Bulimia nervosa (often shortened to “bulimia”) is a serious medical and psychological illness related to eating. People with it have the frequent urge to eat large quantities of food (binge), and then often use self-induced vomiting and/or abuse of laxatives, enemas, suppositories, or diuretics to get rid of the food (purge). Some individuals with bulimia do not purge, but try to burn off calories after binging by fasting (going long periods without eating) or exercising intensely. People with bulimia are afraid of becoming fat, but they often also realize that their behavior is not normal, so they may actually have normal weight or even can be overweight.
Although this problem has existed since at least the 17th century, people are more aware of it in recent years, especially in cultures where being thin is considered attractive. Bulimia usually begins in middle or late adolescence and is much more common than anorexia. Most of those affected with bulimia are adolescent girls or young women, but adolescent boys and young men can also develop it. Most males with bulimia do not purge.
The cause of bulimia nervosa is not known. Eating disorders tend to run in families and are likely related to a combination of biological, psychological and social factors. Some examples include peer and societal pressure to be thin, fear of becoming an adult, family conflicts, depression, and obsessive-compulsive tendencies.
It is common for teens to worry about their weight and appearance, but this does not mean that they have an eating disorder. Those with an eating disorder such as bulimia usually have taken these worries to an extreme. Parents and friends may notice some of the following behaviors:
- Binging on huge quantities of high-calorie foods
- Occasional bursts of severe dieting or intense exercise
- Self-induced vomiting, sometimes covered up by running water while spending long periods in the bathroom
- Widely varying body weight
- Swollen hands, feet or joints
- Acting secretive
- Difficulty concentrating, making decisions or thinking
- Depression or social withdrawal
- Fainting, dizziness, lack of energy
- Feeling cold when others feel warm
The diagnosis of bulimia is made by a health professional, typically either your teen’s pediatrician or a psychiatrist. In addition to the above behaviors, which have been noticed by parents and friends, the specific medical and psychological criteria include:
- Repeated episodes of binge eating, at least twice a week for three months
- Repeated purging behaviors, such as self-induced vomiting, or misuse of laxatives, diuretics, suppositories or enemas
- Distorted body image, feeling fat despite being of normal weight
- Lack of control during binge eating episodes
Some of the physical signs of bulimia include low blood pressure, slow heart rate, low body temperature, dry skin, enlarged salivary glands, swollen joints, constipation, sore throat and dental problems. Blood tests also may be ordered to look for some of the complications of repeated binging and purging, such as dehydration and anemia (low iron). Other medical complications of bulimia may include inflammation or tearing of the esophagus and heart problems.
If you suspect your adolescent may have an eating disorder, please seek medical help immediately. Severe weight loss or starvation is a medical emergency, so early treatment is important. Bulimia nervosa is usually treated by a combination of psychotherapy, medication and nutrition counseling. In some cases, teens need to be hospitalized, either to address any problematic behaviors that cannot be handled well as an outpatient or to treat medical complications.