Bulimia Nervosa

Are you suffering from repeated episodes of binge eating and vomiting? Watch out, for you might be having Bulimia Nervosa (BN). Read on to find out all about the disease as well as its causes, symptoms, effects, diagnostic criteria and treatment.

What is Bulimia Nervosa?

It is a form of eating disorder characterized by recurrent episodes of binge eating and purgation of the food eaten as a means of weight control. Eating is accompanied by a feeling of losing control.

Purging of food is generally done by vomiting, excessive exercising or by taking a diuretic or laxative. Apart from the acts of eating and purging food, an individual having BN also goes through fasting over extended periods of time. A patient of BN may also display behavioral abnormalities such as overspending and substance abuse and may have mood swings. Like anorexia, the root cause of BN is psychological in nature. Gerald Russell, a renowned British psychiatrist, first described and named this disorder as Bulimia Nervosa in 1979.

The condition is also known as Bulimia.

Bulimia Nervosa Causes

The disorder has complex psychological issues as its cause. Although there is as such no definite cause of BN, several factors can be held responsible for its development. In general, people suffering from bulimia or other related eating disorders have difficulty in managing their emotions in an effective way. In such cases, eating proves to be an emotional release. As such, many people find themselves attached to food when they feel depressed, angry, anxious or stressed.

The major causes for the development of BN include the following:

Poor body image

Women are often under constant mental pressure to conform to the ideal of beauty where thinness is equated with good looks. As the media frequently showcases images of unusually thin females, it becomes hard for many women to be happy with their bodies. This general dissatisfaction thereby leads to negative or poor image about the body.

Low self esteem

People who consider themselves unattractive, worthless and useless are highly prone to BN. Low self-esteem makes it difficult for many people to control impulsive behaviors. People who find it difficult to express their anger may also suffer from low self-esteem. The various factors which can lead to the development of low self esteem include:

  • Mood swings
  • Perfectionism
  • Depression
  • Childhood abuse
  • Problematic home environment

History of abuse or trauma

Women suffering from BN often have a history of rape or sexual abuse. Patients of Bulimia are also more prone to have parents who have some sort of psychological disorder or have a history of substance abuse.

Major changes in life

BN is frequently caused by stressful transitions or changes in life, such as puberty-related physical alterations, going away for attending college, or breaking up of a relationship. Binge eating and purging can be seen as a way to deal with the stress.

Highly appearance-oriented professions

People who experience intense image pressure are highly prone to bulimia. These include professionals such as models, ballet dancers, runners, wrestlers, gymnasts and actors.


The genetic structure of an individual or the chemicals in his or her brain may also act as a catalyst for the development of BN.

Bulimia Nervosa Signs and Symptoms

BN involves cycles of rapid, out-of-control eating by a patient which is then followed by self-induced purging. These cycles are often repeated numerous times in a week or several times in a day, which may directly cause the following signs and symptoms:

  • Eating, followed by chronic gastric reflux
  • Hypokalemia and dehydration due to frequent vomiting
  • Inflammation of esophagus or esophagitis
  • Boerhaave syndrome, which is characterized by a rupture in esophageal wall caused by vomiting
  • Electrolyte imbalance that may cause cardiac arrest, cardiac arrhythmia or even death
  • Oral trauma
  • Delayed emptying or gastroparesis
  • Infertility
  • Constipation
  • Gas
  • Diarrhea
  • Nausea
  • Abdominal pain
  • Peptic Ulcers
  • Enlargement of glands in the neck of patients, under jaw line
  • Scars or calluses on the back of the hands, caused by repeated trauma from incisors
  • Frequent fluctuations of weight
  • Low blood pressure
  • Low self esteem
  • Irregular menstrual cycle
  • Depression
  • Delusions
  • Feelings of guilt and shame associated with eating
  • Frequent trips to the washroom, especially during and after meals
  • Obsession with calorie consumption and extreme fear of weight gain

Repeated vomiting also brings one’s teeth into frequent contact with gastric acid, which leads to the following symptoms:

  • Bad breath
  • Mouth sores and sore throat
  • Swollen salivary glands
  • Severe dental erosion
  • Erosion of the tooth enamel, or Perimolysis
  • Gastroesophageal reflux

People having BN often have a normal weight, although they might consider themselves to be overweight. Since the weight of the patient often falls under the normal range, other people might not notice that the individual has an eating disorder.

