Type of eating disorder
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Medical condition
Bulimia nervosa Other names Bulimia Loss of enamel (acid erosion ) from the inside of the upper front teeth as a result of bulimia Specialty Psychiatry , clinical psychology Symptoms Eating a large amount of food in a short amount of time followed by vomiting or the use of laxatives , often normal weight[ 1] [ 2] Complications Breakdown of the teeth, depression , anxiety , substance use disorders , suicide [ 2] [ 3] Causes Genetic and environmental factors[ 2] [ 4] Diagnostic method Based on person's medical history[ 5] Differential diagnosis Anorexia , binge eating disorder , Kleine-Levin syndrome , borderline personality disorder [ 5] Treatment Cognitive behavioral therapy [ 2] [ 6] Medication Selective serotonin reuptake inhibitors , tricyclic antidepressant [ 4] [ 7] Prognosis Half recover over 10 years with treatment[ 4] Frequency 3.6 million (2015)[ 8]
Bulimia nervosa , also known as simply bulimia , is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight.[ 9] [ 2] This activity aims to expel the body of calories eaten from the binging phase of the process.[ 9] Binge eating refers to eating a large amount of food in a short amount of time.[ 2] Purging refers to the attempts to get rid of the food consumed.[ 2] This may be done by vomiting or taking laxatives .[ 2]
Other efforts to lose weight may include the use of diuretics , stimulants , water fasting , or excessive exercise.[ 2] [ 4] Most people with bulimia are at normal weight.[ 1] The forcing of vomiting may result in thickened skin on the knuckles , breakdown of the teeth, decreased brain matter,[ 10] and effects on metabolic rate and caloric intake which cause thyroid dysfunction .[ 2] [ 11] Bulimia is frequently associated with other mental disorders such as depression , anxiety , borderline personality disorder ,[ 12] bipolar disorder ,[ 13] and problems with drugs or alcohol.[ 2] There is also a higher risk of suicide and self-harm .[ 3]
Bulimia is more common among those who have a close relative with the condition.[ 2] The percentage risk that is estimated to be due to genetics is between 30% and 80%.[ 4] Other risk factors for the disease include psychological stress , cultural pressure to attain a certain body type, poor self-esteem, and obesity .[ 2] [ 4] Living in a culture that commercializes or glamorizes dieting and having parental figures who fixate on weight are also risks.[ 4]
Diagnosis is based on a person's medical history;[ 5] however, this is difficult, as people are usually secretive about their binge eating and purging habits.[ 4] Further, the diagnosis of anorexia nervosa takes precedence over that of bulimia.[ 4] Other similar disorders include binge eating disorder , Kleine–Levin syndrome , and borderline personality disorder .[ 5]
Signs and symptoms
How bulimia affects the body
The erosion on the lower teeth was caused by bulimia. For comparison, the upper teeth were restored with porcelain veneers.[ 14]
Bulimia typically involves rapid and out-of-control eating, which may stop when the person is interrupted by another person or the stomach hurts from over-extension, followed by self-induced vomiting or other forms of purging. This cycle may be repeated several times a week or, in more serious cases, several times a day[ 15] and may directly cause:
Chronic gastric reflux after eating, secondary to vomiting[ 16]
Dehydration and hypokalemia due to renal potassium loss in the presence of alkalosis and frequent vomiting[ 17]
Electrolyte imbalance can lead to abnormal heart rhythms , cardiac arrest , and even death
Esophagitis , or inflammation of the esophagus
Mallory-Weiss tears
Boerhaave syndrome , a rupture in the esophageal wall due to vomiting
Oral trauma , in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat
Russell's sign : calluses on knuckles and back of hands due to repeated trauma from incisors[ 18] [ 19]
Perimolysis , or severe dental erosion of tooth enamel[ 20]
Swollen salivary glands (for example, in the neck, under the jawline)[ 20] [ 21]
Gastroparesis , or delayed gastric emptying
Constipation or diarrhea
Tachycardia or palpitations
Hypotension
Peptic ulcers
Infertility
Constant weight fluctuations are common
Elevated blood sugar , cholesterol , and amylase levels may occur
Hypoglycemia may occur after vomiting
These are some of the many signs that may indicate whether someone has bulimia nervosa:[ 22]
A fixation on the number of calories consumed
A fixation on an extreme consciousness of one's weight
Low self-esteem and/or self-harming
Suicidal tendencies
An irregular menstrual cycle in women
Regular trips to the bathroom, especially soon after eating
Depression , anxiety disorders , and sleep disorders
Frequent occurrences involving the consumption of abnormally large portions of food[ 23]
The use of laxatives , diuretics , and diet pills
Compulsive or excessive exercise
Unhealthy/dry skin, hair, nails, and lips
Fatigue , or exhaustion
As with many psychiatric illnesses, delusions can occur, in conjunction with other signs and symptoms, leaving the person with a false belief that is not ordinarily accepted by others.[ 24]
People with bulimia nervosa may also exercise to a point that excludes other activities.[ 24]
^ a b Bulik CM, Marcus MD, Zerwas S, Levine MD, La Via M (October 2012). "The changing "weightscape" of bulimia nervosa" . The American Journal of Psychiatry . 169 (10): 1031–6. doi :10.1176/appi.ajp.2012.12010147 . PMC 4038540 . PMID 23032383 .
