression, or anxiety when relevant

Read more about finding the best eating disorder treatment plan for you.

Takeaways 

Some signs of bulimia nervosa include binge eating on large amounts of food, an intense fear of gaining weight, and self-induced vomiting or over-exercising. If you exhibit any of these symptoms or think you may have bulimia, it's important to reach out to a medical professional as soon as possible.

It can be difficult for people living with bulimia to seek treatment as they may be incredibly anxious about "normalizing" eating and giving up their coping strategies of binging and purging. However, if left untreated bulimia can cause long-lasting medical complications and impair one's quality of life. 

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