What is bulimia? The impact of the binge-purge cycle and how to start the healing process

Bulimia nervosa (or bulimia for short) is a serious and potentially life-threatening eating disorder. A person with bulimia will eat a lot in a short period of time and then will use behaviors like self-induced vomiting to “get rid” of the food they ate.

Bulimia isn’t really about food, but how you see yourself. If you have bulimia, your weight and body size is always on your mind, even when you should be thinking about other things. You may also be overly critical about what you see as flaws in your appearance and personality.

Having bulimia is not a choice. It’s a complex mental health condition that’s hard to overcome on your own. But if left untreated, it can be life threatening, so it’s important to get help for bulimia as soon as possible.

Below, we share information about symptoms and causes of bulimia, how it affects your health and what steps to take toward recovery.

What is bulimia nervosa?

Bulimia is an eating disorder characterized by periods of binge eating, followed by periods of compensatory behaviors (purging) to make up for the calories that were consumed. The binge-purge cycle can happen from many times a day to several times a week

What it means to binge eat

Binge eating is where a person eats an amount of food definitely larger than what most people would eat in a similar situation and period of time. When eating, it can seem like there’s a loss of control, and they’re unable to stop, even if not hungry. Binge eating is often done in secret and followed by feelings of guilt or shame, and can be a symptom of multiple eating disorders, including bulimia, anorexia nervosa and binge eating disorder.

What it means to purge

After binge eating, a person with bulimia uses certain behaviors to try to “get rid” of the food they ate. These are known as purging or compensatory behaviors, and include:

• Self-induced vomiting
• Misuse of laxatives (medicines that make you poop), diuretics (medicines that increase how much you pee) or diet pills
• Fasting or restrictive eating
• Excessive exercise

The difference between anorexia and bulimia

There can be a lot of overlap in anorexia symptoms and bulimia symptoms. Restrictive eating is the main symptom of anorexia, but it can also be regular behavior for some people with bulimia. The binge-purge cycle is the main symptom of bulimia. However, people with a binge-purge type of anorexia also have episodes of bingeing and purging.

If an eating disorder includes symptoms of bingeing, purging and restrictive eating, the main difference is often in a person’s weight. People with anorexia have a very low body weight, whereas people with bulimia do not.

Bulimia and anorexia are both serious eating disorders. If you or a loved one have any eating disorder symptoms, schedule an initial assessment to learn about diagnosis and treatment.

Bulimia nervosa symptoms

It’s not always possible to tell if someone has bulimia by looking at them. People with bulimia are usually of average weight. They may also change how they eat and interact with others to keep people from finding out.

Behaviors that may be signs of bulimia

People with bulimia often hide bingeing and purging behaviors, so they can be hard to spot. Symptoms to look for include:

• Eating that’s chaotic with no regular eating patterns
• Overeating or eating very quickly
• Fear of being unable to stop eating
• Constantly preoccupied with food control
• Hoarding food or eating in secret
• Self-induced vomiting or misusing laxatives, diuretics or diet pills
• Using the bathroom to vomit immediately after meals or snacks
• Exercising too much to make up for eating
• Anxiety about appearance, low self-esteem and depression
• Feeling that life is out of control
• Withdrawal from friends and activities

Physical symptoms of bulimia

Bulimia behaviors can damage the body, which may lead to long-term complications (more on that later in this post). Physical symptoms caused by bulimia behaviors include:

• Stomach pain
• Constipation or diarrhea
• Headaches and fatigue
• Weight fluctuations from bingeing and purging, even though weight may be normal
• Swollen glands along the jaw and cheeks, puffiness around the face – this is sometimes known as “bulimia face” or “bulimia cheeks”
• Burst blood vessels in the eyes
• Dry skin, weak nails and brittle hair
• Calluses on the knuckles or back of hand, resulting from frequent self-induced vomiting – this is known as Russell’s sign or “bulimia knuckles”

Causes of bulimia can be biological, psychological or environmental

Bulimia can affect people across all ages, races and socioeconomic statuses. It’s more common in females, but men have it too. It most often starts when a person is about 12 years old.

