Self-Image & Self-Harm

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Bulimia Nervosa

Bulimia nervosa involves episodes of eating large amounts of food (bingeing) and purging through compensatory behaviors such as vomiting, excessive exercising, fasting, and laxative abuse.

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Your relationship with food can take over your life, making it difficult to function in social situations and maintain close relationships. Sometimes, bulimia nervosa can exist with other mental health conditions, such as anxiety, depression, and substance abuse. But with treatment, individuals with bulimia can improve their quality of life and foster a healthy relationship with food.

How Common is Bulimia Nervosa?

Eating disorders affect approximately 20 million women and 10 million men in the United States at some point in their lives. Among all mental health conditions, eating disorders have the highest mortality rate—at least one person dies every 62 minutes as the direct result of an eating disorder, according to the National Eating Disorders Association.

In the United States, bulimia has a lifetime prevalence of 1.5% in women and 0.5% in men, meaning that nearly 5 million women and 1.5 million men in the general population are affected by bulimia during their lifetime.

Recognizing the Signs and Symptoms of Bulimia

The symptoms of bulimia include emotional and behavioral symptoms relating to an intense fear of weight gain, a loss of control over food, and an unhealthy preoccupation over body image. Although eating disorders affect everyone differently, some common symptoms of bulimia include:

  • Feeling preoccupied with thoughts about your body shape or bodyweight
  • Living in fear of weight gain or worrying about being fat, even at a normal weight
  • Recurrent episodes of binge eating (eating large amounts of food in a short period)
  • Feeling a lack of control during episodes of binge eating
  • Forcing yourself to vomit (purging) or engaging in excessive exercise to avoid gaining weight after bingeing
  • Using laxatives, diuretics, or enemas to avoid weight gain
  • Fasting, restricting calories, or avoiding certain foods between binge-purge cycles

Some signs that an individual has bulimia include:

  • Leaving at the end of a meal to use the bathroom or using it several times throughout a meal
  • Eating large quantities of food but experiencing weight loss or not gaining weight
  • Calluses or sores on knuckles from self-induced vomiting
  • Swollen neck glands and/or puffy cheeks and face
  • Discovering vomit in unexpected places, such as in the shower
  • Social isolation, withdrawal, and depression

What Causes Bulimia?

The exact cause of bulimia is unknown. Many factors play a role in developing bulimia, including genetics, emotional health, and social expectations. You may be at an increased risk for bulimia if:

  • You have family members with eating disorders
  • You’re in a profession that promotes weight loss and thinness, such as gymnastics
  • You’ve experienced childhood trauma, sexual abuse, or other stressful experiences
  • You’ve faced societal pressure or peer pressure

Like anorexia, bulimia is associated with numerous serious—and even life-threatening—medical complications. According to the American Psychiatric Association, some possible complications include:

  • Low self-esteem and relationship problems 
  • Chronic throat inflammation or irritation
  • Dehydration, low potassium levels, and electrolyte imbalances, which can lead to kidney failure
  • Heart problems, e.g., irregular heartbeat or heart failure
  • Irregular periods in young women
  • Severe tooth decay, gum disease, and other dental problems
  • Digestive problems due to the misuse of laxatives, diuretic abuse, and self-induced vomiting
  • Anxiety, depression, and other mental health conditions
  • Impulsive behaviors, such as substance abuse
  • Self-injury and suicidal thoughts

How is Bulimia Diagnosed?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic criteria for bulimia nervosa are:

  • Recurring binge episodes characterized by eating a significant amount of food in a short period 
  • A sense of lack of control over eating during the binge episode
  • Recurrent compensatory behavior to avoid weight gain
  • Co-occurring binge eating and compensatory behavior
  • Low self-worth due to self-perception of body shape, image, and weight

Treatment Options for Bulimia Nervosa

If you or a loved one shows any bulimic symptoms or disordered eating behaviors, it’s essential to seek medical help as soon as possible. If left untreated, bulimia can take a negative toll on your health.

Depending on the severity of your bulimia, you may need several types of treatment, although combining psychotherapy with antidepressants is often the most effective treatment of bulimia. Treatment typically involves a comprehensive approach that includes you, your family members, your primary care physician, a nutritionist, and a mental health professional.

Some bulimia treatment options and considerations include:

  • Therapy: Psychotherapy allows you to discuss your eating disorder and body image issues with a mental health professional.
  • Nutritional counseling: A nutritionist or registered dietician can design a custom eating plan to help you work toward healthy eating habits, avoid compensatory behaviors, and overcome binge episodes. Eating regularly and not restricting your calorie intake is essential to overcoming bulimia.
  • Medication: In combination with psychotherapy, antidepressants can help reduce the symptoms of bulimia. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), have been approved by the Food and Drug Administration (FDA). SSRIs may help to treat bulimic symptoms, even if you’re not depressed.
  • Hospitalization: If the symptoms of bulimia are severe and pose serious medical complications, you may require hospitalization. Some eating disorder treatment programs offer day treatment, while others provide inpatient hospitalization.

While most people with bulimia successfully recover from their eating disorder, some find that bulimic behaviors don’t disappear entirely. Periods of bingeing and purging may come and go throughout the years during periods of acute stress.

If you’ve had an eating disorder in the past and you’re experiencing symptoms, seek medical help immediately.

Finding the Right Therapist

If you’re concerned a loved one may be struggling with bulimia, urge them to reach out to a mental health professional. If you’re struggling with binge eating, or if you think you may have an eating disorder, seeking help is critical to your well-being.

Some common psychological treatments used in the treatment of bulimia include:

  • Cognitive-behavioral therapy (CBT): CBT can help you normalize your eating patterns and replace unhealthy thoughts and behaviors related to food and body image with healthy, positive ones.
  • Interpersonal psychotherapy (IPT): IPT can help you address challenges in your interpersonal relationships and improve your communication skills.
  • Psychodynamic psychotherapy: Psychodynamic psychotherapy can help you explore past experiences to identify the cause of self-esteem and body image issues, according to a systematic review.

If you’re struggling with bulimia, anorexia, or another eating disorder, reach out to a mental health professional through WithTherapy.

We’ll connect you to a therapist you feel comfortable with, regardless of your personal preferences and requirements. One of the professional therapists on the WithTherapy platform will help you gain a sense of control over food, work toward a healthy relationship with body image, and find healthy ways to cope with stress.

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