Bulimia Nervosa Basics

Bulimia is characterized by out-of-control eating offset by purging, fasting or extreme exercise designed to maintain weight. This guide to bulimia explores how the disorder is recognized, diagnosed and treated.

Bulimia: What Is It?

Bulimia nervosa is an eating disorder characterized by out-of-control eating offset by fasting, extreme exercise, or purging—voiding food by self-induced vomiting or other means. Children with bulimia, unlike those with anorexia, often maintain healthy weight—they can even be overweight—but the way they go about it is anything but healthy. Like anorexia, the vast majority of those diagnosed with bulimia are female, though actual prevalence in males is unknown. There is evidence that societal norms of appearance propagated through the media—the “beauty ideal”—could contribute to the prevalence of bulimia, which typically manifests in late adolescence or early adulthood.

Bulimia: What to Look For

A child with bulimia nervosa may well seem a healthy weight for her age, and appear to eat normally—bulimia is much harder to detect than anorexia, and secretiveness is a key facet of the disorder. But there are signs to look for. She may be dehydrated, and experience acid reflux from frequent vomiting, along with sore throats, swollen glands, and the deterioration of teeth due to contact with stomach acids. Sudden absences from the dinner table or routine trips to the bathroom right after eating are key signs. An unrealistic body image is also a possible sign of bulimia, as with anorexia. Bulimics often prefer to binge and purge in private.

Bulimia: Risk Factors

Children with weight concerns, low self-esteem, and depressive or anxious temperaments are more likely to develop bulimia, as are children who have been sexually or physically abused. Childhood obesity and early pubertal maturation also put children at risk. The disorder is more common among children with a family history of bulimia, and is much more common in girls.

Bulimia: Diagnosis

The key to diagnosing bulimia nervosa is whether a child is a binge eater, meaning that she consumes much more in a given period than average, and has a “sense of lack of control” during the binge episode, which is often described as a sort of “out-of-body” experience. The diagnosis also requires that she compensate for the binge episode inappropriately—self-induced vomiting, off-label use of laxatives or diuretics, fasting, or excessive exercise—and her self-image be dominated by her body weight and appearance. The biinging and compensating behavior must occur on average once a week for 3 months.

Bulimia: Treatment

Psychotherapeutic: Behavioral management is the first-line treatment for bulimia—professionals will address the dangerous and worrying purging behavior and ensure that a patient is healthy before moving on to more long-lasting interventions.

Cognitive behavioral therapy is employed to alter body image and eating habits by teaching patients how their thoughts turn into unwanted, even disturbing feelings and actions. CBT is effective in 50 to 60% of those treated. Interpersonal therapy, which focuses on how the child’s relationships with others impact her feelings and actions, is also employed.

Pharmacological: If behavioral therapy does not yield the desired results, antidepressant medications—particularly selective serotonin reuptake inhibitors or SSRIs—can have positive results.

In addition, nutrition education may be necessary to convince someone with bulimia of the disastrous effects of her disorder, and may help her amend her behavior.

Bulimia: Other Concerns

Like anorexia, the unhealthy behaviors associated with bulimia can lead to severe medical problems and even death. Associated conditions include irregular heartbeat and heart failure, tooth decay, and severe digestive problems. Individuals with bulimia are also more likely than most to become dependent on alcohol and drugs, including those that they may use to purge.

Bulimia: Risk For Other Disorders

Children with bulimia are also at increased risk for other psychiatric disorders, primarily depression, obsessive compulsive disorder, and substance use disorder.