Symptoms Of Bulimia Nervosa
Stereotypes about eating disorders can make it difficult for individuals to know when they might be experiencing bulimia nervosa, a mental illness and eating disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Several unique symptoms of bulimia nervosa set it apart from other eating disorders. Knowing the signs and symptoms and being concerned about yourself or someone you love can be essential, including accompanying thought patterns, health risks, and maladaptive behaviors.
About bulimia nervosa
Bulimia is characterized by cycles of binge eating large amounts of food followed by purging behaviors like using laxatives or inducing vomiting. Individuals with bulimia may also purge by exercising excessively to prevent weight gain, which can lead to life-threatening health issues and co-occurring conditions such as depression and anxiety. This binge and purge cycle of bulimia often stems from a distorted body image and an intense fear of gaining weight.
Bulimia nervosa often occurs alongside other eating disorders like anorexia nervosa and binge eating disorder.
For diagnosis and treatment, the first step is to find a doctor experienced with eating disorders. Individuals may also be advised to incorporate support groups and behavioral therapy as components of their recovery.
Diagnostic criteria for bulimia nervosa
Although commonly called bulimia, the official diagnostic name for this condition is bulimia nervosa. When mental health care professionals and physicians diagnose eating disorders like bulimia (and other conditions), they use the DSM-5. With that guide, they use the following criteria to diagnose bulimia nervosa:
- Recurrent episodes of binge eating
- Recurrent compensatory behavior to prevent weight gain, such as vomiting, using laxatives, or attempting to purge
- Binge eating and compensatory behaviors that occur at least once per week for at least three months
- Hyper-focus on an unrealistic body type or weight that determines how often the person engages in these behaviors and to what severity
The specific criteria above are used to diagnose bulimia. If you read through the above list and think that some but not all of the symptoms match the experiences of you or your loved one, it's still important to get help. It is not uncommon for a person to have some symptoms of an eating disorder but not meet the full criteria.
Contact a professional if you or someone you know is showing any of these symptoms. It may be a sign of another eating disorder. Getting a diagnosis and treatment plan early on can prevent the potentially severe consequences of an eating disorder like bulimia.
Typical symptoms of bulimia
One of the primary symptoms of bulimia is binge eating. According to the DSM-5 criteria, a binge involves eating a large and excessive amount of food in a short period (two hours or less). Binges may be accompanied by feeling a loss of control over how much food is consumed. People with bulimia often feel unable to stop themselves from eating more food, even if they feel full. Bulimia differs from anorexia nervosa, as binging is absent from the diagnostic criteria for anorexia.
The symptom distinguishing bulimia from binge eating disorder is that those with bulimia also engage in purging behaviors while those with binge eating disorder do not. Purge behavior is intended to eliminate the food or calories consumed. Some people with bulimia purge by vomiting. However, some people use laxatives and diuretics to clear the food from their system. Other people fast ahead of the binge or after the binge. Some use excessive amounts of exercise to eliminate consumed calories.
Characteristics associated with bulimia
Aside from the critical symptoms of binging and purging, bulimia nervosa can also be characterized by the following characteristics.
A history of trauma
Some people with bulimia have had some history of trauma or adverse family experiences. It can be challenging to cope with these traumas. Binging and purging behaviors may develop and be used as a coping mechanism. However, this type of coping is maladaptive. Although it might cause short-term emotional relief, it can have long-term consequences.
If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.
A complex relationship to food
Beyond turning to food for comfort, individuals with bulimia often have a complex relationship with food. They might have grown up in homes where parents negatively judged their appearance or how much they ate. In addition, their caregivers may have made decisions related to food, restricting what could be eaten or locking cupboards. Other times, food intake may have felt like the only controllable factor in their childhood.
Difficulty concentrating
Another sign of bulimia can be difficulty concentrating. When living with an eating disorder like bulimia, thoughts may be preoccupied with food. In some cases, people with bulimia may spend hours thinking about the food they want to eat. They may plan out a binge and look forward to it. After a binge, they may feel overwhelmed with feelings of guilt and regret, filling their mind with thoughts of purging.
