Bulimia Nervosa Symptoms and Effective Treatments
Written by ‘Ai Pono Hawaii Staff Writer
Bulimia nervosa (usually shortened to bulimia) is a serious and possibly life-threatening type of eating disorder. People who suffer from bulimia usually consume huge amounts of food (or binge) even when they’re not hungry—and usually in secret—with no control over their eating behavior, and then purge in order to unload those additional calories and avoid gaining weight. They typically feel ashamed, guilty, and disgusted while binging, and then comforted after purging.
Purging behaviors come in a variety of forms: some people induce vomiting, while others misuse weight loss supplements, laxatives (medications that quicken the passing of food through one’s body), enemas (fluids that stimulate the emptying of one’s bowel), or diuretics (also called water pills, which help the body remove salt/sodium and water). In addition, some people with bulimia perform strict dieting, fasting, or extreme exercise.
Foods consumed during binges are usually what people consider ‘comfort foods’: sweet, salty, smooth, soft, and often high in calories. People suffering from bulimia may have binging episodes several times a week or as often as multiple times every day.
Common Characteristics of People Struggling with Bulimia
People who are suffering from bulimia are often preoccupied with the shape of their body as well as their weight. They also usually view themselves negatively and focus excessively on what they consider as their imperfections.
Bulimia usually develops during one’s late childhood or early adulthood years—usually from age 15 to 20. However, anyone of any age can develop bulimia.
This eating disorder affects people of all genders, ages, ethnicities, and body types. In fact, between 1 to 2 percent of the general population will suffer from bulimia in any year. However, it affects more people who were assigned female at birth (around 85 to 90 percent) compared to people who were assigned male at birth.
There are two types of bulimia nervosa:
Purging bulimia — Patients with this type self-induce vomiting after they binge. They may also use laxatives, diuretics, suppositories, or enemas to rapidly clear out the foods that they ate.
Non-purging bulimia — Instead of engaging in purging behaviors, patients with this type either go on long fasting periods or exercise much more than is needed in an effort to burn off the calories that they consumed.
Some people suffer from bulimia for only a short period of time (such as when they’re facing stressful events). Meanwhile, other people may struggle with this eating disorder for many years or even decades until they seek treatment.
Differences Between Bulimia and Other Eating Disorders
Bulimia may appear similar to another common eating disorder, which is anorexia nervosa (or simply anorexia), since people with bulimia may also limit their food intake (the hallmark of anorexia) and people with anorexia may also binge and purge. However, there are differences between the two. People with bulimia go through cycles of binging and purging and may not be considered underweight. On the other hand, those suffering from anorexia are usually underweight. Both diagnoses tend to involve an element of body image dissatisfaction or even body dysmorphia.
Bulimia may also be compared to binge eating disorder (BED). However, the main difference between these two eating disorders is that people who are suffering from BED have binging episodes but don’t engage in compensatory behaviors like vomiting or overexercising, unlike people with bulimia.
Signs and Symptoms of Bulimia Nervosa
There are a number of signs and symptoms that a person struggling with bulimia may exhibit.
Common physical symptoms of bulimia:
Weight fluctuations
Bloodshot eyes
Sore throat
Swollen face, cheeks, jaw, and neck (from enlarged glands)
Muscle fatigue and cramps
Dental issues, such as bad breath, inflamed gums, tooth decay or cavities, severe gum disease, teeth sensitivity to hot or cold food or drinks, or discolored teeth (due to constant exposure to stomach acid)
Gastrointestinal issues, including heartburn, new food intolerances, frequent constipation, bloating, indigestion, gastroparesis, diarrhea, stomach ulcers, and ruptures of the esophagus or stomach
Changes in bowel habits
Heart problems—from irregular heartbeats and low blood pressure, to even heart failure or heart attack
Dizziness and fainting
Fatigue and sleep problems
Irregular or absent periods (in menstruating females)
Decrease in sex drive
Dry skin
Dry and brittle nails
Scars, sores, or calluses on their hands or knuckles (from making themselves vomit)
Swollen hands and feet
Often feeling cold
Common psychological symptoms of bulimia:
Feelings of guilt, shame, and disgust, particularly after binging and/or purging
Obsession or preoccupation with food, body image, dieting, or exercise
Irritability during mealtimes
Distorted view of one’s body or extreme dissatisfaction with one’s figure
Low self-esteem
Irrational fear of gaining weight
Hypersensitivity to other people’s feedback about one’s diet, body shape, or exercise habits
Anxiety
Depression
Common behavioral symptoms of bulimia:
Uncontrollable and excessive eating—usually within 2 hours, which is followed by purging (According to The National Institutes of Health, a patient has bulimia if he or she does this at least twice every week for 3 months.)
