Bulimia

Alternative names
Bulimia nervosa; Binge-purge behavior; Eating disorder - bulimia

Definition

Bulimia is an illness defined by food binges, or recurrent episodes of significant overeating, that are accompanied by a sense of loss of control. The affected person then uses various methods - such as vomiting or laxative abuse - to prevent weight gain.

Someone with bulimia may also suffer from anorexia nervosa, an eating disorder involving severe, chronic weight loss that proceeds to starvation, but many bulimics do not suffer from anorexia.

Causes, incidence, and risk factors

In bulimia, eating binges may occur as often as several times daily for many months. These binges cause a sense of self-disgust, which leads to compensatory behaviors like self-induced vomiting or excessive exercise. A person with bulimia may also abuse laxatives, diuretics or enemas in order to prevent weight gain.

Such behaviors can be quite dangerous and may lead to serious medical complications over time. For example, the stomach acid which is introduced into the esophagus (the tube from the mouth to the stomach) during frequent vomiting can permanently damage this area.

Women are much more commonly affected than men. The affected person is usually aware that her eating pattern is abnormal and may experience fear or guilt associated with the binge-purge episodes. Although the behavior is usually secretive, clues to this disorder include overactivity, peculiar eating habits or rituals, and frequent weighing. Body weight is usually normal, although the person may perceive themselves as overweight. If bulimia is accompanied by anorexia, body weight may be extremely low.

The exact cause of bulimia is unknown, but factors thought to contribute to its development are family problems, perfectionist personalities, and an overemphasis on physical appearance. Bulimia may also be associated with depression and occurs most often in adolescent females.

Symptoms

     
  • binge eating  
  • self-induced vomiting  
  • inappropriate use of diuretics or laxatives  
  • overachieving behavior

Signs and tests

A dental exam may show dental cavities or gum infections (such as gingivitis). The enamel of the teeth may be eroded or pitted because of excessive exposure to acid in vomitus.

A chem-20 may show an electrolyte imbalance (such as hypokalemia) or dehydration.

Treatment

Treatment focuses on breaking the binge-purge cycles. Outpatient treatment may include behavior modification techniques as well as individual, group, or family counseling.

Antidepressant drugs may also be used in cases that are coincide with depression.

Support Groups

Self-help groups like Overeaters Anonymous may help some people with bulimia. The American Anorexia/Bulimia Association is a source of information about this disorder. See eating disorders - support group.

Expectations (prognosis)


Bulimia is a chronic illness and many people continue to have some symptoms despite treatment. People with fewer medical complications of bulimia, and who are willing and able to engage in therapy, tend to have a better chance of recovery.

Complications

     
  • pancreatitis  
  • dental cavities  
  • inflammation of the throat  
  • electrolyte abnormalities  
  • dehydration  
  • constipation  
  • hemorrhoids  
  • esophageal tears/rupture

Calling your health care provider

Call for an appointment with your health care provider if you (or your child) are exhibiting behaviors of any eating disorder, including bulimia.

Prevention

Less social and cultural emphasis on physical perfection may eventually help reduce the frequency of this disorder.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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