BN sufferers are also known to indulge in intense workouts and exercises to the point of exclusion of other activities. They may suffer from other serious complications, such as:

  • Muscle weakness
  • Epileptic seizures
  • Tetany
  • Cardiac arrhythmias

Bulimia Nervosa Effects

Bulimia causes dehydration and electrolyte imbalance in the body. Lowered levels of potassium in the body may lead to lethargy, cloudy thinking, kidney failure, irregular heartbeat or even death. Other most common adverse effects and medical complications of BN include the following:

  • Weight gain
  • Bloating and abdominal pain
  • Swelling of hands and feet
  • Hoarseness and chronic sore throat
  • Breakage of the blood vessels of the eye
  • Dizziness and weakness
  • Mouth sores and tooth decay
  • Ulcers and acid reflux
  • Swelling of the salivary glands and cheeks
  • Rupture of stomach or esophagus
  • Chronic constipation, due to laxative abuse
  • Irregularities in menstrual periods

Bulimia Nervosa and Pregnancy

An actively bulimic woman may sometimes miss her periods. She may even hardly have her periods. If such happens, it means that the woman is not ovulating and so it is difficult for her to get pregnant. A woman who has recovered from bulimia has got a better possibility of getting pregnant if her monthly cycle is going normal. If a woman is having difficulty in getting pregnant, she should consult her doctor.

The various pregnancy-related complications that might arise due to bulimia include the following:

  • Miscarriage
  • Low birth weight
  • Giving birth by C-section
  • Giving birth to a pre-term child
  • Giving birth to a stillborn baby
  • Postpartum depression
  • Problems in breastfeeding
  • Having high blood pressure
  • Baby coming out with bottom or feet first
  • Having diabetes during pregnancy
  • Birth defects, like mental retardation or blindness

Bulimia Nervosa Diagnosis

As in anorexia, denial and secrecy makes it difficult to diagnose BN. An individual suffering from this disorder normally do not come to the medical practitioner’s attention until a serious psychological problem or any other associated medical condition comes to the surface. A truthful disclosure of eating habits and behaviors is essential for the accurate diagnosis of Bulimia Nervosa. Compared to anorexia nervosa, bulimia is difficult to detect as bulimics are usually average or below average or slightly above average in their weights. The diagnostic criteria for Bulimia Nervosa as prescribed by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) are presented below:

  • Recurrent binge eating episodes: The patient usually eats high quantities of food within a 2-hour bracket that is much larger than what most other people would eat within that period or consume under similar conditions.
  • The patient also experiences a feeling that he or she cannot stop eating or has lost control over his or her consumption of food.
  • In addition to binge eating, the patient also indulges in inappropriate compensatory behavior for preventing weight gain. These behaviors include activities such as self-induced vomiting, consumption of laxatives, diuretics or other medications, fasting, using enemas, or excessive exercising.
  • Both binge eating and compensatory behaviors have to occur at least 2 times every week for 3 months and should not occur especially during anorexic episodes.
  • The patient also has to have dissatisfaction with his or her body shape and weight.

The DSM-IV criteria also divide bulimics into 2 types:

Purging Type

These bulimics indulge in self-induced vomiting to quickly get rid of the food before it is digested, or make the use of diuretics, laxatives or enemas. They may also fast or exercise excessively to reduce body weight, but always does so as a secondary means of weight control.

Non-purging Type

These bulimics mainly fast for a long time or exercise excessively to reduce their intake of calories after eating.

Bulimia Nervosa Treatment

BN patients suffer from numerous psychological and medical complications that are believed to be reversible through the implementation of multidisciplinary treatment. Treatment for this disorder can be managed and monitored either by the physician, a psychiatrist or a clinical psychologist. The methods of treatment are primarily dictated by the extent of medical complications. A psychiatrist having both psychological and medical training can be considered as the optimum manager of treatment.

Several antidepressant medications have also been proven beneficial for treating bulimia. Studies have shown that fluoxetine (Prozac), which is a type of SSRI or selective serotonin reuptake inhibitor class of antidepressants, is a potent cure for bulimia. Fluoxetine has also been approved by the U.S. Food and Drug Administration for the medical treatment of BN.

