What is bulimia?

Bulimia is a mental health condition and a type of eating disorder typically characterised by a cycle of enforcing strict rules about eating; binge eating (eating large amounts of food in a short space of time without control) after not following these rules; feeling guilty for losing control; purging this food in attempts to lose the calories and then experiencing hunger, causing the cycle to start again.

People with bulimia will often make themselves sick, use laxatives after eating, misuse weight loss supplements, fast or exercise excessively to compensate for binge eating.

Bulimia effects both men and women, of any age, but it is most common amongst younger women, typically starting in teenage years.

What are the symptoms of bulimia?

The symptoms of bulimia include:

• Repeated episodes of binge eating and then purging
• A preoccupation with body weight and image
• Vomiting and/or the use of laxatives or diuretics
• Exhaustion
• Changes in mood, such as feeling anxious or depressed
• Avoiding social activities that involve food
• Bloating and a puffy face including enlarged glands (commonly known as 'chipmunk cheeks')
• Sore throat
• Dental problems

Bulimia can be difficult to identify, as people suffering from this disorder can behave secretively in attempts to hide their symptoms.

In the long term, bulimia can lead to serious and life-threatening complications: 

• Problems with interpersonal relationships and social events
• Dehydration
• Kidney problems
• Heart conditions such as arrhythmia
• Irregular or absent menstrual periods
• Problems with digestion
• Alcohol or drug abuse
• Suicidal thoughts or self-harm
• Bone conditions such as osteoporosis
• Hypertension
• Brittle fingernails
• Tears in the throat
• Anaemia

What causes bulimia?

The causes of bulimia are not black and white and there is no known exact cause. However, medical research indicates that a combination of factors play a role in bulimia’s onset. These factors include a person’s biology, their emotional wellbeing, societal pressures and other environmental factors at play.

Certain risk factors have been identified as increasing susceptibility to bulimia. Such risk factors include:

• Age: onset usually starts in mid to late teens.
• Gender: females are considered more likely to have bulimia.
• Genetics: research has shown that bulimia can run in families and could be hereditary. Being overweight can also increase the risk.
• Emotional and psychological wellbeing: stress, anxiety, poor self-esteem, negative body image and traumatising events have all been linked with contributing to the onset of bulimia.
• Societal pressures: the media and images of slim models and celebrities have been identified as a potential trigger for this eating disorder.

What other conditions can happen at the same time as bulimia?

People with bulimia often have underlying coexisting conditions that need to be addressed as well. In some cases, these conditions can be the causal factor of the eating disorder and in other cases, vice-versa, so it is important for both of them to be treated accordingly.

Other conditions that can occur at the same time as bulimia include: 

• Anxiety
• Depression
• Substance abuse
• Obsessive compulsive disorder
• Panic disorder
• Social phobia
• Stress

How is bulimia diagnosed?

In order to diagnose bulimia, a doctor will usually: 

• Ask about eating habits
• Perform a physical exam
• Order blood and urine tests
• Request an electrocardiogram to identify heart conditions
• Conduct a psychological evaluation

Additional tests may be ordered to make a final diagnosis, rule out other conditions and check for health complications. 

How can bulimia be prevented?

As the cause of bulimia is unknown, knowing how to prevent its onset is also unclear. However, medical professionals recognise that education and awareness are important in helping to prevent susceptibility to this eating disorder.

Encouraging young people to have a positive body image and teaching awareness of how beauty’s portrayal in the media is unrealistic are both ways to help in the prevention of bulimia. Equally important is identifying early indications of bulimia in friends and family and encouraging them to find support or to talk about their problems.

What is the treatment for bulimia?

It is possible to recover from bulimia, but recovery differs for everyone. Treatment plans will usually involve a combination of treatments, consisting of programmes as well as individual, group or family therapy sessions. 

If psychological support has not been effective after a month, cognitive behavioural therapy (CBT) or the use of medication may be offered to help manage bulimia and other underlying conditions. Antidepressants will rarely be prescribed for children or people under 18. CBT will involve a weekly session with a therapist for 20 weeks, learning about the disorder and being able to identify certain triggers, making structured meal plans and finding healthier ways of coping with emotions. 

Treating bulimia often involves a team of people, including the patient, their family, a doctor, a mental health professional and sometimes dieticians who are experienced in treating eating disorders. Most people will be able to follow their treatment at home, only coming to the hospital to have their usual monitoring appointments. 

However, people who are severely underweight, have problems with their heart, are under 18, are very ill, or are at risk of self-harm or suicide may be admitted to hospital to receive urgent medical care.

Successful treatment of bulimia should result in having a patient return to normal eating patterns and having good physical health.  

How does bulimia affect pregnancy?

Many women with bulimia will have irregular menstrual cycles, meaning the ovulation will not happen every month, making it more difficult to get pregnant. 

Some medication used to treat mental health symptoms can pose a risk to the baby if they are taken while pregnant or breastfeeding so it is important for doctors to be notified. However, women with bulimia should not stop taking their medication before talking to their doctor as this could lead to withdrawal symptoms.

During pregnancy, some women may find that their symptoms of bulimia improve while others may find that their eating disorder persists, aggravates or relapses with pregnancy. Abnormalities in electrolytes and a higher risk of heart disease in addition to inconsistent food intakes, can increase the risk of: 

• Preterm birth 
• Placenta previa
• Hypertension
• Diabetes
• Having a low birth-weight baby
• A caesarean delivery
• Miscarriage
• Labour complications
• Having a baby with birth defects
• Postpartum depression

In severe cases, hospitalisation may be needed to help treat a pregnant woman with bulimia, especially if she has severe dehydration, imbalanced electrolytes, cardiovascular conditions or is at a risk of self-harm.

What is the difference between anorexia and bulimia?

Anorexia and bulimia are two of the most common eating disorders. While the signs and symptoms of both conditions can overlap, people with anorexia will severely restrict their calorie intake due to an intense fear of gaining weight, for example by not eating enough food or exercising too much. This can lead to serious illness, because they can start to starve.

People with bulimia are likely to have a low body weight and a distorted body image of their appearance. Thus, in many instances, the behavioural and physical symptoms of anorexia will be more apparent than those of bulimia.

How does bulimia affect the brain?

Bulimia disrupts healthy nutrition intake, causing the brain to be depleted of the nutrients it needs to function properly. 

Although studies are limited, research has found out that eating disorders negatively affect the nervous system, causing: 

• Imbalanced levels of neurotransmitters, especiallly serotonin
• Structural changes in parts of the brain
• A reduction in brain size
• Difficulties switching between tasks, prioritising and thinking
• A negative effect on the emotional areas of the brain

Can bulimia cause cancer?

Repeated vomiting exposes the fragile cells of the oseophagus to large quantities of stomach acid, which irritates the oseophagul walls. 

Some studies have found out that, eventually, the continued irritation can lead to Barrett's oseophagus, a condition that increases the risk for the abnormal growth of cells and cancerous tumours on and around the oesophagus. If a patient has Barrett's oesophagus, they may be asymptomatic or their symptoms may be similar to those of gastroesophageal reflux disease, another disorder. 

The abuse of laxatives can also lead to several complications such as irritable bowel syndrome. Long-term abuse of laxatives contributes to the risk of colon cancer.