Perfectionism and low self-esteem
Some people with bulimia also struggle with perfectionism and low self-esteem. They may have a history of feeling negatively toward themselves, including negative views about their abilities and self-worth. They may engage in destructive self-talk and self-deprecating criticism. In some cases, people with bulimia feel a sense of shame about how they look and are fearful of gaining weight. This shame can lead to guilt during bingeing and purging.
Co-occurring mental illness
People living with bulimia may also experience other mental health concerns. They may have symptoms of anxiety and depression or struggle to manage their emotions. Due to these experiences, they might try to hide symptoms from those around them. As such, they may display behaviors like secrecy or quick anger when asked about their eating.
Warning signs of bulimia nervosa
If you are concerned that you or someone you care about is living with bulimia, you may not know what warning signs can showcase bulimia. People struggling with symptoms of bulimia often engage in behaviors that may seem unusual to their usual behavior. Keeping watch for these warning signs can help determine if someone has bulimia. Below are a few:
- Secretive eating habits, such as hiding eating and eating late at night
- Withdrawing from friends and family after meals
- Spending excessive amounts of time, such as hours a day, exercising
- Injuries and scars on knuckles or hands (a sign of using fingers to induce vomiting)
- Sudden stomach injuries or illnesses reported by a doctor
- Hiding the body with baggy clothing
If someone shows these warning signs, it does not necessarily mean they have bulimia. However, if you suspect they are engaging in binging and purging behaviors, it can be valuable to approach them with your concerns and help connect them to professional support. Left untreated, bulimia can lead to physical and mental health consequences.
Medical risks of bulimia
People with bulimia may have any weight, including an average weight for their height. They may not be aware of how this mental illness can cause physical harm. However, the binge and purge behaviors characteristic of bulimia can lead to significant health consequences. Dentists may be able to see if a person is engaging in purging behaviors through vomiting because it wears down the enamel on their teeth and can lead to other dental problems. Other health symptoms might include:
- A sore and irritated throat (from vomiting and dehydration)
- Swollen parotid glands (saliva glands irritated by vomiting)
- Esophagitis (esophagus inflammation associated with acid reflux and chest pain)
- Hypertension (low blood pressure, often due to dehydration)
- Electrolyte imbalance (due to poor nutrition as well as vomiting and laxative use)
- Edema or bloating (often the result of dehydration and resulting water retention)
- Muscle cramps and weakness (due to electrolyte imbalance)
Having one or more of the above symptoms can be concerning. You may notice muscle cramps and bloating yourself, but you may not be aware of the problems that can be happening internally. If you are struggling with symptoms of bulimia, seek support before you develop more severe physical symptoms and complications.
Treatment options for bulimia
If you have observed signs of bulimia in yourself or someone else, finding support may be a practical next step. Therapeutic intervention is often recommended for those struggling with bulimia, particularly therapists with experience treating eating disorders like bulimia. A therapist can help you learn new ways to interact with food, new coping skills to replace unhealthy ones and healthier ways of viewing yourself. Often, they integrate various techniques to provide you with individualized care. Therapy may also address concerns related to self-esteem, anxiety, and depression.
Given the health risks, you may be referred for a physical evaluation and medical care. Working with a dietician or nutritionist can help you develop healthier eating patterns. If you have been exercising excessively, you might benefit from working with a physical therapist. They may help you create and use an exercise regimen to keep your body healthy and safe.
Alternative counseling options
If you’re struggling with disordered eating that doesn’t seem to improve, receiving prompt treatment can help reduce the chances of adverse health impacts. Although each person may respond differently to different therapeutic methods, a therapist can work with you to find an option that works for you.
