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Bulimia: What Is It and What Can It Do to Your Body?

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  • Bulimia is an eating disorder characterized by repetitive periods of binge eating followed by different inappropriate compensatory behaviors for trying to get rid of the excess calories and avoiding weight gain
  • Most people with bulimia have a normal weight or may be slightly overweight, so it can be hard to determine that they’re battling with an eating disorder. A combination of behavioral, psychological and physical warning signs of bulimia may be observed from affected individuals
  • Bulimia may be managed with a multimodal treatment plan that focuses on restoring healthy eating habits, maintaining healthy weight, promoting adequate nutrition and reducing excessive exercise. This usually involves a combination of psychotherapy and nutrition counseling

If you aren't struggling with bulimia nervosa, the choice of overindulging on particular foods or eating just the right amount may be easy to make, depending on your lifestyle choices. But for bulimics, this decision is more than just a matter of dietary preferences, as it's also influenced by a strong preoccupation with weight and body image.

Bulimia nervosa is a serious eating disorder that can become life-threatening if not properly addressed.1 The first step to managing bulimia and reducing its impact on your or your loved one's life is to have a better understanding of this condition, its causes, symptoms and treatment options.

What Is Bulimia Nervosa?

Bulimia nervosa, simply called bulimia, is a complex psychiatric illness that falls under the category of eating disorders. It is characterized by repetitive periods of binge eating, wherein an individual eats excessive quantities of food without the ability to control themselves. This is shortly followed by a variety of inappropriate compensatory behaviors for trying to get rid of the excess calories and avoiding weight gain.2

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must have recurring binge eating and purging episodes at least once per week for three months to be diagnosed with bulimia.3,4 Bulimics can be categorized into two types depending on their weight loss methods:5

Purging type — The majority of bulimia cases fall under this type. It involves self-induced vomiting or abusing the use of laxatives, weight loss pills, diuretics and enemas in an effort to compensate for binge eating.

Non-purging type — This less common type of bulimia is characterized by excessive exercise, fasting or strict dieting to try to stop gaining weight.

Bulimia can affect anyone — young or old, male or female. However, statistics show that women are more commonly affected by this disorder, accounting for 90% of diagnosed cases. Surveys also show that the prevalence of bulimia nervosa in young women in the U.S. is between 0.5% and 1%, and it can occur as early as mid- to late teens. Meanwhile, men account for 10% of bulimia cases, with a prevalence of 0.1%.6,7,8

Bulimia Symptoms to Look Out For

Most people with bulimia have a normal weight or may be slightly overweight, so it can be hard to determine that they're battling with an eating disorder. A combination of behavioral, psychological and physical warning signs of bulimia may be observed from affected individuals. Behavioral signs include:9,10,11

  • Evidence of binge eating, such as disappearance of large amounts of foods over a short period of time
  • Evidence of purging behavior, such as frequent trips to the bathroom after meals or the presence of laxative or weight loss pill packaging
  • Developing food rituals
  • Avoiding meals with other people
  • Constantly worrying or complaining about body image
  • Secretly hoarding uneaten foods
  • Compulsive exercising, such as exercising even when injured

Meanwhile, the psychological signs of bulimia include:

  • Low self-esteem
  • Feelings of shame, self-loathing and guilt
  • Extreme mood swings
  • Anxiety and depression
  • Having an extremely negative body image
  • Being sensitive to comments about dietary habits, lifestyle and body shape

The physical signs of bulimia are the easiest to spot. These include:

  • Fluctuations in body weight
  • Sores, cuts or calluses on the knuckles or hands caused by self-induced vomiting
  • Dental problems, such as damaged gums, cavities, enamel erosion and tooth sensitivity
  • Esophageal irritation
  • Facial and cheek swelling caused by inflamed salivary glands
  • Swelling of the hands and feet
  • Menstrual irregularities
  • Feeling dizzy and weak
  • Fainting
  • Gastrointestinal problems, such as abdominal pain, bloating and flatulence

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Anorexia Versus Bulimia: How Do These Two Eating Disorders Differ?

Anorexia and bulimia are both potentially fatal eating disorders rooted in the intense fear of gaining weight and an extreme desire to achieve a distorted body image though unhealthy weight loss methods, which is why it's easy to confuse them with each other.