The exact cause of bulimia is unknown, but there are biological, psychological and environmental factors that can increase the likelihood that someone develops bulimia.

Biological causes

• Family history – You’re more likely to develop an eating disorder if you have a close relative (sibling, parent or child) with an eating disorder. It’s also more likely if there’s family history of weight-control issues, mental illness or substance abuse.
• Heredity – Your genes can increase your chance of developing an eating disorder by as much as 40-60%, according to research. Your genes can make you more likely to have impulse control problems or make you more responsive to food reward systems.

Psychological causes

• Other mental health concerns – Anxiety, depression and substance abuse are closely linked with bulimia and eating disorders.
• Difficulty dealing with emotions – People with bulimia may have intense emotional reactions and trouble calming down when feeling stressed. Food can be a way to cope with upsetting situations.
• Poor self-esteem – People with bulimia usually have a negative body image or self-image.
• Tendency for impulsivity – People with bulimia are more likely to make impulsive decisions.

Environmental causes

• Weight teasing and bullying – People with bulimia may feel badly about themselves, especially if they're bullied or teased about weight or shape.
• History of abuse or other traumatic events – In some cases, events and factors that cause emotional distress may play a part, such as being mistreated as a child.
• Dieting – There’s a strong connection between dieting and eating disorders like bulimia. When you diet, it can be difficult to resist hunger cues and the foods you cut out from your diet. This can lead to binge eating. After a binge eating episode, a person with bulimia may severely limit food intake to compensate for the binge, possibly leading to a cycle of bingeing and purging.

Bulimia health risks and complications

Bulimia can lead to long-term health problems, no matter a person’s size. The following are just some of the ways that bulimia affects how your body works.

How bingeing and purging damages your body

Frequent bingeing and purging can damage the throat, stomach and intestines, and cause a range of problems, some of which can be permanent.

• Acid reflux – Frequent vomiting can irritate the esophagus, leading to acid reflux (also called gastroesophageal reflux disease or GERD). Symptoms include heartburn, chest pain and regurgitation.
• Tooth decay – People with bulimia who purge by self-induced vomiting can develop irreversible tooth and gum damage in as little as six months. This is sometimes called “bulimia teeth.”
• Tears in the lining of the stomach or esophagus – Forceful vomiting can cause tears in the lining of the esophagus or stomach, which can result in bloody vomit or bloody stools. Blood loss from these tears can cause fatigue, shortness of breath and anemia. It’s also possible that damage to the esophageal lining may increase the chance of developing esophageal cancer.
• Hemorrhoids – If you misuse laxatives and have frequent bowel movements, it can irritate the blood vessels near your anus (where your poop comes out), making hemorrhoids more likely. Chronic constipation caused by the misuse of laxatives or diuretics also increases the chance of hemorrhoids because straining during bowel movements increases pressure on these blood vessels and can cause them to bulge out.
• Rectal prolapse – A rectal prolapse is where part of the rectum slips through the anus. Straining during vomiting or bowel movements increases the likelihood of a rectal prolapse.
• Heart problems – Chronic dehydration from laxative and diuretic misuse can lead to heart problems, such as an irregular heartbeat and heart failure.
• Kidney problems – Chronic dehydration can also affect the kidneys and, over time, lead to problems like kidney failure.

How bulimia affects pregnancy and fertility

Bulimia can affect reproductive health, pregnancy and fertility, even if a person is at a “normal” weight. Bulimia can cause irregular menstrual cycles or stop menstruation – in fact, about 50% of females with bulimia lose their period, according to research.

Having bulimia also affects a person’s ability to have a healthy pregnancy and carry a baby to full term. And babies born to parents with bulimia are more likely to have fetal development problems and low birth weight.