Periods or restrictive eating including skipping meals, eating only small portions, fasting, counting calories, and avoiding specific food items
Performing rituals around food, such as chewing more often than is needed, or preventing foods from touching each other
Using laxatives, diuretics, enemas, appetite suppressants, herbal products, dietary supplements, etc. to avoid gaining weight or to lower one’s current weight
Preferring to eat by themselves or in secret
Withdrawing from other people or avoiding social situations
Frequently going to the bathroom during or immediately after meals, or for extended periods of time
Consuming large amounts of water and other calorie-free drinks
Frequently using gum, mints, or mouthwash
Spending a lot of money on food
Hoarding or even stealing food
Excessive or compulsive exercising
Misusing or abusing substances (such as alcohol or drugs)
Avoiding other activities that one previously enjoyed
Displaying mood swings
Having relationship and other social problems
The severity of a person’s bulimia depends on the number of times per week that the person engages in compensatory behaviors.
Risks and Possible Complications of Bulimia Nervosa
Besides the signs and symptoms listed above, bulimia can also lead to a number of severe and even life-threatening complications. One of these is dehydration, which can result in health complications like kidney failure, heart problems, or seizures.
All in all, bulimia is proven to be linked to an increase in death from all causes. People with bulimia may also have suicidal thoughts and even attempt suicide. This is why it’s crucial to seek help as early as possible to prevent potential complications.
Treatment Objectives for Bulimia Recovery
If you or a loved one has an unhealthy amount of attention to weight and body shape and/or seems excessively concerned with food, it’s best to seek treatment as soon as possible. The sooner treatment begins, the better the chances for a successful recovery from bulimia.
Throughout the recovery process, the patient’s treatment team will actively collaborate with the patient and one another in designing and accomplishing a number of objectives that will serve as the foundation for sustainable recovery.
Three essential goals for patients who are receiving treatment for bulimia are the discontinuation of binge/purge behaviors, development of effective emotional coping strategies, and exposure work:
1. Improve One’s Overall Relationship With Food
It may be challenging, but ending the vicious cycle of binging and purging is definitely achievable. This can be successfully accomplished using a number of interventions, such as developing regular eating patterns, receiving psychoeducation about this eating disorder, and getting support in a caring and therapeutic environment throughout the process of adopting healthier eating behaviors.
2. Develop Better Coping Skills for Managing Emotions
For the vast majority of patients who are struggling with bulimia, their disordered eating behavior is an unhealthy means of coping with distressing thoughts and emotions. Therefore, having a kit of coping skills can be very beneficial in helping patients regulate their emotions and, as a result, choose healthier ways of soothing themselves in challenging times.
3. Regain Trust on Oneself and One’s Intuition
Last but not the least, exposure work focuses on helping patients learn how to deal with a variety of demanding situations related to food, body image, social scenarios, exercise, and others. Therapists assist patients with bulimia in taking small yet helpful actions that will enhance their confidence and improve their mastery, without resorting to dysfunctional behaviors in the form of binging and purging.
Standard Treatment Options for Bulimia Nervosa
People with bulimia can benefit from multiple types of treatment. At present, the combination of psychotherapy and antidepressants is regarded as the most effective treatment for this eating disorder.
Similar to most eating disorders, treatment for bulimia requires a team approach—active collaboration among the patient, his or her family, and the treatment team. After bulimia is diagnosed, a team of healthcare professionals who are experienced in treating bulimia will be created, which usually includes a psychiatrist, a psychologist, dietitian, family therapist, and a social worker.
Comprehensive blood tests are normally performed first in order to check the patient’s general health and nutritional status before proceeding with the eating disorder treatment program. Treatment for bulimia includes the following:
Psychotherapy
Often referred to as talk therapy or psychological counseling, psychotherapy is at the core of bulimia treatment. It involves the patient talking with a mental health professional about the patient’s eating disorder. Therapy may be in the form of one-on-one, family, or group psychotherapy. In many cases, bulimia can be effectively treated using psychotherapy alone.
The types of psychotherapy that have been shown to help patients who have bulimia include these:
Cognitive behavioral therapy
Commonly abbreviated as CBT, this therapy aims to help patients change their thoughts (the cognitive aspect) and actions (the behavioral aspect). Therapists help patients normalize the latter’s eating behaviors by empowering patients to recognize their irrational and dysfunctional views and behaviors around food, weight, and their body shape.
Through CBT, patients learn how to replace their negative beliefs and actions with positive ones. They also learn healthy eating habits and how to deal with specific triggers that lead them to binging and purging episodes.
