Bulimia nervosa

Bulimia (boo-LEE-me-uh) nervosa, commonly called bulimia, is a serious, potentially life-threatening eating disorder. People with bulimia binge eat. This means people feel like they've lost control over their eating. They eat large amounts of food in one sitting. This often occurs in secret, and they often feel very guilty and shameful. Then they try to get rid of the food and extra calories in an unhealthy way, such as vomiting or misusing laxatives. This is called purging.

If you have bulimia, you probably focus on your weight and body shape even when you're trying to think about other things. You may judge yourself severely and harshly for what you see as flaws in your appearance and personality. Bulimia is related to how you see yourself — not just about food. It can be hard to overcome, and it can be dangerous.

It's important to remember that an eating disorder is not something you choose. Bulimia is a complex illness that affects how your brain works and how you make decisions. But effective treatment can help you feel better about yourself, eat healthier and reverse serious complications.

Bulimia symptoms may include:

• Living in fear of gaining weight and trying to lose weight in unhealthy ways.
• Repeatedly eating unusually large amounts of food in one sitting.
• Feeling a loss of control during binge eating. You may feel like you can't stop eating or can't control what you eat.
• Vomiting on purpose or exercising to extremes after binge eating so that you don't gain weight.
• Using medicines that make you urinate, called water pills or diuretics, or laxatives or enemas to pass stool when they're not needed.
• Fasting, limiting calories or not eating certain foods between binges.
• Using dietary supplements or herbal products for weight loss. These products can be dangerous.
• Being very unhappy with your body shape and weight.
• Letting your body shape and weight guide how you feel about yourself and your worth.
• Having extreme mood swings.

People with bulimia may use different methods to purge. The severity of bulimia depends on the number of times a week that you purge and the problems caused by doing so.

When to see a doctor

If you have any bulimia symptoms, seek medical help right away. If left untreated, bulimia can severely affect your physical and mental health.

Talk to your primary healthcare professional or a mental health professional about your bulimia symptoms and feelings. If you're not sure if you want to seek treatment, talk to someone about what you're going through. This could be a friend or loved one, a teacher, a faith leader, or someone else you trust. This person can help you take the first steps to get help.

Helping a loved one with bulimia symptoms

If you think a loved one may have symptoms of bulimia, talk with the person openly and honestly about your concerns. You can't force someone to get help, but you can give encouragement and support. You also can help find a healthcare professional or mental health professional, make an appointment, and even offer to go along to the appointment.

People with bulimia can be at any weight. For example, they could be average weight or overweight. That's why you can't tell just by looking at someone's size whether that person has bulimia.

Signs of bulimia that family and friends may notice include:

• Always worrying about eating or being overweight.
• Having a distorted or negative body image or both.
• Eating unusually large amounts of food over and over again in one sitting.
• Following a strict diet or fasting after binge eating.
• Having acid reflux, a hard time passing stool and other stomach problems.
• Not wanting to eat in public or in front of others.
• Going to the bathroom right after eating or during mealtime, or for long periods.
• Exercising a lot.
• Having sores, scars or calluses on the knuckles or hands.
• Having damaged teeth and gums.
• Changing weight — up and down.
• Swelling in the hands and feet, and cheeks and jaw area.

The exact cause of bulimia is not known. Genes may play a role in the development of bulimia and other eating disorders. Emotional health and family history may play a role. Also, pressures from society to be thin may play a role.

Females are more likely to have bulimia than males. Bulimia often begins in the late teens or young adulthood.

Factors that raise your risk of bulimia include:

• Family history and genes. Having a family history of eating problems and weight-control issues can increase the risk of an eating disorder. People with first-degree relatives — siblings, parents or children — who are diagnosed with an eating disorder may be more likely to have an eating disorder. This suggests a possible genetic link.
• Mental health and emotional issues. Mental health and emotional problems, such as depression, anxiety or substance misuse, are linked closely with eating disorders. People with bulimia may feel badly about themselves, especially if they're bullied about weight or shape. In some cases, distressing events and factors that cause emotional distress may play a part, such as being mistreated as a child.
• Dieting. People who diet are more likely to have eating disorders. Many people with bulimia severely limit calories between binge-eating sessions. This may cause them to binge eat again and then purge. Other causes for binge eating can include stress, strong emotions, having a distorted or negative body image and boredom.