The primary difference between these conditions is that with anorexia, an individual imposes self-starvation to achieve their perceived image of the perfect body shape and weight, which is often a lot thinner or lighter than what most people would normally consider healthy. Hence, anorexics mostly have abnormally low body weight and may look emaciated, whereas bulimics have a normal weight or may even be overweight.12,13

Bulimia Causes and Risk Factors

The exact cause of bulimia is currently unknown, but genetic, biological, emotional and societal factors are believed to play a role in its development. You may have a higher risk of developing this condition if you:14,15

  • Have a first-degree relative who has an eating disorder
  • Were overweight during your childhood or teenage years
  • Were criticized for your weight, body shape or eating habits
  • Experience societal pressure to be slim
  • Feel like your job requires you to keep in shape
  • Have psychological or emotional problems, such as depression and anxiety
  • Have been sexually abused
  • Have negative body image and low self-esteem

6 Tips to Help Prevent Bulimia

There's no definite way to prevent bulimia, but there are ways to lower your or your loved one's risk of this condition. Here's how:16,17

1. Help your child build confidence and form a healthy body image, regardless of their size, shape or weight.

2. Focus on adopting a healthy diet and lifestyle instead of food shaming and putting too much importance on weight.

3. Always have enjoyable meals with your family.

4. Discourage unhealthy weight loss diets and compulsive exercises.

5. Look for positive role models to help boost your self-esteem.

6. If you notice food issues that could lead to an eating disorder from a loved one, consider talking to them about it, ask them what you can do to help and offer them support.

Bulimia Treatment Options

Since the exact cause of bulimia remains undetermined, there's currently no known cure for this disorder. However, bulimics may have a chance of recovering and leading a normal life with the help of a multimodal treatment plan that focuses on restoring healthy eating habits, maintaining healthy weight, promoting adequate nutrition and reducing excessive exercise.18

Bulimia treatment often involves a combination of psychotherapy and nutrition counseling. During psychotherapy sessions, an individual with bulimia discusses their condition and other related health issues with a mental health professional to address underlying emotional and psychological factors that may trigger bulimia. Common types of psychotherapy recommended for this disorder include:19,20

Cognitive behavioral therapy (CBT) — CBT helps identify and manage the negative emotions and feelings that may contribute to the development of bulimia. This method also helps teach bulimics how to maintain healthy eating habits to avoid relapses once the therapy ends.

Interpersonal psychotherapy — This method focuses on interpersonal relationships to help improve an individual's communication and problem-solving skills.

Family therapy — This is ideal for bulimic children and young people, as it involves their parent's help in intervening with their unhealthy eating behaviors. Family therapy is also useful for helping relatives deal with the common problems associated with having a bulimic family member.

Medications, particularly selective serotonin reuptake inhibitor (SSRI) antidepressants, are conventionally prescribed along with psychotherapy for the management of bulimia.21 Keep in mind, though, that these antidepressants are linked to a long list of side effects,22 yet studies show that they work no better than placebo.23,24,25 Patients must weigh if its small chance of providing benefits is worth the risk.

Bulimia Diet: What You Should and Shouldn't Eat With This Condition

Developing a healthier relationship with food by following a healthy diet is an important step to recovering from bulimia. Part of the treatment plan for this condition is nutrition education, which involves talking to a dietitian to come up with an eating plan that helps curb hunger and cravings while providing all the necessary nutrition.26

Foods to Avoid

A basic step you can take to improve your mental and physical health is to eliminate all processed foods from your diet, as they provide little to no beneficial nutrients. They also contain ingredients that can trigger inflammation and alter your gut flora, which are factors that can predispose you to mental disorders like bulimia as well as other chronic diseases.27 These processed foods include:

Aspartame and other artificial sweeteners

Nonorganic produce and genetically engineered products like soy and corn

Processed meats and animal products from concentrated animal feeding operations (CAFOs)

Canned goods and foods in plastic packaging

Add These Foods to Your Diet

Nutrition has long been implicated in behavior, mood and the pathology of mental illness.28 A growing body of research also found that the foods you eat affect your mental health.29 This means that one of the ways to potentially help manage bulimia is by eating healthy, whole foods that are grown organically. Some of the foods you should include in your diet to promote optimal mental health include:

Omega-3 fatty acids A 2017 study published in the journal Eating Disorders found that omega-3 fatty acids may be a valuable adjunctive treatment for children and adolescents with eating disorders.30 Some of the best sources of omega-3s include wild-caught Alaskan salmon, avocados, grass fed dairy products and meat, coconuts and coconut oil, organic pastured egg, and raw nuts such as macadamias and pecans.