Specific types of CBT have been designed for treating eating disorders (CBT-E), and even bulimia nervosa in particular (CBT-BN). Cognitive Behavior Therapy – Guided Self Help (CBT-GSH) is also frequently used for treating bulimia.
Interpersonal psychotherapy
IPT is a form of psychotherapy that tackles problems in a patient’s close relationships. This therapy is based on the belief that one’s interactions with other people impacts the person’s mental and emotional state. Specifically, it focuses on improving patients’ communication and problem-solving skills, which are necessary in managing their symptoms and gradually recovering from bulimia.
IPT focuses on current interpersonal issues instead of past ones, lowering distress, and enhancing social relationships and support. Some research has shown that IPT is as effective as CBT in treating eating disorders, but it may take a longer time to show results (however, its positive outcomes can last as long as CBT).
Nutrition education
Dietitians play an important role in the recovery process from bulimia. Dietitians teach patients ways to recognize their body's cues for hunger and fullness. They also create customized eating plans to help patients in forming healthier eating habits.
Meal plans are designed to satisfy the patient’s hunger and minimize cravings, while ensuring proper nutrition. Patients with bulimia are also instructed to eat at regular times and avoid restricting their food intake. All of these help patients in stabilizing their weight and adopting healthier attitudes and behaviors toward food, which are crucial in healing from this disorder.
Hospitalization (if needed)
While bulimia treatment is usually done outside a hospital setting, hospital treatment may be given for a short period of time to patients who have severe and life-threatening complications. Once they are restored to a stable condition, they are either treated in a recovery center or at home (through an outpatient program).
Alternative Therapies for Bulimia Nervosa
Most alternative therapies used in treating bulimia do not tackle the root causes of this eating disorder, and as such, are not recommended to be used on their own. However, these complementary therapies can help relieve some physical symptoms of bulimia. Acupuncture and biofeedback are two of the popular alternative therapies for this condition.
Body exercises like tai chi, yoga, qigong, and dance (or other movement therapy) can be helpful to people struggling with bulimia in terms of enhancing their body image. Reprogramming mental processes to manage binge-and-purge cycles is another beneficial strategy used in dealing with bulimia. This usually involves either hypnotherapy or EEG biofeedback.
Keep in mind that the inclusion of any alternative or complementary therapy in one’s bulimia treatment program should be advised and regularly monitored by the patient’s treatment team.
Last but not the least, support groups can be very helpful to patients in their recovery journey, in combination with proven treatment modalities. Support groups provide a warm and accepting environment for patients (as well as their families) to share their struggles and inspire one another as they heal from bulimia.
Self-Care Tips for Coping With Bulimia
Besides seeking professional treatment for bulimia, people who are struggling with this eating disorder can benefit from these self-care techniques:
First, it’s crucial to follow your treatment plan. Attend all of your therapy sessions and do your best to follow the meal plan that’s recommended for you.
Work on food variety and flexibility. If you aren't eating enough or you're engaging in compensatory behaviors, there’s a high likelihood that you won’t receive all the nutrients that you need. Bulimia can also effect your bodies ability to absorb nutrients. Consult your healthcare provider and/or dietitian about this.
Keep in touch with your supportive circle of family members and friends. Keep in mind that they want to see you get better from bulimia, especially at times when they have to remind you to stick to your meal plan.
Learn more about bulimia. There’s plenty of information about this eating disorder (as well as others) on the Internet. Knowing more about what you’re going through will empower you to adhere to your treatment plan. Just make sure that you use trusted and credible websites and content written by actual specialists in treating eating disorders.
Take precautions when engaging in exercise. Check with your healthcare provider if exercise is allowed in your case, and if so, which physical activities are recommended for you.
Last but not the least, be kind to yourself. You have the power to refrain from weighing yourself constantly or checking how you look in the mirror regularly. You may fail every once in a while, particularly at the beginning, but as long as your good times exceed your bad ones, you’re going in the right direction.
Receive Effective Treatment for Bulimia and Other Eating Disorders
Bulimia is a serious condition, but it is treatable. People suffering from this eating disorder should seek help as soon as possible to avoid serious complications and other risks that may cause long-lasting effects and regain control of their life.
A serene recovery center located in beautiful Maui, ‘Ai Pono Hawaii takes pride in having over 35 years of experience in providing effective and holistic treatment to patients with bulimia and other types of eating disorders.
Here in ‘Ai Pono, our team of experienced specialists conduct a thorough evaluation of each patient before creating a customized and holistic treatment plan that includes evidence-based treatment modalities.