Bulimia Nervosa

Causes

The cause is not known. It may be due to a mix of genes and the environment.

Risk Factors

Bulimia is more common in young women. It is also more common in lesbian, gay, bisexual, and transgender youth. Other things that may raise the risk are:

• Emotional concerns, such as:
• Low self-esteem
• Feelings of helplessness
• Wanting to be perfect
• Stress
• Fear of gaining weight
• Not being happy with weight and size
• Pressure to be thin
• Having other family members with the same problems
• Prior obesity or anorexia
• Having other mental health problems, such as depression or anxiety
• Substance use disorder
• A way of life that highlights being thin as ideal

Symptoms

People with bulimia usually have a healthy weight. But, their habits are not healthy. They may:

• Eat large amounts of food at one time
• Feel like their eating is out of control
• Force themselves to vomit
• Take laxatives, enemas, diuretics, or diet pills
• Exercise too much
• Have mood swings and problems controlling impulses
• Misuse alcohol or other substances

Physical problems from bulimia may be:

• Digestive problems, such as:
• Belly pain
• Bloating
• Heartburn
• Menstrual problems
• Swollen cheeks and jaw
• Sore throat
• Swollen glands in the mouth and throat
• Stained or chipped teeth—due to contact with stomach acid
• Cuts or scars on back of hands—from scraping skin on teeth during forced vomiting

Bulimia can lead to other health problems. Some examples are:

• Mineral imbalances
• Gastroesophageal reflux
• An inflamed or torn food pipe (esophagus)
• Dependence on laxatives

Diagnosis

The doctor will ask about symptoms, past health, and eating habits. A physical and mental health exam will be done. Other tests may be:

• Blood tests to look for mineral imbalances
• Urine tests to check for dehydration and other problems
• ECG to check heart function

Treatment

The goal of treatment is to develop healthy habits and thought patterns. Treatment can include a combination of:

• Nutrition counseling and support
• Mental health counseling methods, such as individual or group cognitive-behavioral therapy
• Vitamins and minerals
• Antidepressants along with therapy

Those with more severe symptoms may need hospital care.

Prevention

Some things that may help prevent weight-related problems are:

• Focusing on healthful habits rather than dieting and weight
• Promoting a positive body image in adolescents
• Encouraging family meals and talking about healthy eating
• Avoiding teasing about weight