Bulimia nervosa

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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, and effects on metabolic rate and caloric intake which cause thyroid dysfunction.^[2][10] Bulimia is frequently associated with other mental disorders such as depression, anxiety, borderline personality disorder,^[11] bipolar disorder,^[12] 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

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^[14] and may directly cause:

• Chronic gastric reflux after eating, secondary to vomiting^[15]
• Dehydration and hypokalemia due to renal potassium loss in the presence of alkalosis and frequent vomiting^[16]
• 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^[17][18]
• Perimolysis, or severe dental erosion of tooth enamel^[19]
• Swollen salivary glands (for example, in the neck, under the jawline)^[19][20]
• 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:^[21]

• 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^[22]
• 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.^[23]

People with bulimia nervosa may also exercise to a point that excludes other activities.^[23]