Bulimia Nervosa: Causes, Treatments & Complications

Bulimia Nervosa: Causes, Symptoms, Signs & Treatment

Bulimia nervosa commonly called bulimia, is a serious potentially life-threatening type of eating disorder. People with bulimia will consume a large amount of food. Whiles most people cannot consume such amount in a similar situation or that short period of time (binge). Following food consumption they fear to gain weight. Therefore, in order to prevent it, they will do something to get rid of the food (purge). They may vomit, exercise too much, or use medicines like laxatives.

People with bulimia are often at a normal weight, but they may see themselves as being overweight. Because the person’s weight is often normal, other people may not notice this eating disorder.

Lady hiding in the washroom and binging in bulimia nervosa

People who have bulimia nervosa judge themselves harshly on their body weight and shape. In order to help them cope with these feelings, they follow a strict diet to try to lose weight. But over time the hunger from the strict diet triggers them to binge eat. After binge eating, they feel out of control, ashamed, guilty, and afraid of gaining weight. This distress causes them to purge, in hopes of “undoing” any possible weight gain from the binge.

Without treatment, this “binging and purging” cycle can lead to serious, long-term health problems. Acid in the mouth from vomiting can cause tooth decay, gum disease, and loss of tooth enamel. Any type of purging can lead to bone thinning, kidney damage, heart problems and sometimes even death.

What causes bulimia nervosa?

Many more women than men have bulimia nervosa. The disorder is most common in teenage girls and young women. The person usually knows that her eating pattern is abnormal. She may feel fear or guilt with the binge-purge episodes.

The exact cause of bulimia nervosa is unknown. But genetic, psychological, family, society, or cultural factors may play a role. Bulimia is likely due to more than one factor. However, you may be more likely to have bulimia nervosa if:

  • Other people in your family are obese or have an eating disorder.
  • You have a job or do a sport that stresses body size, such as ballet, modelling, or gymnastics.
  • You are often on a diet or you exercise too much in order to lose weight or change your body shape.
  • Have a poor body image, or feel that your body should be slim like many people in the media.
  • You are the type of person who tries to be perfect all the time, never feels good enough, or worries a lot.
  • You are dealing with stressful life events, such as divorce, moving to a new town or school, or losing a loved one.

Lady purging in the washroom in bulimia nervosa after binge eating

What are the symptoms?

With bulimia, eating binges may occur as often as several times a day for many months. The person often eats large amounts of high-calorie foods, usually in secret. During these episodes, the person feels a lack of control over the eating.

People with bulimia nervosa behave in ways such as:

Binge eat on a regular basis. They eat larger amounts of food in a short period of time (2 hours or less). During a binge, they feel out of control and feel unable to stop eating.

Purging to get rid of the food and also avoid weight gain. They may make themselves vomit, exercise very hard or for a long time, or misuse laxatives, enemas, water pills (diuretics), or other medicines.

Symptoms that other people can see include:

  • Buying large amounts of food that disappear right away
  • Regularly going to the bathroom right after meals
  • Throwing away packages of laxatives, diet pills, emetics (drugs that cause vomiting), or diuretics

How can you know if someone has bulimia nervosa?

Bulimia nervosa is different from anorexia nervosa, another eating disorder. People who have anorexia eat so little that they become extremely thin. People who have bulimia nervosa may not be thin. They may be a normal size. They may binge in secret and deny that they are purging. This makes it hard for others to know that a person with bulimia has a serious problem.

If you are concerned about someone, look for the following signs. A person may have bulimia if he or she:

  • Goes to the bathroom right after meals.
  • Is secretive about eating, hides food, or will not eat around other people.
  • Exercises a lot, even when he or she does not feel well.
  • Often talks about dieting, weight, and body shape.
  • Uses laxatives or diuretics often.
  • Has teeth marks or calluses on the back of the hands or swollen cheeks or jaws. These are caused by making oneself vomit.

How is bulimia diagnosed?

Your doctor or nurse will ask you questions about your symptoms and medical history. It may be difficult to talk to a doctor or nurse about secret eating, purging, or exercise behaviors. But doctors and nurses want to help you get better. Being honest about your eating behaviors with a doctor or nurse is a good way to ask for help.

Your doctor may do blood or urine tests to rule out other possible causes of your symptoms. Your doctor may also do other tests to see whether you have any other health problems caused by bulimia nervosa. These tests may include kidney function tests or an electrocardiogram (ECG or EKG) to see if or how repeated binging and purging has affected your health.

What treatments are available?

Talking therapies

Cognitive-behavioural therapy (CBT) is the most common type of therapy used for treating bulimia nervosa. CBT can help you to learn healthier ways of thinking about food and also rebuild your self-esteem.

CBT may be between 16 and 20 sessions, each lasting about an hour. This takes over six months duration. In between sessions, you will be asked by the therapist to perform different tasks, such as slowly making small changes to your eating habits, or keeping a daily diary of when and what you eat.

Interpersonal therapy (IPT)

IPT is another talking therapy. It allows you to discuss your relationships with other people. Rebuilding these relationships may stop you turning to food for emotional support.


For some people medication can be offered alongside a programme of self-help or talking therapies. Sometimes, it’s a first line of treatment. Antidepressants are also often prescribed to people with bulimia nervosa. Though psychiatric medications are not equally effective for everyone, some people find relief through antidepressants.


Keeping a diary of your eating habits may also be helpful. Because, it can help you in understanding what triggers binges. You may find that support groups are useful. It can be comforting to talk to others who have had the same feelings and also experiences.

What should you do if you think someone has bulimia nervosa?

It can be very scary to realize that someone you care about has an eating disorder. If you think a friend or loved one has bulimia nervosa, you can help.

  • Talk to him or her. Tell the person how much you care and why you are worried.
  • Urge him or her to talk to someone who can help, such as a doctor or counsellor. Offer to go along.
  • Tell someone who can make a difference, like a parent, teacher, counsellor, or doctor. The sooner your friend or loved one gets help, the sooner she will be healthy again.

Possible Complications

Bulimia can be dangerous. It may lead to serious health problems over time. For example, vomiting over and over can cause problems such as:

  • Stomach acid in the esophagus (the tube that moves food from the mouth to the stomach). This can lead to permanent damage of this area.
  • Tears in the esophagus.
  • Dental cavities.
  • Swelling of the throat.

Vomiting and overuse of enemas or laxatives can lead to issues such as:

  • Your body not having as much water and fluid as it should
  • Low level of potassium in the blood, which may lead to problems such as heart attack
  • Hard stools or constipation
  • Hemorrhoids
  • Damage of the pancreas

About felclinic 593 Articles
Felix Ntifo is a Registered General Nurse who has so much passion to improve health care delivery. He founded FelClinic with the hope of making health information accessible to everyone who may not come in contact with him personally. "At felclinic.com we are very passionate about health and well-being of everyone. Our team is made up of professional doctors, nurses, midwives and lab technicians."

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