Bulimia may cause many serious and even life-threatening complications, including:

• Not seeing yourself as worthy and feeling hopeless or even suicidal.
• Problems getting along with others or being socially isolated.
• Poor nutrition.
• Not drinking enough fluids, which can lead to major medical problems, such as kidney failure.
• Heart problems, such as an irregular heartbeat or heart failure.
• Severe tooth decay and gum disease.
• Not having a period or not having a period on a regular schedule.
• Gastrointestinal problems, including tears in the tube that carries food, or a hole in your stomach or small intestine. You also could have rectal prolapse, which is when part of the large intestine slips outside the anus.

Conditions that often occur along with bulimia include anxiety, depression, personality disorders or bipolar disorder, and misuse of alcohol or drugs. Self-harm, thoughts about suicide or suicide also can occur.

Although there's no sure way to prevent bulimia, you can steer someone toward healthier behavior or professional treatment before it gets worse. Here's how you can help:

• Promote and support a healthy body image in your children, no matter what their size or shape. Help them become more confident in many parts of their personality, not just how they look.
• Have regular, enjoyable family meals.
• Don't talk about weight or shape at home.
• Discourage dieting. This is especially important when it involves unhealthy weight-control behaviors, such as fasting, labeling foods as good or bad, using weight-loss supplements or laxatives, or vomiting.
• Talk with your primary healthcare professional to look for early signs of an eating problem.
• If you notice a loved one or friend who seems to have food issues that could lead to or suggest an eating disorder, think about talking to the person about these issues and ask how you can help. If you do so, be supportive.

To diagnose bulimia, your healthcare professional will:

• Talk to you about your eating habits, ways to lose weight and physical symptoms.
• Do a physical exam.
• Request blood and urine tests.
• Request an ECG or other tests to look for problems with your heart.
• Do a mental health evaluation, including talking about how you feel about your body and weight.

Your healthcare professional also may request more tests to pinpoint a diagnosis, rule out medical causes for weight changes and check for any related complications.

A diagnosis of bulimia usually includes episodes of binging and purging at least once a week for three months. But any binge and purge behaviors, even when done less often, can be dangerous and need treatment. The more often the episodes occur, the more severe the bulimia is.

When you have bulimia, you may need one or more types of treatment. Treatment includes proven therapies and medicines that may help you get better.

Treatment generally involves a team approach that includes you, your family, your primary healthcare professional, a mental health professional and sometimes a dietitian who knows how to treat eating problems.

Here's a look at bulimia treatment options.

Talk therapy

Talk therapy, also known as psychotherapy, involves talking to a mental health professional about your bulimia and related issues.

Studies show that these types of talk therapy can reduce symptoms of bulimia:

• Enhanced cognitive behavioral therapy, also known as CBT-E, to help teenagers and adults with bulimia create healthy-eating patterns and replace unhealthy, negative beliefs and behaviors with healthy, positive beliefs and behaviors.
• Family-based treatment, also known as FBT, to help the parents of children and teenagers with bulimia learn what to do about unhealthy-eating behaviors and help their child regain control over what is eaten.
• Dialectical behavioral therapy, to help people better tolerate distress, become more emotionally balanced, be more mindful and get along better with others.

Ask your mental health professional which type of therapy will be used and how that therapy helps treat bulimia.

Medicines

Specific antidepressants may reduce the symptoms of bulimia. The only antidepressant that the U.S. Food and Drug Administration (FDA) has approved specifically to treat bulimia is fluoxetine (Prozac). This is a selective serotonin reuptake inhibitor, also known as an SSRI. It may help with symptoms of bulimia, even if you're not depressed. This medicine works better when it's used with talk therapy.

Nutrition education

Dietitians with special training in treating eating disorders can help. They can design an eating plan to help you eat healthier, manage feelings of being overly hungry or having too many cravings, and provide good nutrition. Eating regularly and not limiting the amounts or types of food you eat is important in overcoming bulimia.

Hospitalization

Usually, bulimia can be treated outside of the hospital. But if symptoms are severe and you have serious health complications, you may need to be treated in a hospital. Some programs for eating disorders may offer day treatment rather than a hospital stay.

Treatment challenges in bulimia

Although most people with bulimia get better, some find that symptoms don't go away entirely. Periods of binge eating and purging may come and go through the years. For example, some people may binge eat and purge when they're under a lot of stress.

If you find yourself back in the binge eating-purge cycle, get help. Follow-up sessions with your primary healthcare professional, dietitian or mental health professional may help you before your eating disorder gets out of control again. Learning positive ways to cope, finding healthy ways to get along with others and managing stress can help keep an eating problem from returning.

If you've had an eating disorder in the past and you notice your symptoms returning, seek help from your medical team right away.

