Download Commonly Asked Questions: Bulimia Nervosa1 - EDIS

FCS2121
Commonly Asked Questions: Bulimia Nervosa1
Garret D. Evans, Samuel F. Sears, and Heidi L. Radunovich2
What is it?
Bulimia nervosa is an eating disorder. People with this
disorder often eat in “binges” and then try to eliminate the
food from their system by making themselves vomit, using
laxatives, dieting or exercising excessively, and using other
techniques.
Sometimes people confuse bulimia nervosa with anorexia
nervosa. Unlike people with anorexia, people with bulimia
stay at an average or above-average weight for their height.
While people with anorexia may binge-eat from time to
time, they tend to exercise, diet, or eliminate food from
their system so frequently that their body weight is dangerously low.
Approximately nine out of ten people diagnosed with
bulimia are female. Most are diagnosed in their late teens
or early- to mid-20s; that said, their symptoms often begin
several years earlier. Like anorexia, bulimia is seen mostly
in the cultures of North America, Europe, and parts of the
South Pacific.
What are the symptoms?
If you are wondering whether someone you know has
bulimia, here are a few critical characteristics to look for:
Frequent Binge Eating
Binge eating means eating a significantly larger amount of
food than normal (usually two to three times the amount
the average person would eat, which may amount to
thousands of calories) over a short period of time (usually
less than two hours). Eating a large meal during a holiday
or celebration or snacking all day are not considered eating
binges.
People with bulimia often binge on sweet, high-calorie
foods, such as chocolate, cookies, cake, or ice cream.
However, they can also binge on other types of foods, such
as fried chicken, hamburgers, or pizza, as well as highcarbohydrate foods, such as crackers or breads.
People diagnosed with bulimia often say that they feel “out
of control” when they binge-eat. They feel as though they
cannot stop eating, even when they experience physical
pain or emotional distress from it.
Drastic Attempts to Prevent Gaining
Weight
People with bulimia often try to prevent weight gain
through two basic patterns.
• Purging—These individuals regularly attempt to
eliminate food from their system by making themselves
vomit or misusing laxatives or enemas. Approximately
80 to 90% of people who are treated for bulimia regularly
attempt to make themselves vomit. It appears that vomiting helps calm their worries about gaining weight and
relieves the physical discomfort of overeating. However,
1. This document is FCS2121, one of a series of the Family, Youth and Community Sciences Department, UF/IFAS Extension. Original publication date
June 1997. Revised August 2015. Visit the EDIS website at http://edis.ifas.ufl.edu.
2. Garret D. Evans, former associate professor, Department of Family, Youth and Community Sciences; Samuel F. Sears, former associate professor,
Department of Clinical and Health Psychology; and Heidi L. Radunovich, associate professor, Department of Family, Youth and Community Sciences;
UF/IFAS Extension, Gainesville, FL 32611.
The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information and other services only to
individuals and institutions that function with non-discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, marital status, national
origin, political opinions or affiliations. For more information on obtaining other UF/IFAS Extension publications, contact your county’s UF/IFAS Extension office.
U.S. Department of Agriculture, UF/IFAS Extension Service, University of Florida, IFAS, Florida A & M University Cooperative Extension Program, and Boards of County
Commissioners Cooperating. Nick T. Place, dean for UF/IFAS Extension.
research indicates that purging does not remove most of
the calories from the body.
• Non-purging—These individuals try to limit weight gain
by going on “crash” or starvation diets and/or exercising
excessively. Like people who attempt to purge their food,
these individuals are trying to overcompensate for their
binge eating.
Many people with bulimia do not fit neatly into one category. They may combine vomiting with crash diets or the
use of laxatives with exercising three times a day.
People who have eaten or exercised a lot more than usual
over the past few weeks do not necessarily have bulimia.
Bulimia is a lasting condition. It is generally accepted that
people must be binging and compensating at least once
a week for three months before the diagnosis of bulimia
nervosa can be considered.
Sometimes the binging and compensating activities may
disappear for months or even years only to come back
during times of stress. Other times they may morph into
overeating without purging. They may disappear and never
return, or they may continue, especially if left untreated,
without ever stopping.
Are there any medical
complications?
Unfortunately, yes. As with anorexia nervosa, women with
bulimia may menstruate (have their periods) irregularly.
These problems may be due to malnutrition, emotional
stress, or rapid changes in weight.
In addition, the electrolyte imbalances caused by vomiting
or laxative use and the extreme changes in diet often seen
with bulimia may cause cardiac (heart) or gastrointestinal
(stomach and intestines) problems. Frequent vomiting may
cause tooth decay or chipping of teeth.
What are the psychological
factors?
There is no one “personality” that describes people with
bulimia. However, we know that people with bulimia
often feel ashamed about their eating problems. They may
attempt to hide their binge eating while others are around.
Food may be hidden away in closets or at work for times
when no one can see them.
Credits: AlexRaths/iStock/Thinkstock.com
Self-Esteem and Body Image
For most of us, our self-esteem is partly related to our
thoughts about how we look. It is natural to feel better
about yourself when you think that you look pretty good.
However, the self-esteem of people with bulimia hinges
almost completely on their thoughts and fears of being
overweight.
Do people have bulimia forever?
In most cases, the answer is “no.” Some people are successfully treated, while others seem to “grow out” of the
problem. However, researchers are not yet sure of the
long-term course of bulimia.
Part of the problem is that bulimia has only been frequently
diagnosed in the past 20 to 30 years. In many cases, it can
take several years before the bulimic behaviors are reduced
or eliminated.
Commonly Asked Questions: Bulimia Nervosa
Most people with bulimia are afraid of gaining weight. They
may become very nervous about any perceived or actual
changes in their body shape.
People with bulimia are more likely to be depressed or
have problems with anxiety than others. These emotional
difficulties may have been part of the reason they developed
bulimia, or they may be in response to their eating
problems.
Also, people with bulimia tend to be more impulsive in
general and are more likely to abuse alcohol and drugs
(especially stimulants) to cope with depression and anxiety
or to lose weight.
Can bulimia be treated?
Fortunately, health care professionals are having more
success in treating bulimia. Typically, treatment is coordinated by a physician, psychologist or other mental health
professional, and a registered dietitian.
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The first step in getting help for people with bulimia
nervosa is to have them see a doctor. A physician can assess
their general health and provide more information about
their current and expected weights.
Mental health professionals, such as psychologists or
licensed clinical social workers, who specialize in eating
disorders often provide psychotherapy designed to help
these individuals understand and modify their thoughts
and behaviors to help decrease binge eating and purging
and improve mood and self-image. The mental health
professional can help them learn new strategies to cope
with their negative feelings and understand and modify
their expectations for themselves, family members, significant others, or the world in general. Especially with
younger patients, family therapy is often used to address
body image and expectations as well as family issues that
may be contributing to the eating disorder.
Long-term nutritional counseling may also be required.
This counseling can best be accomplished by a registered
dietitian who can assess the patients’ current dietary
practices and establish eating plans that meet their individual needs.
References
American Psychiatric Association (2013). Diagnostic and
statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Publishing.
Sanders, P. (1998). Handbook of medical nutrition therapy.
Lake Dallas: Helm Publishing.
Commonly Asked Questions: Bulimia Nervosa
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