Bulimia is a disorder described as food binges, devouring large amounts of food in a very short period of
time, followed by immediate self-induced vomiting eliminating the body of the food just eaten. Binge eating
involves consuming larger than average portions of food within a 2-hour period. Some individuals with
bulimia may take enemas, diet pills, or abuse laxatives to prevent weight gain. Typically, bulimic behavior is
performed secretly, because it is often accompanied by feelings of disgust or shame. Some signs of bulimia
include excessive exercise, unusual eating patterns or rituals, and frequent weighing.
Some studies have reported that individuals with bulimia average about 2 episodes per day of binge eating
ensued by vomiting. To be diagnosed with bulimia, however, a person must binge and purge at least twice a
week for 3 months. Some experts believe that going through the cycle only once a week is enough for a
diagnosis. Bulimia nervosa is more common than anorexia, and it usually begins early in adolescence.
Types of Bulimia Nervosa
• Purging type – habitual self-induced vomiting or misuse of laxatives, diuretics, or enemas.
• Non-purging type - uses other improper behaviors, such as fasting or excessive exercise, rather than
regularly purging to reduce caloric intake of excessive amounts.
The complications of bulimia nervosa are serious and can adversely affect teeth, the esophagus, the
reproductive cycle and hormones, and electrolyte balances, which in turn can affect the heart. If left
untreated, bulimia nervosa can lead to serious and even life threatening problems, such as depression,
anxiety disorders, heart damage, kidney damage, injury to all parts of the digestive system, and severe dental
damage from stomach acid. In addition, individuals with underlying depression may be at risk of suicide.
The menstrual cycles of females with bulimia nervosa can be altered, although few patients have long-term
interruption of periods.
Stomach acid can erode the enamel of teeth, making the teeth more susceptible to cavities. Dentists have
many ways to repair eroded enamel, including fillings, composites, root canals, crowns, and dentures.
However, most dentists suggest not performing these restorative procedures until the patient is in recovery
from bulimia nervosa.
Bulimic behaviors can be quite dangerous and may lead to serious medical complications over time. For
example, the stomach acid which is raised into the esophagus (the tube from the mouth to the stomach)
during frequent vomiting can permanently damage this area. Those with bulimia nervosa are at risk for
dangerous impulsive, self-destructive behaviors, such as self-mutilation, alcohol and/or drug abuse, and
Bulimia symptoms include:
• Preoccupation with food, weight, and body shape
• Severe dehydration from purging fluids
• Dry mouth
• Constant burning and or sore throat
• Swollen glands in the neck area
• Irregular menstrual periods
• Suddenly eating large quantities of food or groceries disappear instantly
• Frequently goes to the bathroom right after meals
• Instability in weight / Is obsessively concerned about weight
• Rashes and pimples
• Feels guilty or ashamed about eating
The person suffering from bulimia usually knows that their eating pattern is abnormal and may experience
fear or guilt associated with the binge purge cycles. Although the behavior is usually secretive, body weight
is usually normal, although the person may perceive themselves as overweight. If bulimia is accompanied by
anorexia, body weight may be extremely low.
The exact cause of bulimia is unknown, but factors thought to contribute to its development are family
problems, perfectionist personality, and an overemphasis on physical appearance. Bulimia may also be
associated with depression. Researchers do not know why one particular person develops the disorder while
another person with a very similar upbringing does not. Clinicians have several theories about the causes of
bulimia nervosa; however no single theory explains all possible causes and symptoms. Pinpointing the causes
of bulimia nervosa has proven difficult because the disorder has both mental and physical elements, and it
develops in many age groups, races, socioeconomic classes, and both sexes.
Bulimia is common among adolescent girls in the U.S. Many studies suggest that there has been an increase
in the number of cases of bulimia over the past 50 years in the U.S. It is estimated that 1-5% of adolescents
have bulimia. Adolescents who develop bulimia are more likely to come from families with a history of
eating disorders, physical illness, and other mental health problems, such as mood disorders or substance
abuse. Other mental health problems, such as anxiety disorders, or depression, are commonly found in teens
Many situations and feelings can trigger bulimic behavior: extreme emotional distress, anxiety, depression,
dieting, exposure to certain foods (especially high-sugar or high-fat foods), or disappointment with body
image. People with bulimia nervosa have reported extreme mood changes before, during, and after binge
eating and purging or non-purging compensatory behavior. They have also reported feeling depressed or
anxious before binge eating, and then feeling temporary relief or even euphoria afterwards. These feelings
are often followed by feelings of guilt, shame, and self-loathing. Then purging or excessive exercise occurs
to regain feelings of self-control. Concerns about weight and body shape play a role in all eating disorders,
the actual cause of these disorders appear to result from many factors, including emotional and personality
disorders. Genetics and biologic factors may influence an individual’s susceptibility to developing an eating
A child psychiatrist or a qualified mental health professional usually diagnoses bulimia in children and
adolescents. A detailed history of the child's behavior from parents and teachers, clinical observations of the
child's behavior, and, sometimes, psychological testing contribute to the diagnosis. Treatment for bulimia, in
adolescents, is usually a combination of individual therapy, family therapy, behavior modification, often
involves a combination of options and depends on the needs of the child. Parents play a vital supportive role
in any treatment process.
To reduce or eliminate binge and purge behavior, the individual may go through nutritional counseling and
psychotherapy, especially cognitive behavioral therapy or be prescribed medication. Some antidepressants
for treating bulimia may help patients who also have depression and/or anxiety. It also appears to help reduce
binge eating and purging behavior, reduces the chance of relapse, and improves eating mind-sets. Cognitive
behavior therapy that has been customized to treat bulimia also has shown to be effective in changing
binging and purging behavior, and eating attitudes. Therapy may be individually oriented or group-based.
Specific treatment for bulimia will be determined by the child's physician based on:
• the child's age, overall health, and medical history
• degree of the child's symptoms
• the child's tolerance for specific medications, procedures, or therapies
• probability of progression from the condition
Bulimia nervosa can normally be treated on an outpatient basis, although more severe cases may require
inpatient residential treatment. The treatment plan should be developed by a multidisciplinary team after
accurately evaluating the patient and consulting with the individual and parents or guardians. Many
interventions that do not involve prescription drugs or psychotherapy have been used as supplements or
supportive therapy; speak with a health professional regarding alternatives available for treating bulimia.