Online counseling for bulimia
If you face barriers to in-person treatment or feel shameful about seeing a face-to-face therapist, you can also try therapy through an online platform like BetterHelp. While not a replacement for an inpatient hospitalization, online counseling may help you understand your symptoms, find resources, and cope with maladaptive thoughts or behaviors. From the safety and comfort of your home, you can receive specialized mental healthcare through video, phone, or chat sessions.
Online counseling can be successfully utilized to manage challenges related to eating disorders, such as bulimia. In one study that assessed the effectiveness of online-based therapy for eating disorders, researchers found that participants experienced reductions in anxiety and depression and a reduction in harmful eating disorder symptoms.
Takeaway
Bulimia can have specific symptoms and characteristics that can be challenging to spot in yourself or others. Many behaviors associated with bulimia happen behind closed doors, making it hard to recognize when someone you care for might be struggling.
If you suspect you or someone you love has bulimia, seek support immediately. Left untreated, bulimia can have physical and mental health consequences and may be life-threatening. While bulimia can require specialized, in-person care, counseling can also be an effective supplement to other types of treatment, including online.
Read more below for answers to questions commonly asked about symptoms of bulimia.
How will you recognize the signs and symptoms of bulimia?
People with bulimia nervosa frequently attempt to conceal their behaviors from those around them, which can make it difficult to identify. Friends and family often notice changes in habits and behavior long before they’re aware of the binging and purging behaviors that characterize the condition.
The National Eating Disorders Association (NEDA) suggests some warning signs to watch out for, including:
- Isolating or heading to the bathroom after meals
- Hoarding or concealing food
- Large numbers of empty food containers
- Empty packages of laxatives, diuretics, or diet pills
- Excessive exercise
- Rigid rituals about food and eating
- Drastic dieting
- Preference for eating alone
- Using unusual amounts of gum, mouthwash, mints, etc.
- Social withdrawal
A change in a person’s attitudes and feelings about food, eating, weight, or appearance could also be an indicator of bulimia or another eating disorder. Someone who formerly held healthy attitudes about eating and weight might start showing an unusual concern for weight loss. They might also make unrealistic negative judgments about their appearance, critiquing themselves as “fat” despite having a healthy weight.
Physical bulimia symptoms may also be harder to hide than behavioral ones. A person with this condition may gain and lose weight rapidly. Purging behaviors may also lead to physical changes such as stained teeth or a swollen jaw.
Why do people develop bulimia?
The causes of bulimia and other kinds of eating disorders are not yet fully understood. However, researchers have identified several important risk factors that may shed light on how this condition takes root.
A poor self-image seems to be one important trigger for developing bulimia. This may be caused in part by sociocultural influences such as:
- Body shaming
- Cultural norms promoting low body weight
- Strong parental expectations around weight and appearance
- Bullying
People in adolescence and early adulthood may be particularly susceptible to these influences.
Personal characteristics such as perfectionism and a strong desire for control may also increase the risk of bulimia. There appears to be some overlap between eating disorders like bulimia and obsessive-compulsive disorder, perhaps due to the role that emotions like shame, self-loathing, and anxieties about personal control play in both conditions.
Genetics likely play some role as well. Estimates of how much of the variability in bulimia nervosa diagnosis can be explained by inheritance vary widely — anywhere from 28% to 83%. While genetic factors alone cannot account for the development of bulimia, they may place some individuals at greater risk.
What is bulimia characterized by?
According to the American Psychiatric Association (APA), bulimia is characterized by an alternating pattern of two types of behavior:
- Binge eating. Eating excessive amounts of food (often foods high in calories, fat, or sugar) in a short period. During binge episodes, an individual may feel unable to control their eating. This behavior often takes place in secret and may be associated with feelings of guilt, shame, and disgust.
- Purging. Binge eating in bulimia is usually followed by attempts to shed as many calories as possible and avoid gaining weight. This can take various forms, such as self-induced vomiting, excessive exercise, severe dieting or fasting, or overuse of laxatives or diuretics.
Where does bulimia stem from?
