Bulimia nervosa is an eating disorder that involves cycles of binge eating (eating large quantities of food in a short amount of time) followed by compensatory behaviors. These behaviors can include purging, calorie restriction, laxative abuse and/or overexercising.
What is Bulimia Nervosa?
Bulimia nervosa, or bulimia, is an eating disorder characterized by recurring cycles of binge eating and attempts to compensate for the overeating.
Bulimia can occur after long periods of dieting. Calorie restriction over time often leads to uncontrollable urges to eat. Binge eating episodes see the person consume large amounts of food within a small time frame.
When a person with bulimia goes on a binge or overeats, the subsequent guilt causes them to try to compensate for the excess calories. This compensation comes in the form of dangerous purging behaviors.
Examples of purging behaviors include:
- Self-induced vomiting
- Calorie restriction
- Compulsive exercising
- Abuse of laxatives, enemas or diuretics
Bulimia and the DSM-5
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies bulimia nervosa as a type of eating disorder.
For a person to be diagnosed with bulimia, the following criteria should be met:
- Recurring cycles of binge eating and behaviors to avoid weight gain
- Feelings of loss of control during binge eating episodes
- Cycles of binging and purging behaviors happen, on average, at least once a week for three months
- Self-image is dictated by the person’s weight and body shape
- Overeating does not occur exclusively during periods of caloric restriction
Bulimia Signs & Symptoms
Not all people struggling with bulimia have the same experience with the disorder. Each person will exhibit different symptoms with varying levels of intensity. Still, there are common signs and symptoms that appear when a person is battling bulimia.
- Fear of eating in public or with other people
- Extreme mood swings
- Constant preoccupation with body weight and shape
- Evidence of binge episodes, including rapid disappearance of food or accumulation of food wrappers in a short time frame
- Evidence of purging behaviors, such as going to the bathroom after meals
- Development of food rituals and rules, such as only eating at certain times or cutting out entire food groups
- Skipping meals or eating small portions
- Stealing or hoarding food
- Excessively drinking water or zero-calorie drinks
- Excessively using gum or mints
- Using baggy clothes or extra layers to hide the person’s body
- Maintaining strict exercise routine to “burn off” calories consumed
- Scheduling days around binge episodes and purging behaviors
- Withdrawal from friends and social activities
- Frequent “body checking” to look for perceived weight loss or gain
- Substance abuse
- Impulsive behaviors
- Diabulimia (intentionally abusing insulin for Type 1 diabetes)
- Noticeable increases and decreases in weight
- Gastrointestinal (GI) problems
- Trouble concentrating
- Abnormal laboratory findings, such as low hormone levels
- Trouble sleeping
- Cold body temperature
- Cuts/calluses on finger joints or dental problems (due to self-induced vomiting)
- Dry skin and nails
- Swollen area surrounding salivary glands
- Fine layer of hair on body (for warmth due to weight loss)
- Thinning hair
- Muscle weakness
- Loss of menstrual cycle or menstrual irregularities
- Weakened immune system
- Slow wound healing
- Swollen cheeks or jaw
- Bloating due to fluid retention
Timeline of the Disorder
Bulimia is typically sparked by periods of dieting. The caloric restriction leads to malnourishment. Eventually, this extreme dieting creates feelings of uncontrollable hunger.
The desire for food is typically physical and mental, as the person’s body is starved for calories. The mental hunger is the result of restricting the amount and types of foods eaten.
In time, the uncontrollable hunger takes over and the person battling bulimia gives in to their desire to eat. When a person struggling with bulimia begins to eat again, they will typically overeat or have a binge.
Binge eating creates overwhelming feelings of guilt and shame. To combat these negative feelings, the person with bulimia will then take dangerous action to “make up” for the calories they took in.
Over time, people with bulimia may adopt a distorted view of how much food is “too much.” Even a small amount of overeating can spark a full-blown binge, causing the person to eat well past the point of feeling uncomfortable. This increases the person’s purging behaviors as well.
At first, those struggling with bulimia may believe their compensatory behaviors are good. By “making up” for the excess calories through purging, over-exercising or laxative abuse, people with bulimia can reduce their guilt and fear of gaining weight.
While the purging actions start as an attempt to feel safe around food, they can easily become a method of dealing with other negative feelings. These behaviors may evolve into the way a person deals with their anger, loneliness or anxiety.
Some people with bulimia will plan their binges in advance as the disorder progresses. They will schedule their day intentionally to include times for binging and compensatory behaviors. Those battling bulimia may even waste hours of their day shopping for food, planning where to eat and determining how to hide their purging episodes.
Binge eating and the behaviors that can follow eventually become compulsive. Without proper treatment and care, bulimia can lead to serious health risks and even death.
Health Risks of Bulimia
Bulimia and the related purging behaviors put the afflicted person at risk of serious health issues. One of the most common compensatory behaviors is self-induced vomiting.
The nature of bulimia itself presents many different health risks. However, the act of purging wreaks the most havoc on the body of someone with bulimia
Examples of health risks related to bulimia include:
- Electrolyte imbalances that lead to poor functioning of the organs and digestive system
- Irregular heartbeat or heart failure
- Edema (swelling due to fluid trapped in the body’s tissues)
- Depletion of the body’s potassium, sodium and chloride
- Inflammation or rupture of the esophagus and tooth decay (due to self-induced vomiting)
- Gastrointestinal (GI) problems such as irritable bowel syndrome
Bulimia in Society
Like any other eating disorder, bulimia can happen to anyone. Dozens of celebrities and other public figures have struggled with this this disorder. Many of them have spoken out and shared their stories to encourage men and women facing similar challenges.
Russell Brand, Actor & Comedian
Russell Brand proves that even men can struggle with eating disorders. As a teenager, Russell battled both bulimia and substance abuse. After working hard toward sobriety and recovery, he now uses his story to raise awareness about eating disorders. He has even helped raise money for addiction recovery programs.
Paula Abdul, Musician & Dancer
Paula Abdul began feeling insecure about her body at the age of seven. These insecurities caused her to develop bulimia as a young adult. Fortunately, in 1994 she began seeking treatment for her eating disorder at a mental health clinic. In more recent years, she spent time working with the National Eating Disorders Association (NEDA).