Bulimia nervosa is an eating disorder characterized by repeated episodes of binge eating followed by unhealthy behaviors to compensate. Individuals who binge repeatedly consume an unusually large amount of food compared to what most people would eat in a similar period of time. During an episode of binge eating, patients with bulimia may feel a lack or loss of self-control over how much they eat.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-5; American Psychiatric Association, 2013), the diagnostic criteria of bulimia nervosa include the following:
- Repeatedly eating large amounts of food during a short period of time (e.g., within two hours)
- Loss of control over how much they eat
- Purging or other behaviors to compensate, including methods like self-induced vomiting, taking diet pills, excessive exercise to burn off excess calories and misuse of medications such as laxatives or diuretics
Patients diagnosed with bulimia often experience intense feelings of guilt, self-hatred and body dissatisfaction, which fuels their use of unhealthy and extreme methods to avoid weight gain. To be diagnosed with bulimia, binging and purging behaviors must occur at least once per week for a period of three months or longer. The severity of bulimia nervosa depends on the how often the patient engages in binging and purging behaviors, which can range from mild (one to three episodes per week) to extreme (14 or more episodes per week).
Who is affected?
Eating disorders can affect everyone regardless of age, gender or ethnicity; however, bulimia nervosa most commonly develops among females during adolescence and young adulthood. While the causes of bulimia are still unknown, bulimia nervosa and other eating disorders are common in societies and cultures that promote an idealized body image and size, such as extreme thinness. Many women will develop extreme and restrictive dieting or exercise methods at an early age in an effort to be thin.
Many genetic, environmental, psychological, cultural and interpersonal factors can increase a person’s risk of developing bulimia nervosa. Some of the risk factors for bulimia nervosa include:
- Anxiety and depressive symptoms
- Negative self-image
- Personality traits such as perfectionism or having a tendency to please others
- Lacking coping skills to deal with stress
- Having a first-degree relative (e.g., parent or sibling) who is diagnosed with an eating disorder, who is overweight or who has another mental health problem
- Childhood obesity, weight concerns and early pubertal maturation
- Sexual and/or physical abuse, neglect or other trauma (e.g., being teased for size or weight) during childhood
Neuroimaging studies using functional magnetic resonance imaging (fMRI) have also noted disturbances in areas of the brain responsible for regulating cognition, emotion, appetite and visual perception among patients with bulimia nervosa.
Many people with bulimia nervosa maintain a normal or healthy weight, or are slightly overweight, which may make it difficult to recognize that a problem exists among these individuals. While it may be difficult to tell if someone has an eating disorder, some of the common warning signs of bulimia nervosa include:
- Frequent trips to the bathroom after meals
- Hiding or hoarding food
- Avoiding eating in public places or around other people
- Eating large amounts of food or buying large quantities of food that disappear quickly
- Compulsive, excessive exercising
- Broken blood vessels in the eyes
- Pouch-like appearance in the corners of the mouth
- Rashes and pimples
- Small cuts and calluses on the knuckles of hands
- Dental problems (e.g., cavities, diseased gums, erosion of tooth enamel)
- Discarded boxes for laxatives, diet pills, diuretics or other medications
Due to purging and/or the use of extreme methods to avoid weight gain, people who are diagnosed with bulimia may be prone to experiencing a number of health problems. Some of the most common medical complications associated with bulimia nervosa include:
- Loss of dental enamel
- Tooth damage (e.g., chipped, ragged and “moth-eaten”)
- Discolored or stained teeth
- Calluses or scarring on hand
- Chronically inflamed and sore throat
- Enlarged or swollen salivary glands in neck and jaw area
- Acid reflux disorder and other gastrointestinal problems
- Intestinal distress and irritation from laxative abuse
- Severe dehydration form purging of fluids
- Sleep problems or insomnia
- Menstrual irregularities or amenorrhea (i.e., loss of menstruation)
- Fatigue or fainting
- Tingling in hands or feet
- Muscle cramps
- Hair loss, dry skin and brittle nails
Patients who purge by self-inducing vomiting may also be more likely to experience dehydration and electrolyte imbalances due to having too low or too high levels of sodium, calcium, potassium and other minerals. Electrolyte imbalances can be life-threatening as they can contribute to other significant health problems such as kidney failure, irregular heartbeat, heart attacks and heart failure. Chronic inflammation of the stomach or esophagus due to excessive straining to induce vomiting can also lead to potentially fatal consequences such as gastric ruptures or esophageal tears. These dangerous effects are additional reasons to seek help through bulimia treatment centers as it could save the life of the affected individual.
In addition to the physical signs, patients with bulimia nervosa may be embarrassed or ashamed of their eating problems and attempt to conceal their behaviors. They may isolate themselves, be reluctant to develop relationships with others, or withdraw from their usual activities and friends, which can contribute to feelings of loneliness, low self-esteem and dysphoria. Some of the mental health problems that occur with bulimia include:
- Depressive symptoms
- Low self-esteem
- Mood swings and/or emotional outbursts
- Fear of social situations
- Bipolar disorder
- Avoidant personality disorder and borderline personality disorder
- Personality traits such as perfectionism)
- Changes in their personality
There are no diagnostic tests available for bulimia nervosa, but laboratory and physical findings can determine whether a patient has medical complications or other physical effects that would indicate repeated binge eating and unhealthy compensatory behaviors. For example, repeated vomiting episodes can lead to damaged teeth, stomach and esophagus. The three criteria specified in the DSM-5 are currently used to determine if a patient has bulimia. If a professional does determine that an individual is struggling with this disorder they will normally recommend bulimia nervosa treatment which can be found at bulimia rehab centers such as the ones provided by Sovereign Health.
Treatment at Sovereign Health of California
Sovereign Health of California provides high-quality care to adolescent and adult female patients who need bulimia nervosa treatment at our San Clemente and Rancho San Diego locations. Our Eating Disorder Treatment Program helps females to achieve and maintain healthy behaviors and learn to manage stress and emotional issues in a healthy way to promote their recovery.
Sovereign Health of California’s therapeutic bulimia treatment programs for eating disorders are group-based, tailored to each patient’s needs and comprised of elements such as:
- 24/7 supervision
- Medical monitoring
- Supervised meals
- Individual, group and family therapy
- Medication and illness management
- Stress and relaxation techniques
- Experiential treatments (e.g., art therapy, equine therapy, yoga, mindfulness)
- Relapse prevention and discharge planning
- Case management
- Nutritional counseling
As part of our holistic approach to treatment, we provide an array of evidence-based treatment options for bulimia, which include psychotherapy, cognitive behavior therapy (CBT), dialectical behavior therapy (DBT) and psychodynamic therapy to assist patients in overcoming abnormal behaviors regarding food and weight. Patients also receive complementary treatments for bulimia nervosa such as meditation, yoga and neurofeedback.
Sovereign Health of California’s positive approach to treatment ensures that patients with eating disorders and any co-occurring conditions receive the highest-quality care possible to help them succeed in their treatment and recovery. To learn more about bulimia nervosa or bulimia treatment at Sovereign Health of California, please contact our 24/7 helpline to speak to an admissions representative today.