If you’re pregnant and struggle with bulimia, let your doctor know right away. There are hormone treatments that can support you and your baby during pregnancy.

The impact of bulimia on mental and emotional health

Bulimia can cause moodiness and irritability, and make mental health conditions worse. People with bulimia may also have anxiety, obsessive-compulsive behaviors, depression, personality disorder or bipolar disorder, and misuse alcohol or drugs. Self-harm, thoughts about suicide or suicide attempts are also more likely in people with bulimia.

How bulimia is diagnosed

The first step is an eating disorder assessment. During the appointment, the doctor will ask about eating behaviors, mental health, lifestyle and medications.

To evaluate mental health, the doctor will use screening inventories to explore a patient’s history, relationship with food and body image. It’s likely that they’ll also perform a physical exam, lab work and an electrocardiogram (EKG) to test heart function.

Bulimia treatment

Each person’s experience with bulimia is unique, which means they may respond to treatment differently. Treatment is always personalized for an individual’s needs and may include:

Family-based treatment (FBT)

This treatment is used for children and adolescents living at home with their families. With this therapy, parents or caregivers take a leading role in addressing unhealthy eating behaviors and normal growth patterns.

Cognitive behavioral therapy enhanced (CBT-E)

With CBT-E, a patient has weekly sessions with a therapist to work through what’s influencing their eating patterns and identify how to change their behaviors.

Group therapy

Group therapy allows people with bulimia to share their experiences while also learning from others with similar experiences.

Nutrition education

A key aspect of bulimia treatment is nutrition education. A dietitian will help determine your nutritional needs and provide guidance to help with planning balanced meals and satisfying snacks.

Bulimia nervosa medication

Behavioral therapy is the most effective treatment for bulimia. However, antidepressants are sometimes used as part of bulimia treatment. Taking an antidepressant can help some people with bulimia symptoms, even if they’re not depressed. Fluoxetine (Prozac) is the only antidepressant specifically approved by the U.S. Food and Drug Administration (FDA) to treat bulimia nervosa.

Get help if you think you or a loved one has bulimia

If you think you or a loved one has bulimia, it’s important that you get help right away. Treatment is most successful when it starts soon after you develop bulimia. It is also the best way to avoid damage to your overall health. Most people can make a full recovery if they start treatment within 3-5 years of when they develop bulimia. But starting earlier is even better.

How to know if you have bulimia

If you have periods of binge eating, followed by periods of purging, you may have bulimia. Taking an online eating disorder quiz can be helpful in understanding your symptoms but getting an eating disorder assessment is the best way to know if you have bulimia and the treatment that may work for you.

What to do if you think someone has bulimia

If you think someone you love has bulimia, the best thing to do is talk to them about it. Even though it can be uncomfortable to talk about such a sensitive topic, it’s very important to start the conversation. Here are some things to keep in mind:

• Before talking with them, learn about bulimia and find helpful resources to share.
• Discuss your concerns privately to keep them from feeling pressured or outnumbered.
• Mention specific behaviors that concern you. For example, that they don’t eat within a group or that they seem to be spending more time alone.
• Be a good listener and speak calmly. It’s important that they don’t feel judged or shamed about their behavior.
• Offer to help them find an eating disorder program or schedule an assessment at Melrose Center by calling 952-993-4100.

Start healing at Melrose Center

At Melrose Center, healing comes first. Our licensed psychologists, psychiatrists, medical providers, registered dietitians and other specialists work together as a team to provide expert, individualized treatment for adults and children with bulimia.

There are different levels of treatment, depending on how severe the symptoms are. Whenever possible, we start with outpatient treatment for bulimia. This allows people to live at home and continue with their everyday activities. With outpatient care, a person spends a few hours a week in the clinic, meeting with different members of their treatment team.

We also offer partial hospitalization and a residential treatment program for bulimia for people with more severe cases who may benefit from 24/7 support and an environment dedicated to healing. Recovery from bulimia is possible. Take the next step today.