In addition to professional treatment, use these self-care tips:

• Follow your treatment plan. Don't skip therapy sessions. Also, try to follow what you and your therapist plan for the time between sessions, even if those plans make you uncomfortable.
• Learn about bulimia. Knowing more about your condition can help you stay with your treatment plan.
• Get the right nutrition. If you aren't eating well or you're purging a lot, your body likely isn't getting all the nutrients it needs. Talk to your primary healthcare professional or dietitian about what vitamin and mineral supplements you need. But you should try to get most of your vitamins and minerals from food.
• Stay in touch. Don't stay away from caring family members and friends who want to see you get healthy. Know that they have your best interests at heart. And having people who care about you in your life is healthy for you.
• Be kind to yourself. Try not to weigh yourself or check yourself in the mirror a lot. These actions may fuel your drive to keep unhealthy habits.
• Be cautious with exercise. Talk to your primary healthcare professional about what kind of physical activity is right for you, especially if you exercise a lot to burn off calories after binge eating.

People with eating disorders are at risk of misusing dietary supplements and herbal products designed to make them less hungry or help them lose weight. Weight-loss supplements or herbs can have serious side effects and be even more dangerous when taken with other medicines.

The FDA does not need to approve weight-loss and other dietary supplements to go on the market. And "natural" doesn't always mean safe. If you use dietary supplements or herbs, talk to your primary healthcare professional about the risks.

You may find it hard to cope with bulimia when the media, coaches, family, and maybe your own friends or peers are giving you mixed messages. How do you cope with a disease that can be deadly when you're also getting messages that being thin is a sign of success?

Be sure to:

• Remind yourself what a healthy weight is for your body.
• Try not to diet or skip meals, which can cause binge eating.
• Don't skip therapy sessions.
• Don't visit websites that support or praise eating disorders.
• Work with your treatment team to figure out which situations cause thoughts or behaviors that may play a part in your bulimia. Create a plan to deal with those situations.
• Make a plan to cope with the hardships of setbacks.
• Look for positive role models who can make you feel better about yourself.
• Find activities and hobbies that you enjoy to distract you from thoughts of binge eating and purging.
• Feel better about yourself by forgiving yourself, focusing on the positive, and crediting and accepting yourself.

Get support

If you have bulimia, you and your family may find support groups to be a source of encouragement, hope and advice on coping. Group members can understand what you're going through because they've been there. Ask your healthcare professional if a group is in your area.

Coping advice for parents

If you're the parent of a child with bulimia, you may blame yourself for your child's eating disorder. But eating disorders have many causes, and it's known that parents do not cause eating disorders. Parents play a very important role in helping their children recover from these illnesses.

Here are some suggestions:

• Be sure your child gets treatment. Take part in the treatment plan so that you know how you can best support your child.
• Listen. Be an active listener. Give your child a safe space to talk and share feelings without judgment.
• Schedule regular family mealtimes. Eating at routine times is important to reduce binge eating.
• Let your teenager know your concerns. Do not place blame. An eating disorder is not a choice or something your child does. It's a complex illness that affects your child's brain and how your child makes decisions.

Remember that eating disorders affect the whole family. You need to take care of yourself too. If you feel that you aren't coping well with your child's bulimia, professional counseling could help you. Or ask your child's primary healthcare professional about support groups for parents of children with eating disorders.

Here's some information to help you get ready for your appointment, and what to expect from your healthcare team. Ask a family member or friend to go with you, if possible, to help you remember key points and give a fuller picture of what's going on.

What you can do

Before your appointment, make a list of:

• Your symptoms, even those that don't seem to be related to the appointment.
• Key personal information, including any major stresses or recent life changes.
• All medicines, including those available without a prescription, as well as vitamins, herbal products or other supplements you're taking, and their doses.
• Questions to ask your healthcare professional, so you can make the most of your time together.

Some questions to ask your primary healthcare professional or mental health professional include:

• What kinds of tests do I need? Do I need to prepare for these tests?
• Which treatments do you recommend?
• Is there a generic alternative to the medicine you're prescribing for me?
• How will treatment affect my weight?
• Are there any brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your primary healthcare professional or mental health professional will likely ask you several questions, such as:

• How long have you been worried about your weight?
• Do you think about food often?
• Do you ever eat in secret?
• Have you ever vomited because you were too full?
• Have you ever taken medicines for weight loss?
• Do you exercise? If so, how often?
• Have you found any other ways to lose weight?
• Are you having any physical symptoms?
• Have any of your family members had symptoms of an eating problem or been diagnosed with an eating disorder?

Your primary healthcare professional or mental health professional will ask more questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.