Other forms of antidepressants, such as tricyclic antidepressants, MAOIs or monoamine oxidase inhibitors and buspirone have all proven to be effective to reduce the tendency of bingeing and vomiting (purging) in the patients having bulimia. Treatment for BN has also been carried with medications such as mianserin, nomifensine, lithium carbonate, trazodone and bupropion. However, the selective serotonin reuptake inhibitors or the SSRIs have still remained the most preferred way of treatment due to their safety as well as lower side effects.

There are also some other drugs that are currently undergoing investigation as possible forms of treatment for bulimia. Examples of such drugs undergoing studies include the antiepileptic medication Topiramate as well as serotonin antagonist Ondansetron.

In some cases, BN patients may require hospitalization because of the psychological and medical complications associated with the disorder. Some patients may go for outpatient programs. Others might require regular monitoring and weekly counseling by a practitioner. If the patient is currently in a life-threatening condition, the immediate goal of the treatment will be to stabilize the patient’s physical condition. The main aims of the treatment of a BN sufferer should be to address both the physical as well as the psychological requirements of the affected patient so that his or her physical health may be restored and the patient’s eating habits may be brought back to normal.

Cognitive Behavioral Therapy (CBT) is often used to treat the psychological aspects of this disorder. A patient has to identify the internal feelings and the distorted belief systems that were originally responsible for the eating disorder. The appropriate treatment approach should address the underlying issues of self-perception, control as well as family dynamics. Behavior management and nutritional education offers effective and healthy alternatives to out-of-control weight management for the patient. Support groups and group counseling can help the patient to recover quickly as well. It is important to remember that patients of bulimia might relapse to their former ways many times during treatment, and there is nothing to despair in such cases. The doctor may have to apply many different therapeutic methods before the patient is finally cured. It is also necessary to maintain close association with the immediate family members of the patient for assisting him or her to get well as quickly as possible.

The patient should learn to accept himself or herself and try to live a healthy life both physically and emotionally. The restoration of mental and physical health will occur only gradually and so patience is required in the process.


Bulimia Nervosa Complications

BN can eventually lead to some serious medical complications. Vomiting frequently brings the esophagus in contact with the stomach acid, which can damage the esophagus for good. The various possible complications for BN include:

  • Dehydration
  • Constipation
  • Pancreatitis
  • Hemorrhoids
  • Dental cavities
  • Swelling of throat
  • Electrolyte imbalances
  • Rupture of esophagus from excess vomiting

Bulimia Nervosa Prognosis

Many BN patients suffer from a relapse of the condition after treatment, and require long-term care. The various possible complications resulting from repeated patterns of overeating and purging include issues with the stomach, esophagus, lungs, heart, pancreas and muscles. Patients who are suicidal or having severe symptoms require hospitalization. Women having bulimia might find it emotionally difficult to deal with pregnancy due to the changes in body shape. Poor nutritional health of a mother with BN can affect her baby’s health. Women who fail to have regular periods due to bulimia cannot become pregnant.

Bulimia Nervosa Statistics

Check out the following statistics about this disease:


  • According to NIMH or National Institute of Mental Health, between 1.1% and 4.2% of women suffer from bulimia at some point in their lives.
  • The Academy for Eating Disorders suggest that around 50% of bulimia patients recover, 30% of patients show some improvement whereas 20% of sufferers continue as fully bulimic patients.
  • Roughly between 1% and 2% of adults and late adolescent females meet full diagnostic criteria of Bulimia Nervosa.
  • Long term follow-up studies indicate that 10% of bulimia patients still fulfill Bulimia Nervosa’s complete diagnostic criteria even after going through treatment for 10 years.
  • According to studies conducted by National Eating Disorders Association, instances of bulimia multiplied three times in women who were aged between 10 and 39 between the years 1988 and 1993.
  • The total number of bulimia patients receiving mental healthcare is only 6%.
  • The Renfrew Center Foundation reveals that the weight gain by an average woman during pregnancy is around 25 pounds, whereas a bulimic woman only gains an average weight of around 5.7 pounds during pregnancy.

Celebrities with Bulimia Nervosa

Some celebrities who have BN are:


  • Lady Gaga
  • Elton John
  • Kate Winslet
  • Alanis Morissette
  • Katharine McPhee



Bulimia Nervosa is an eating disorder that affects mostly Caucasian women and can lead to many serious medical and psychological health problems. Proper diagnosis and treatment of this disorder is necessary to help a BN patient lead a happy and healthy life.







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