What is Bulimia Nervosa?
Bulimia nervosa — often referred to as “bulimia” — is an eating disorder characterized by regular bingeing followed by purging or other compensatory methods. People with bulimia nervosa place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives. The health risks of bulimia nervosa affect all the major organ systems. With support from expert clinicians, people with bulimia nervosa – regardless of how long they have been living with the condition – can recover.
What are purging and compensation?
Purging
Purging involves the use of compensatory behaviors to help “expel” food, commonly through the use of vomiting, laxatives, diuretics, enemas, excessive exercise, fasting, or other medications.
Compensation
Non-purging compensatory methods are other means of compensating after bingeing, like fasting or excessive exercise.
Signs of Bulimia Nervosa
There are some common behaviors associated with anorexia nervosa. Friends and family can look out for the warning signs below.
Bingeing
Someone with bulimia nervosa will binge by consuming a large quantity of food in a short amount of time.
Frequent bathroom trips
Some of the most common purging methods are self-induced vomiting and the use of diuretics and laxatives. Someone with bulimia nervosa may make frequent trips to the bathroom to purge.
Purging
Someone with bulimia nervosa will purge after their binge, taking frequent trips to the bathroom.
Food restriction & fasting
Food restriction and fasting are other ways to compensate for bingeing and can be warning signs of bulimia nervosa.
Evidence of bingeing
Another warning sign is the disappearance of large amounts of food or appearance of wrappers/packaging in their room, the trash or hidden somewhere.
Fear of weight gain
An extreme fear of gaining weight is also a common sign of an eating disorder. They might weigh themselves excessively, make comments about “feeling fat,” keep track of their weight daily and get upset if they’ve gained or haven’t lost weight.
Compulsive exercising
Some individuals with bulimia nervosa engage in compulsive or excessive exercise to compensate for bingeing.
Russell’s sign
Repetitive scratching of the knuckles and back of the hands against the teeth during self-induced vomiting can cause calluses known as Russell's sign.
Hypokalemia
Recurrent hypokalemia of unknown etiology can be very concerning for those that purge.
Bulimia Symptoms
While severe anorexia nervosa involves many behavioral symptoms, it can also have serious health consequences. Weight loss and compulsive exercise are two of the most common symptoms of anorexia nervosa. Rapid weight loss, low weight, compulsive exercise and malnutrition can pose serious health risks, including:
- Heart problems
- Gastrointestinal problems
- Oral health problems
Medical Complications of Bulimia Nervosa
While bulimia nervosa and other eating disorders are mental illnesses, they are also one of the few conditions that are regularly accompanied by severe medical complications.
Sialadenosis
Sialadenosis, also known colloquially as “chipmunk cheeks,” is a hallmark of purging that causes swelling and discomfort on the sides of the face.
Barrett’s esophagus
Frequent exposure to acidic vomitus can alter the lining of the esophagus and predispose to this pre-cancerous condition.
Pseudo-Bartter Syndrome
Chronic dehydration associated with bulimia nervosa causes retention of water and salt upon refeeding or when provided aggressive intravenous (IV) fluids, thereby increasing risk likelihood of edema.
Low potassium
Chronic purging causes a loss of potassium through vomiting, excessive bowel movements from laxative abuse or urine from diuretic abuse, causing muscle weakness, cardiac arrhythmias and gastrointestinal dysmotility.
Pneumonitis & pneumonia
Inhalation of vomit during purging can cause aspiration pneumonitis.
Gingivitis & periodontitis
Purging through self-induced vomiting can cause gingivitis (gum disease), and if left untreated can lead to periodontitis (a degradation of the jawbone), causing teeth to be loose or fall out.
Perimylolysis
Repeated contact with vomit can cause irreversible loss of the teeth enamel, causing increased teeth sensitivity and cavities.
Psychiatric Comorbidities of Bulimia Nervosa
Research demonstrates that 55-95% of people diagnosed with an eating disorder also receive a diagnosis for another disorder. While mental illnesses can influence each other, it’s often difficult to determine which developed first.
Major depression
Eating disorders and major depressive disorder have significant overlap in emotional presentation, sharing traits like low self-worth, loneliness and isolation, feeling out of control, anger, irritability and inadequacy.
Attention deficit hyperactivity disorder
Research suggests that the occurrence of ADHD is higher in patients with bulimia nervosa. Children with ADHD are at an increased risk for bulimia nervosa symptoms and girls with ADHD are over three times as likely to have an eating disorder.
Bipolar disorder
Patients with bipolar disorder (BD) are much more likely than the general population to meet the criteria of an eating disorder. Studies suggest that the comorbidity of BD and eating disorders are closely linked to bingeing and purging.
