Bulimia Nervosa: Signs, Symptoms and How to Treat It

Bulimia nervosa is one of the most common eating disorders in the United States, and it affects more than six million people in the country. Unfortunately, not everyone is receiving the attention and medical help they deserve for a very serious mental illness that gravely injures someone's self-esteem, mental well-being, long-term physical health, and happiness.

Read on to find information regarding the risk factors, signs and symptoms, and best treatment plans for bulimia nervosa. Take your life back.

What is bulimia nervosa and who is at the highest risk of bulimia?

Bulimia nervosa is an eating disorder that, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), affects about 1.5 percent of young women and 0.5 percent of young men. Bulimia nervosa often first appears during someone's adolescence or young adulthood, and usually during or after an episode of dieting. In addition to dieting, other factors that heighten the risk of bulimia include:

• Childhood obesity
• Anxiety
• Depression
• Low self-esteem
• History of trauma
• Family history of eating disorders
• Other mental health concerns

Although bulimia is more prevalent among women, men with bulimia are less likely to be properly identified and diagnosed by health care providers. Men are also less likely to participate in research studies on bulimia nervosa and other eating disorders, so it's possible that bulimia is more common in men than current statistics suggest.

It's also notable that bulimia nervosa affects individuals from a wide range of backgrounds and cultures. In fact, there's evidence that bulimia nervosa is more common in Latino- and Black-identified individuals. But, similar to men, bulimia is less likely to be diagnosed in certain cultural groups. This makes it all the more important to remember that anyone can be dealing with bulimia nervosa.

What are the criteria for diagnosing bulimia nervosa?

There are three main features of bulimia nervosa:

• Patterned binges where someone repeatedly loses control over their eating
• Compensation of binge eating by use of laxatives, self-induced vomiting, purging, dieting or other extreme measures
• Extreme connections of self-esteem and self-opinion to body weight/shape

Whereas many people might occasionally eat large amounts of food or binge, people with bulimia experience frequent episodes of binge eating—at least weekly over a three-month period.

To avoid weight gain and exert control over body shape, people with bulimia nervosa will compensate for binges through one or more behaviors that include:

• Misuse of laxatives or diuretics
• Misuse of stimulants
• Misuse of insulin
• Self-induced vomiting
• Dieting or not eating for extended periods of time (fasting)
• Excessive exercise

Body weight and shape become some of the most important drivers of self-esteem and mood for a person with bulimia. For example, an individual with bulimia nervosa might feel devastated by a small amount of weight gain, whereas individuals without an eating disorder probably wouldn't notice or care.

What are the mental side effects of bulimia nervosa?

Bulimia can affect a person in many ways, and the side effects can be seen in behaviors not directly related to binge eating or purging. A person with bulimia nervosa might:

• Spend a lot of time focused on food, eating or calorie restriction
• Lose focus during work or daily tasks because of their preoccupation with food
• Experience low self-esteem
• Succumb to perfectionism, rigid thinking, impulsivity or isolation
• Develop other co-occurring issues like anxiety, depression and/or substance abuse

For people with bulimia, it can be hard to concentrate with food and body-related thoughts constantly affecting their mood, energy and self-esteem. This can make it challenging to mindfully engage in otherwise regular tasks like interacting with others, completing homework or focusing at work.

How does bulimia nervosa affect someone's physical health?

As a result of the behaviors that accompany bulimia—binge eating, purging through self-induced vomiting, misuse of laxatives, etc.— there are a number of medical issues that can occur as a result of bulimia. Physical health complications include:

• Gastrointestinal issues that range from mild to severe
• Tooth decay
• Fluid and electrolyte abnormalities
• Heart problems
• Disturbances in menstruation
• Disruptions in hunger and fullness signals
• Weight fluctuations

In addition to the physical health complications, bulimia can also significantly increase one's risk for suicide. It's absolutely critical that people dealing with bulimia nervosa receive proper care.

What kind of treatment is best for bulimia nervosa?

Many people with bulimia nervosa experience symptoms for several years, making an ongoing treatment plan very important. There are many effective treatments that can help make bulimia more manageable, but the treatment plan should be wide-ranging enough to treat all of its repercussions to physical and mental health. Ideally, the treatment plan would include:

• A medical provider to monitor medications and physical effects
• A dietitian who can create a healthy food plan for people with eating disorders
• A therapist who can help address unhealthy behaviors and body dissatisfaction
• Supportive family members, especially for adolescents

The most commonly used, evidence-based psychotherapy treatments for bulimia include:

• Specialized cognitive-behavioral therapy (CBT)
• Dialectical behavioral therapy (DBT)
• Interpersonal psychotherapy (IPT)

Many of these treatments focus on the triggers that people with eating disorders most frequently face and challenge the unhelpful thinking patterns that they experience around food and body. In time, a person receiving treatment for their bulimia (or any eating disorder) will learn to healthfully manage their emotions, normalize their eating behaviors and regain self-esteem.

Schedule an appointment with a licensed specialist to learn more about any of these psychotherapy treatment options.

Are there different levels of treatment for eating disorders?

There's a wide range of severity for bulimia and other eating disorders, like anorexia nervosa, so there are different levels of treatment that may be needed for the highest likelihood of successful recovery.

For example, those who are medically unstable might need inpatient or residential treatment at a specialized treatment center. This way, the patient can receive supervised medical attention while they stabilize and interrupt the unhealthy eating patterns associated with an eating disorder.

For less urgent cases, outpatient programming can provide a supportive environment for people who continue to live and operate from home. But both types of programming often include therapeutic meals and opportunities to work through the urges to engage in binge eating and other compensatory behaviors after eating.

There is always hope for recovery. If you or a loved one are experiencing signs or symptoms that suggest an eating disorder or unhealthy body image and related behaviors, contact a mental health center or specialist to schedule an assessment. They can help you determine whether you meet the criteria for an eating disorder and get you on track to happiness, health and self-acceptance.