Bulimia Nervosa: Types, Signs, Symptoms, Causes, Complications, Diagnosis and Treatment

girl eating with Bulimia Nervosa


Eating disorders are serious and often life-threatening illnesses that cause severe disturbances in an individual’s eating behaviors. Everyone has their eating habits but those who are suffering from eating disorders tend to use their behavior and eating habits to cope with emotional stress. They develop an unrealistic or abnormal fear of calories, food and becoming fat.

Because of this fear, people who have bulimia nervosa opt to restrict their food intake. Bulimia nervosa is a type of eating disorder that is characterized by a cycle of bingeing, accompanied by compensatory behaviors because of guilt. As a result, the person will induce vomiting to undo the effects of binge eating.

Bulimia nervosa is psychological eating disorder wherein a person eats an abnormally large amount of food in a short period, then attempts to prevent gaining weight by trying to vomit what was consumed. There are other types of purging, which includes extreme exercising, excessive use of laxatives and induced vomiting.

Bulimia By The Numbers

Bulimia is more common than anorexia nervosa. However, anorexia may lead to bulimia and in some cases, bulimia may lead to anorexia. How prevalent is bulimia? The lifetime prevalence of bulimia among women is between 1 and 3 percent.

2Major Types Of Bulimia Nervosa

Purging Type

The purging type of bulimia accounts for the majority of those suffering from this eating disorder. In this type, they will perform self-induced vomiting, enemas, abuse of laxatives and diuretics.

Non-purging Type

This type of bulimia nervosa is characterized by the use of other inappropriate methods of compensation for binge bouts like excessive fasting or exercising.

3Signs and Symptoms

The signs and symptoms of bulimia nervosa can range from behavioral to physical signs.

Behavioral Signs

  • Bingeing or eating large amounts of food
  • Purging (vomiting, using laxatives or diuretics, fasting and over exercising after bingeing)
  • Secretive about bulimic episodes
  • Mood swings
  • Feeling tense or anxious
  • Distorted body image
  • Preoccupied with thoughts of food and body shape
  • Feeling a loss of control over eating
  • Feelings of guilt and shame after bingeing
  • Can be associated with low self-esteem, misuse of alcohol, self-harm, and depression

Physical Changes

  • Excessive exercising
  • Induced vomiting
  • Misuse of diuretics or laxatives
  • Disappearing as soon as she finished eating
  • Lethargy and fatigue
  • Feeling bloated
  • Stomach pain
  • Constipation
  • Enlarged salivary glands
  • Amenorrhea ( menstrual periods stop or become irregular)
  • Swelling of the hands and feet
  • Calluses on the back of the hand form as a result of induced vomiting
  • Electrolyte imbalance
  • Regular changes in weight
  • Gastric problems

Warning Signs

 Bulimia is a life-threatening condition if it’s not detected early. You should immediately identify the warning signs of bulimia nervosa which include, an obsessive attitude toward food, frequent visits to the bathroom after eating, he or she will appear flushed and have scarred knuckles or at the back of the hand.

Moreover, people with bulimia have an overcritical attitude toward their shape, body size, and weight. This eating disorder can lead to various physical problems linked to poor nutrient intake, overuse of laxatives and excessive vomiting.


The cause of bulimia nervosa is still unknown, and many scientists are conducting studies on this mental health problem. Many factors can contribute to the development of bulimia – cultural differences, psychological factors, genetics and the environment.

Individuals with symptoms of bulimia may have other emotional and psychological characteristics that contribute to the onset and progression of this eating disorder. These people who are prone to having bulimia may have low self-worth, they struggle with perfectionism and trouble controlling impulsive behaviors.

Here are some of the most common causes or triggers of bulimia:

  • Stressful transitions in life
  • Negative body image
  • History of trauma or abuse
  • Poor self-esteem
  • Professions where you need to be thin and beautiful – like celebrities, models, and ballerinas.


In addition to the signs and symptoms of bulimia, there are significant changes in the health and functioning because of frequent and recurrent binge-and-purge cycles. Bulimia complications are potentially life-threatening. As soon as the disease is detected, immediate medical attention is required.