Borderline personality disorder
Borderline personality disorder (BPD) is more common in patients with bulimia nervosa. Some of the characteristics of BPD are exhibited in binge eating and/or purging, like impulsivity.
What Causes Bulimia Nervosa?
There is no one cause of anorexia nervosa. We know that anorexia nervosa develops through a variety of means. Genetics, personality, co-occurring psychiatric disorders and sociocultural environment can all contribute to the development of an eating disorder.
Genetics
Family history of eating disorders
Twin, family and adoption studies have yielded strong evidence that anorexia nervosa and other eating disorders run in families. Relatives of individuals with bulimia nervosa are up to 9 times more likely to develop the illness.
Molecular genetics
There is no one bulimia gene, and many experts believe there are multiple genes, possibly hundreds, that influence the development of bulimia nervosa. Linkage studies, genome-wide association studies and candidate gene association studies have increased our understanding of the role of genetics in eating disorders.
Personality Traits
Perfectionism
Many studies have demonstrated that patients with bulimia nervosa self-report higher levels of perfectionism and score higher on perfectionism scales, expressing excessive concerns about their mistakes and doubts on the quality of their actions.
Negative urgency
Individuals with bulimia nervosa report significantly higher rates of negative urgency (the tendency to behave impulsively when experiencing strong negative emotions). Individuals may binge to cope with feelings of anxiety, depression or loneliness and subsequently purge to cope with any guilt, disappointment, anger or anxiety they feel after bingeing.
Sensation seeking
Individuals with bulimia score higher in sensation seeking than other diagnoses. This may lead to high-risk behavior or manifest within their eating disorders as a disregard for the risks of over-exercise, malnutrition or purging.
Sociocultural Environment
The thin ideal
Cultural pressures to achieve the thin ideal are linked to increased weight concerns and body dissatisfaction, which may contribute to the development of bulimia nervosa. Pervasive diet talk and edited images on social media can reinforce the thin idea and weight stigma, exacerbating disordered eating.
High-risk social environments
High risk social environments can also increase the likelihood of developing bulimia nervosa. Working in an appearance-driven field like acting or modeling and participation in weight-dependent or aesthetic sports can contribute to the development of bulimia nervosa.
Traumatic experiences
Trauma and adverse childhood experiences can also contribute to the development of an eating disorder. PTSD and eating disorders, especially bulimia nervosa, commonly co-occur.
Bulimia Nervosa in Men & Boys
Bulimia nervosa is often associated with young girls, however eating disorders can impact anyone of any gender or gender presentation. Eating disorders in men often go undiagnosed, even though 25-50% of those with eating disorders are men and boys.
Bulimia Nervosa Treatment
At ACUTE, we believe sustained recovery from bulimia nervosa is possible. Lasting recovery is always the goal, and for some the first steps are medical stabilization and nutritional rehabilitation.
We support patients in their eating disorder recovery by helping them achieve medical stabilization, nutritional rehabilitation and a restored weight. Once patients reach these milestones, they can continue their journey and embrace recovery at lower levels of care.
To achieve these goals, we support patients with:
- World leading medical expertise in the medical treatment of eating disorders
- Evidence-based multidisciplinary care across internal medicine, dietetics, nursing, behavioral health, physical therapy, occupational therapy and speech therapy
- Around-the-clock 1:1 nursing supervision
- Blood chemistry, vitals monitoring and treatments for other medical and/or surgical comorbidities
- Air ambulance transfer when necessary
How is inpatient medical hospitalization different?
ACUTE offers the highest level of eating disorder care. Medical hospitalization is delivered in a hospital setting and is primarily focused on treating severe medical complications, although other forms of support are available to supplement recovery. Patients at an inpatient medical hospitalization level require interventions that aren’t available at lower levels of care, including:
- Monitoring of vitals
- Intravenous fluids
- Daily lab monitoring
- Certain types of medication management
Who does ACUTE treat?
ACUTE accepts patients who are too medically complex for lower levels of care.
- 15+ years of age
- All gender expressions
- <70% of ideal body weight (IBW)
- BMI <14.5
- Severe medical complications associated with bulimia nervosa
Get connected to care
Our admissions specialist can help assess your needs and determine the appropriate level of care.
Even if ACUTE isn’t right for you, our experienced admissions team can connect you with other programs that meet your needs.
Living a life recovering from bulimia nervosa
I can sit with myself without feeling a compulsive need to change the way I’m feeling through self-destructive behaviors. I am so grateful for everyone at ACUTE. Simply put, ACUTE saved my life before I was able to fight for it myself, and for that I am forever grateful.Stephanie