^ a b c d e f g h i j k l m "Bulimia nervosa fact sheet" . Office on Women's Health . July 16, 2012. Archived from the original on June 19, 2015. Retrieved June 27, 2015 .
^ a b Smink FR, van Hoeken D, Hoek HW (August 2012). "Epidemiology of eating disorders: incidence, prevalence and mortality rates" . Current Psychiatry Reports . 14 (4): 406–14. doi :10.1007/s11920-012-0282-y . PMC 3409365 . PMID 22644309 .
^ a b c d e f g h i Hay PJ, Claudino AM (July 2010). "Bulimia nervosa" . BMJ Clinical Evidence . 2010 : 1009. PMC 3275326 . PMID 21418667 .
^ a b c d American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 345–349 . ISBN 978-0-89042-555-8 .
^ Cite error: The named reference Hay2013
was invoked but never defined (see the help page ).
^ Cite error: The named reference Mc2012
was invoked but never defined (see the help page ).
^ Cite error: The named reference GBD2015Pre
was invoked but never defined (see the help page ).
^ a b Flett GL, Newby J, Hewitt PL, Persaud C (September 2011). "Perfectionistic Automatic Thoughts, Trait Perfectionism, and Bulimic Automatic Thoughts in Young Women". Journal of Rational-Emotive & Cognitive-Behavior Therapy . 29 (3): 192–206. doi :10.1007/s10942-011-0135-3 . S2CID 144731404 .
^ Wagner, Angela; Greer, Phil; Bailer, Ursula F.; Frank, Guido K.; Henry, Shannan E.; Putnam, Karen; Meltzer, Carolyn C.; Ziolko, Scott K.; Hoge, Jessica; McConaha, Claire; Kaye, Walter H. (2006-02-01). "Normal Brain Tissue Volumes after Long-Term Recovery in Anorexia and Bulimia Nervosa" . Biological Psychiatry . 59 (3): 291–293. doi :10.1016/j.biopsych.2005.06.014 . PMID 16139807 .
^ biologicalpsychiatryjournal.com/article/0006-3223(93)90168-D/fulltext
^ Hessler, Johannes Baltasar; Heuser, Jörg; Schlegl, Sandra; Bauman, Tabea; Greetfeld, Martin; Voderholzer, Ulrich (2019). "Impact of comorbid borderline personality disorder on inpatient treatment for bulimia nervosa: Analysis of routine data" . Borderline Personality Disorder and Emotion Dysregulation . 6 : 1. doi :10.1186/s40479-018-0098-4 . PMC 6335811 . PMID 30680217 .
^ McElroy SL, Kotwal R, Keck PE, Akiskal HS (June 2005). "Comorbidity of bipolar and eating disorders: distinct or related disorders with shared dysregulations?". J Affect Disord . 86 (2–3): 107–27. doi :10.1016/j.jad.2004.11.008 . PMID 15935230 .
^ Dorfman J, The Center for Special Dentistry Archived February 11, 2015, at the Wayback Machine .
^ "Bulimia Nervosa" (PDF) . Let's Talk Facts : 1. 2005. Archived from the original (PDF) on March 19, 2015. Retrieved September 13, 2013 .
^ Mehler PS (August 2003). "Clinical practice. Bulimia nervosa". The New England Journal of Medicine . 349 (9): 875–81. doi :10.1056/NEJMcp022813 . PMID 12944574 .
^ Mehler PS, Crews C, Weiner K (2004). "Bulimia: medical complications" . Journal of Women's Health . 13 (6): 668–75. doi :10.1089/jwh.2004.13.668 . PMID 15333281 .
^ Joseph AB, Herr B (May 1985). "Finger calluses in bulimia". The American Journal of Psychiatry . 142 (5): 655a–655. doi :10.1176/ajp.142.5.655a . PMID 3857013 .
^ Wynn DR, Martin MJ (October 1984). "A physical sign of bulimia" . Mayo Clinic Proceedings . 59 (10): 722. doi :10.1016/s0025-6196(12)62063-1 . PMID 6592415 .
^ a b "Eating Disorders" . Oral Health Topics A–Z . American Dental Association . Archived from the original on February 3, 2009.
^ Mcgilley BM, Pryor TL (June 1998). "Assessment and treatment of bulimia nervosa" . American Family Physician . 57 (11): 2743–50. PMID 9636337 .
^ "Symptoms Of Bulimia Nervosa" . Illawarra Mercury . February 23, 2001. Archived from the original on February 21, 2016.
^ "Bulimia Nervosa" . Proud2BME . The National Eating Disorders Association. Archived from the original on December 10, 2014. Retrieved December 5, 2014 .
^ a b Barker P (2003). Psychiatric and Mental Health Nursing: The Craft of Caring . Great Britain: Arnold. ISBN 978-0340810262 . [page needed ]