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Eating Disorders Explained: Bulimia

Someone with an eating disorder could be sitting next to you right now. You might think you can spot them. It’s obvious because they’re incredibly thin, right? Wrong.

Some eating disorders occur right under your nose, unless you know what to look for. Bulimia nervosa is one of them. Over the past few decades, bulimia has become more widely talked about, even popularized by those who don’t understand the dangers. But those who have it are good at hiding it, and weight loss isn’t an identifying trait.

We talked to OhioHealth sports medicine dietitian Dawn Holmes, MS, RD, CSSD, and primary care and sports medicine physician Marguerite Weston, MD, to gain a better understanding of this deadly eating disorder, so you can spot the signs and learn how to overcome it.

What is bulimia?

Bulimia is an eating disorder characterized by binge eating (consuming more than the average person would) in response to emotional triggers, like stress, sadness or anger, followed by a compensatory period of purging, either through exercise, fasting, vomiting, diuretics or laxatives.

People with bulimia have less of a problem with food than they do aspects of their life they feel are out of their control. This might be their weight, but it isn’t always. Binging gives them something to focus on other than their emotions, and purging to prevent weight gain gives them a sense of control over their life.

Bulimia is not the same as a binge eating disorder, which does not include the act of purging.

What are the warning signs and symptoms of bulimia?

Unlike those with anorexia, people with bulimia usually maintain a normal body weight or may gain weight over time, so even if they have unusual eating habits, family and friends may overlook it.

Signs to watch for include:

  • Chronic dieting.
  • Poor body image.
  • Eating large amounts of food in a short period of time.
  • Going to the bathroom immediately after a meal.
  • Smelling of vomit, or using excessive amounts of gum, mints or mouthwash to cover the smell.
  • Uncomfortable eating around others.
  • Skipping meals and eating one large meal per day.
  • Calluses on the backs of hands or scrapes on knuckles (caused by inducing vomiting).
  • Stained teeth and cavities (caused by enamel erosion from vomiting).
  • Weight fluctuation.
  • Many food wrappers in unexpected places.
  • Broken blood vessels in the eyes.
  • Excessive exercising.
  • Stealing or hoarding food.
  • Dehydration.
  • Swollen, puffy cheeks or jaw.
  • Low blood sugar, especially in young women with Type 1 diabetes.
  • Feelings of anxiety, depression, hopelessness or extreme mood swings.
  • Impulsive, risky behavior, such as shoplifting or sexual promiscuity.
  • Self-injury, such as cutting or substance abuse.

Anyone can develop bulimia. It does not discriminate by age, race, gender or socioeconomic status. Bulimia affects about 1.5% of females and .5% of males, and while it is more common during late adolescence and the early 20s, it is becoming more prevalent among older adults.

How does bulimia affect the body?

Bulimia can become a very self-destructive disorder that controls your life. It’s an endless cycle of malnourishment, overeating and purging. Over time, your body becomes your enemy as the disorder takes its toll on your organs.

Your hair will turn hair brittle and fine. You may have acid reflux, bloating, heartburn, constipation or other gastrointestinal problems. And dehydration can make you weak, dizzy and lightheaded.

Frequent vomiting will make your voice hoarse and your throat sore, and puts you at risk of tears and bleeding in your esophagus. It also irreparably damages your teeth in as little as six months, causing yellowing, chipping and sensitivity to hot and cold temperatures. Eventually, you may even not be able to eat small amounts of food without reflexively vomiting.

Diuretics, laxatives and vomiting all cause a loss of sodium and electrolyte imbalances, which help regulate your heart rate and impact major organ functions. This increases your risk of severe chest pain, arrhythmias, fast heart rates, congestive heart failure and sudden cardiac death.

These physical effects make bulimia one of the deadliest eating disorders, along with anorexia. But bulimia is also a disorder of the mind. If the behaviors continue long enough, the original logic for doing them becomes masked by guilt, shame or the physical side effects, leaving the individual feeling hopeless and seeking a way out. For this reason, bulimia has a high suicide rate of 3.9%. 

How is bulimia diagnosed?

If you suspect bulimia, start by asking the questions on the SCOFF Questionnaire, which is used in the evaluation of all eating disorders. If the answer to one or more questions is yes, seek help from a psychologist.

A medical diagnosis is made when a person has been bingeing and purging at least once a week for three months or more.

How do you treat bulimia?

As with all eating disorders, the longer symptoms persist, the harder the disorder is to treat. Early intervention with a multidisciplinary care team is critical to a successful recovery.

Find a physician who is knowledgeable about eating disorders. Your physician will monitor your electrolyte levels, weight and cardiac function, so if things are disturbed or out of balance they can intervene with appropriate treatment.

A dietitian will help you develop a structured meal plan that gives you a greater sense of control over your day, while still providing adequate nutrition.

Your psychologist will explore the underlying causes of your poor body image and feeling of loss of control, and will share coping techniques to address emotional triggers in healthy ways.

If you are unable to change your behaviors through outpatient treatment, inpatient treatment at a facility that specializes in caring for people with eating disorders may be necessary. This type of care will give you the intensive guidance you need to get back on track and transition back to outpatient care with your regular providers.

Overcoming any eating disorder is challenging, and relapses are not uncommon. But with proper treatment and nutrition, patients with bulimia can recover and live a healthy life.

If you or someone you know needs help with an eating disorder, seek medical care from a physician quickly. You can find primary care physicians and psychologists at OhioHealth.com.