Bulimia may emerge from an exaggerated concern for achieving or maintaining a conventionally attractive weight and body shape. This process can often be reinforced and increased by sociocultural norms favoring a thin shape. Internalizing these ideas appears to lead to restrictive eating behavior and an exaggerated fear of gaining weight.
Eating disorders like bulimia may also stem in large part from negative feelings about oneself, including:
- Shame
- Self-criticism
- Perception of low social rank
- Feelings of not belonging
A person who feels overly critical of themselves could be at higher risk for bulimia. They may turn to bulimic behavior as an attempt to recover a sense of control, pride, and self-worth.
The onset of bulimia might also be linked with other mental health conditions. Anxiety disorders, obsessive-compulsive disorder, substance use disorders, and mood disorders commonly co-occur with bulimia nervosa and may have similar genetic risk factors.
What is the best definition for bulimia nervosa?
Bulimia nervosa can be defined as an eating disorder in which periods of compulsive, uncontrolled food consumption (binge eating) are followed by attempts to mitigate the effects of binging through extreme and unsafe weight loss strategies (also called purging or compensatory behaviors).
When was bulimia first described?
The British psychiatrist Gerald Russell first described behavior consistent with bulimia in 1979. He initially characterized it as a complication or phase of anorexia nervosa. Bulimia nervosa was first categorized as a distinct disorder in 1987, in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R).
Is bulimia characterized by self-starvation?
Some people with bulimia may exhibit restricted eating during phases of compensatory behavior. However, persistent self-starvation is more characteristic of anorexia nervosa.
Individuals with bulimia may be overweight or remain at a normal weight. They may also exhibit dramatic weight fluctuations. Someone who remains consistently underweight is more likely to be diagnosed with anorexia.
What happens to your body when you throw up on purpose?
Deliberately causing yourself to vomit can lead to a wide range of health complications. It may disrupt the normal functioning of the muscles involved in swallowing and digestion while damaging the esophagus, throat, and mouth through exposure to stomach acid. Various nutritional deficits can also occur.
Notable results of self-induced vomiting can include:
- Heartburn
- Burning and irritation in the throat
- Oral bleeding
- Hoarseness
- Damaged and discolored teeth
- Recessed gums
- Swelling of the throat, cheeks, and jawline
- Dehydration
- Potassium deprivation
- Cardiac arrhythmia
- Spasms of the esophagus
- Barrett’s esophagus (growth of intestinal tissue in the esophagus)
- Scars on the backs of hands and fingers (from contact with teeth)
- Redness or bleeding in the eyes
- Rectal prolapse
Which is a potential health effect of bulimia nervosa?
Bulimia can have many different kinds of health effects. Some of these may depend on the specific purging behaviors an individual engages in. We noted many potential effects of deliberate vomiting above, but other compensatory behaviors can have serious complications as well.
Misuse of laxatives or diuretics might cause:
- Acid reflux
- Constipation
- Kidney inflammation
- Kidney stones
- Tachycardia (irregular heartbeat)
- Cardiac arrest
- Muscle tissue breakdown
- Softened bones
- Rectal bleeding
Purging through excessive exercise may lead to various forms of muscle, bone, and ligament injuries. Bulimic individuals may overexert themselves while exercising without getting enough rest and nutrition to repair the damage to their bodies.
Binge eating in bulimia can also lead to health problems. For example, people with this condition may be at higher risk of Type 2 diabetes.
What is the primary difference between anorexia and bulimia?
The main difference between anorexia and bulimia is that anorexia nervosa involves more persistent and severe self-starvation. While some periods of caloric restriction may occur as a compensatory behavior in bulimia, these are generally only used as a compensatory behavior following purges. A diagnosis of anorexia nervosa requires an individual to be significantly underweight, while a bulimia diagnosis does not.
Some forms of anorexia can involve binging and purging behaviors. Still, these episodes occur in the context of prolonged, sustained restricted calorie intake.
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