Bulimic behaviors can lead to electrolyte and chemical imbalances in the body that affect some vital organs. Here are the potential complications of bulimia nervosa:

  • Severe dehydration and electrolyte imbalances
  • Imbalances of sodium, calcium, potassium, and other minerals – may lead to irregular heartbeats, possible heart failure, and death
  • Inflammation of the throat
  • Potential gastric rupture
  • Edema or swelling
  • Tooth decay
  • Acid reflux disorder
  • Infertility, increased risk of miscarriage and other fetal complications
  • Swollen salivary glands
  • Pancreatitis and peptic ulcer
  • Irregular bowel movements and other gastrointestinal problems.

Bulimic patients who are suffering from severe medical conditions as a result of the binge-purge behavior need to stay in the hospital for treatment. Those with cardiac abnormalities and electrolyte imbalances should be treated in the hospital until he or she normalizes.


Aside from the signs and symptoms, the doctor will conduct a further evaluation to land on a diagnosis. A complete physical examination will provide the doctor will cue on the condition. For example, a callus on the back of the hands would mean that the patient has frequently been purging. There are other ways to diagnose bulimia nervosa.

Laboratory Studies

There are laboratory studies that may be utilized to diagnose bulimia:

  • Comprehensive blood chemistry panel – these will include the electrolyte levels in the body to determine imbalances, which are potentially life threatening.
  • Complete blood count
  • Urinalysis
  • Urine toxicology screen
  • Amylase level

Electrocardiography (ECG)

Because one of the complications of bulimia is irregular heartbeats or arrhythmias,  ECG is necessary to detect these potentially fatal conditions. Doctors should routinely perform ECG to patients who are very thin, complaining of palpitations and has other signs and symptoms of cardiovascular disease.

Dual-Energy Radiographic Absorptiometry (DEXA)

Osteoporosis is a concern when dealing with a patient with bulimia. The DEXA will scan the bone density of the patient, especially those who have mood disorders, have irregular menstruations and smokes cigarettes.


The treatment for bulimia involves psychological counseling and medicines if needed. In people with this condition, however, they are not required to stay in the hospital, but they are treated as outpatients. In some cases, they need remain in the hospital, especially if they’re suffering from severe complications.

Psychological Counseling

Two types of counseling are needed in treating bulimia, cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT).

Cognitive-behavioral Therapy (CBT)

In CBT, the patient needs to change negative thoughts she might have for food, body, and weight. The goals of CBT include:

  • To use nutritional counseling to help the patient understand and learn how to eat regular meals per day. Moreover, he or she will learn to avoid eating unhealthy foods.
  • To help the patient reduce the triggers of binge eating
  • To contribute to reducing concern over one’s body weight and shape.

Interpersonal Psychotherapy (IPT)

In IPT, the patient will learn how relationships affect his or her binge-purge bouts. The goals of IPT include:

  • To understand and determine relationships that are related to binge eating and purging.
  • Learn how these emotions that come from these relationships impact bulimic behavior
  • Help correct and modify these relationship patterns, so the bulimic behaviors will be curbed



Some antidepressants like Prozac, the only drug approved by the Food and Drug Administration (FDA) to treat bulimia, may help patients who aside from bulimia, suffers from anxiety and depression. The medicine will also reduce the behavior of bingeing-purging.

Since bulimia is a potentially-fatal condition, keeping an eye on the patient is necessary. This will prevent the relapse of bulimic behaviors that can aggravate the present physical condition of the patient. When the patient continues this practice, it may lead to gross and life-threatening effects.

Getting Help

Various treatment centers aim to help patients suffering from eating disorders. Aid and support groups are also available. In these groups, bulimic patients get to know and talk to others who have the same plight, and they get inspired by the recovery stories.

One of the important factors needed to help the patient recover is to involve the family members in the treatment. Family and emotional support during the recovery phase are necessary to prevent relapse and fasten the patient’s journey to recovery.


Patients suffering from bulimia may have an average onset of 18 years. However, many patients, especially those who meet the diagnostic criteria for bulimia do not seek medical help. Of those who seek treatment, 45 to 75 percent recover completely, 27 percent improve significantly, and 23 percent may have chronic bouts.

The good news is, bulimia is treatable but once a patient is treated, continuous monitoring is essential. The follow-up program of the disease depends on the patient’s response to treatment.

  • Antidepressants, when prescribed, should be taken for at least 6 to 12 months. Having a normal life will help decrease the risk of a relapse. The doctor will taper then stop the medicine, depending on the recovery pace of the patient.
  • Cognitive behavioral therapy patients should visit for 6 to 12 months to prevent relapse