Bulimia

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Introduction

Bulimia is a type of eating disorder.  People with eating disorders have problems with their eating behavior, thoughts, and emotions.  They have a distorted body image and attempt to control their weight by controlling their food intake.  People with bulimia have recurrent episodes of significantly overeating and a sense of loss of control.  Purging and feelings of shame or guilt follow the binge-eating.  Individuals with bulimia may abuse laxatives, diuretics, enemas, or self-induce vomiting.  Bulimia can be a long-term condition.  People that participate in therapy to break the binge-eating and purging cycle tend to have the most positive outcomes.

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Causes

The exact cause of bulimia is unknown, but it is important to remember that eating disorders are a real illness, not a choice, and they can be treated.  Researchers have identified factors that may contribute to the condition.  People with bulimia commonly have low-self esteem and are perfectionists.  They usually have underlying emotional problems, including depression, and a distorted body image.  The family environment may play a role as well.  Family conflict, over-controlling parents, and parents that do not allow emotional expression are factors that increase the risk of bulimia.  People with bulimia may perceive pressure from family, friends, and society to be thin or equate a thin body with ideal attractiveness.  For people with bulimia, controlling food intake may be used as a coping mechanism for negative emotions.

New findings from researchers suggest that brain abnormalities may contribute to bulimia.  It may be too much or too little of certain brain chemicals affect the way that the brain processes thoughts and emotions.  Researchers think that some people may be genetically predisposed to eating disorders, meaning that they inherit a risk of developing the condition under certain circumstances.  Research will continue to investigate inherited factors; however, people with no known family history have developed bulimia.

Bulimia is more common among females than males.  It occurs most frequently in teenage girls.  People with bulimia tend to know that their actions are inappropriate, but may be unable to stop the destructive cycle without treatment intervention.  Bulimia can be a chronic illness; however, treatment can help people control the symptoms and maintain health.  Untreated bulimia can lead to serious medical complications and cause death.
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Symptoms

It may be difficult for people with bulimia to indicate that they have a problem.  People with bulimia are aware of their inappropriate thoughts and behavior, but may work very hard to keep their secret from others.  Frequently, the loved ones of a person with bulimia recognize the symptoms and help an individual access treatment.

People with bulimia binge eat frequently.  Episodes may occur a couple of times per week or several times per day.  An enormous amount of food is eaten in a short amount of time. Some people may eat the entire contents of a refrigerator or their cupboards.  They may buy and hide large amounts of food.  People with bulimia feel a loss of control while they binge eat.  The food may be gulped so fast that it is not even tasted.  The food and junk food may contain thousands of calories and is high in fats and sugars.

Following a binge-eating episode, people may feel shame or disgust.  They may be sleepy or have stomach pain.  They will purge to compensate for the binge-eating.  People with bulimia may abuse laxatives, diuretics, enemas, or make themselves throw up to avoid weight gain.  They may fast or exercise excessively.  Their body weight may remain normal, although the person may think that he or she is overweight.  For others, their body weights may range from being underweight to obese.  Additionally, depression, anxiety, panic disorder, obsessive compulsive disorder, or substance abuse may accompany bulimia.

Bingeing and purging can cause serious medical complications.  Repeated vomiting can cause stomach acid to irritate and inflame the throat.  Tooth decay and gum disease can result because the excess stomach acid removes the enamel from teeth and irritates the gums.  Repeated vomiting can result in gastroesophageal reflux disorder (GERD), a painful digestive tract condition or tearing of the esophagus.  The glands in the neck and below the jaw may become swollen and result in a puffy or chipmunk looking face.  Laxative abuse can lead to intestinal problems.  It may cause ulcers, constipation, and hemorrhoids.  Diuretic abuse can cause kidney problems.  Dehydration can result from a lack of or loss of fluids.  Bingeing and purging can also lead to severe problems including pancreas, liver, or kidney failure and electrolyte abnormalities, low blood pressure, and heart attack.  It can even cause death.
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Diagnosis

A psychiatrist can determine if a person meets the diagnostic criteria for bulimia.  A psychiatrist can identify co-existing disorders, such as depression, which is essential information for treatment planning.  A complete medical examination may be necessary to rule out other disorders and to evaluate the general health of an individual.  A dental examination is necessary to assess the teeth and gums. 

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Treatment

Treatment for bulimia includes addressing the physical and emotional health of the individual.  A foremost goal is to attain proper nutrition and hydration while ending the cycle of bingeing and purging.  Associated medical and dental conditions must be treated.  Psychotherapy is helpful for the emotional, thought, and behavioral problems associated with bulimia.  It may include individual therapy, family counseling, or group therapy.  Nutritional education, structured meal planning, and healthy exercise training are helpful as well.  Medications, such as antidepressants, can be helpful.

Recovery from bulimia is different for everyone.  Bulimia is a chronic condition and many people continue to have symptoms despite treatment.  People that have fewer medical complications and that participate in treatment tend to experience the best outcomes. 
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.