Probiotics According to a study published in the journal Current Psychiatry Reports, "[I]ntestinal microbiota is a contributing factor to both host energy homeostasis and behavior —two traits commonly disrupted in patients with eating disorders."31 With that said, be sure to optimize your gut health by eating probiotic-rich foods like fermented vegetables, raw grass fed yogurt, tempeh and natto.

Dark leafy greens — Dark green leafy vegetables like kale, spinach and Swiss chard contain a number of phytochemicals, vitamins and minerals that can help fight inflammation,32 which is a potential risk factor for poor mental health.33

Antioxidant-rich foods — A study published in the European Journal of Clinical Nutrition found that antioxidants may provide therapeutic properties to damaged oral cavities of bulimia nervosa patients.34 Antioxidants are also necessary for maintaining structural integrity and optimal function of the brain.35 Foods that contain high amounts of antioxidants include fresh, organic vegetables, sprouts and microgreens, and fresh berries like blueberries and blackberries.

Long-Term Bulimia Side Effects

Prolonged periods of binge eating and purging can take a toll on the health of a person with bulimia. If not addressed promptly, this can eventually lead to dangerous complications such as:36,37,38

  • Dehydration
  • Heart problems like irregular heartbeat
  • Damaged tooth enamel
  • Severe gum disease
  • Mental health problems such as anxiety and depression
  • Menstrual irregularity
  • Gastrointestinal disorders like constipation, diarrhea or heartburn
  • Esophageal damage
  • Muscle weakness
  • Misuse of alcohol or drugs

Frequently Asked Questions (FAQs) About Bulimia

Q: What is bulimia?

A: Bulimia is an eating disorder characterized by recurrent episodes of uncontrollable binge-eating and compensatory behaviors to avoid gaining weight.39

Q: What are the key symptoms of bulimia nervosa?

A: The hallmark symptoms of bulimia include consumption of large amounts of food within a short period of time, purging behaviors such as self-induced vomiting or misusing laxatives, intense fear of weight gain, and negative body image.40

Q: Can a person die from bulimia?

A: Yes. Bulimia is considered a life-threatening disorder, as it can lead to serious complications such as dehydration and heart failure if not properly treated.41

Q: Does bulimia damage your throat?

A: The high-acid content from self-induced vomiting during episodes of purging can irritate the throat and lead to severe esophageal damage.42

Q: What stomach problems can bulimia cause?

A: The gastrointestinal problems associated with bulimia include bloating, flatulence, constipation, diarrhea, heartburn and irritable bowel syndrome.43,44

Q: Is bulimia a mental disorder?

A: According to the National Alliance on Mental Illness, a mental disorder is a condition that affects a person's moods, thoughts and feelings, influencing their ability to relate to others and perform everyday tasks.45 Since bulimia exhibits these characteristics, it's considered a mental illness.46

Q: What triggers bulimia?

A: The risk factors that may trigger bulimia include:47,48

  • Having a first-degree relative with an eating disorder
  • Having poor body image and low self-esteem
  • Having psychological and emotional problems
  • Experiencing traumatic events or societal pressure
  • Being overweight as a child or teen
  • Following an extreme weight loss diets

Q: What can bulimia do to your body?

A: Bulimia can lead to serious health complications such as damaged teeth and gums, heart problems, dehydration, digestive issues, esophageal damage, menstrual irregularities and muscle weakness, to name a few.4950,51

Q: How can you put a stop to bulimia?

A: There is no cure for bulimia, but it can be managed with a comprehensive treatment plan that involves a combination of psychotherapy and nutrition counseling. Some doctors may also prescribe bulimics with antidepressants. However, the potential side effects of these medications must be taken into consideration prior to intake.50

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