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Bulimia Nervosa

Causes of Bulimia Nervosa
Common Symptoms
Signs and Signals
Seeking help for yourself or someone that you care about


Many women face body image issues at some point throughout their lives. This is a normal part of development and is often influenced by friends, family, romantic partners, society, and the media. In addition, many women are or have been on a diet and try to control their weight in a variety of ways.

Eating disorders have beome common in America - over 7 million people have them. More than ninety percent of those with eating disorders are women. Furthermore, the number of American women affected by eating disorders has doubled to at least five million in the past three decades.[1] They are a critical health issue facing young women today.[2] This fact sheet focuses on bulimia nervosa and contains information that should help clarify what it is, as well as make suggestions on what to do if you or someone you know is dealing with an eating disorder.

Bulimia nervosa is characterized by self-perpetuating and self-defeating cycles of binge eating and purging.[3] Women who suffer from bulimia nervosa follow a routine of secretive, uncontrolled or binge eating (ingesting an abnormally large amount of food within a set period of time) followed by behaviors to rid the body of the food consumed. This includes self-induced vomiting and/or the misuse of laxatives, diet pills, diuretics (water pills), excessive exercise or fasting.[4] [ To Top ]

Causes of Bulimia Nervosa

No exact cause of bulimia has been found, however there are some common characteristics of women with eating disorders. These include low self-esteem, feelings of helplessness, and fear of becoming fat.

Eating disorders appear to run in families, with female relatives most often affected. There is also growing evidence that a girlís immediate social environment, including her family and friends, can emphasize the importance of thinness and weight control - leading to body image issues. Therefore, women who are surrounded by the attitude that it is important to be thin may develop bulimia in order to deal with self-esteem issues associated with food and eating.

Recent studies have revealed that there may be a connection between biological factors associated with clinical depression and the development of eating disorders. Stress hormones such as cortisol are elevated in those with eating disorders, while neurotransmitters such as SEROTONIN may not be present in the correct amounts. [ To Top ]

Common Symptoms

People with bulimia are overly concerned with food, body weight, and shape. Because many women with bulimia ëbinge and purgeí in secret and maintain normal or above normal body weight, they can often hide the disorder from others for years. Binges can range from once or twice a week to several times a day and can be triggered by a variety of emotions such as depression, boredom, or anger. The illness may be constant or occasional, with periods of remission alternating with recurrences of binge eating.

Women with bulimia are often characterized as having a hard time dealing with and controlling impulses, stress, and anxiety. Bulimia nervosa can and often does occur independently of anorexia nervosa, although half of all women with anorexia also develop bulimia.

A woman with bulimia is usually aware that her eating is out of control; she is afraid that she wonít be able to stop eating and is terrified of being fat. She usually feels depressed and guilty after a binge. These emotions may be difficult for women suffering from bulimia to admit to themselves because of the stigma that is often associated with bulimia and fears of becoming overweight, but it is important to note that addressing these feelings may be the first step to recovery.

Since women with bulimia are often of average weight, friends and family should pay particular attention to pick up the sometimes subtle symptoms of bulimia nervosa.[5] [ To Top ]

Signs and Signals

The following warning signs may help identify someone suffering from bulimia. It is important for people to be aware of these behaviors in themselves and in others you they care about in order to identify a friend or loved one who needs help. Bulimia is often wrapped up with guilt and secrecy, so be sensitive when you address the issue of a possible eating disorder in someone that you care about. Signs include:

  • Becoming very secretive about food
  • Spending a lot of time thinking about and planning the next binge
  • Taking repeated trips to the bathroom, particularly after eating
  • Stealing food or hoarding it in strange places
  • Preoccupation with food
  • Binge eating, usually in secret
  • Vomiting after bingeing
  • Abuse of laxatives, diuretics, diet pills or drugs to induce vomiting
  • Compulsive exercising
  • Swollen salivary glands
  • Broken blood vessels in the eyes
  • Yellow and/or eroded teeth
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Many of the medical complications associated with BULIMIA NERVOSA result from electrolyte imbalances and repeated purging behaviors. Women with bulimia nervosa can severely damage their bodies by frequent binge eating and purging. In some cases, binge eating causes the stomach to rupture. Loss of potassium due to vomiting, for example, can damage the heart muscle, and increases the risk for cardiac arrest.

Repeated vomiting can also cause inflammation of the esophagus; the stomach acid wears down the outer layer of teeth and can also cause scarring on the backs of hands if fingers are pushed down the throat to induce vomiting. Also, stomach acid may irritate the esophagus and glands near the cheeks. Bulimia may lead to irregular menstrual periods due to irregular caloric intake and interest in sex may diminish. Some individuals with bulimia also struggle with addictions such as drugs, alcohol, and compulsive stealing. Some people with bulimia suffer from clinical depression, anxiety, obsessive-compulsive disorder and other mental disorders. Link to respective fact sheets.

Physical Complications[7]
  • Malnutrition.
  • Serious heart, kidney and liver damage.
  • Intestinal ulcers.
  • Ruptured stomach.
  • Tears of the esophagus.
  • Dehydration.
  • Tooth/gum corrosion.

Psychological Complications[8]

  • Depression.
  • Shame and guilt.
  • Mood swings.
  • Low self-esteem.
  • Withdrawal.
  • Perfectionism.
  • Impaired family and social relationships.
  • "All or nothing" thinking.

For more information on the psychological & physical effects of eating disorders refer to

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Eating disorders can be treated and a healthy weight restored. The sooner these disorders are diagnosed and treated, the better the outcomes are likely to be. Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, psychosocial interventions, nutritional counseling and, when appropriate, medication management. At the time of diagnosis, the clinician must determine whether the person is in immediate danger and requires hospitalization.

The primary goal of treatment for bulimia is to reduce or eliminate binge eating and purging behavior. To this end, nutritional rehabilitation, psychosocial intervention, and medication management strategies are often used. It is important to establish a pattern of regular, non-binge meals, improve attitudes related to the eating disorder, encourage a healthy, but not excessive, exercise, and resolve co-occurring conditions such as mood or anxiety disorders are among the specific aims of these strategies. Individual psychotherapy, group psychotherapy, and family or marital therapy have been reported to be effective. Specific medications, primarily antidepressants such as the selective SEROTONIN reuptake inhibitors (SSRIs), have been found helpful for people with bulimia, particularly in those with significant symptoms of depression or anxiety, or who have not responded adequately to psychosocial treatment alone. These medications also may help prevent relapse.

People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment. Family members or other trusted individuals can be helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation. For some people, treatment may be long term.

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Seeking help for yourself or someone that you care about

Many women suffering from bulimia are ashamed of their behavior and often do not seek kelp until their 30s or 40s.[10] Furthermore, because of the secretive habits of many individuals with eating disorders, their conditions may go undiagnosed for long periods of time.[11]

This is unfortunate because eating disorders are most successfully treated when diagnosed early. The longer abnormal eating behaviors persist, the more difficult it is to overcome the disorder and its effects on the body. In some cases, long-term treatment and hospitalization is required. Families and friends offering support and encouragement can play an important role in the success of the treatment program.[12]

If you think that you have BULIMIA NERVOSA or have a friend with some of the previously described symptoms, it is important to seek help. For help, go to a physician, nutritionist, campus health center, or another professional with expertise in diagnosing eating disorders. Your college or university may have an organization that specifically on providing support and help for women with eating disorders. Remember that although asking for help can be very difficult, it is necessary to do so in order to get better.

For more information about the importance of seeking medical help, visit:

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for medical advice from a health care professional.