In Physical & Mental Health

Understanding Bulimia and the Different Treatment Options

Bulimia is an eating disorder in which a person periodically binges on food and then either vomits or uses laxatives to purge themselves of the excessive eating. Some individuals who suffer from this disorder may use a combination of both methods to purge themselves. After binging, some people may excessively exercise to burn calories or go several days without eating at all. This type of behavior also qualifies as bulimia. People with this disease often feel out of control concerning how much food they eat.

|SEE ALSO: The Bottom Line on Binge Eating Disorder|

The cycle of binging and purging can take place several times a week. A lot of people who are bulimic also have anorexia nervosa. Since there are a variety of behaviors involved with and methods used by those with bulimia, it may sometimes be difficult to know if an individual is suffering from the disorder. The following information discusses facts, causes, risk factors, symptoms, and treatment options.

Facts about Bulimia

According to this statistics page on, the lifetime prevalence of bulimia nervosa in the United States is 1.5% in women and 0.5% in men. This translates to approximately 4.7 million females and 1.5 million males who will have their lives threatened by this potentially deadly disorder. While bulimia occurs most commonly in the adolescent and young adult years, it has been diagnosed in patients as young as six years old as well as among older adults.

The National Eating Disorders Association (NEDA) states that about 80 percent of those with the disease are females. NEDA goes on to say that binge eating can produce the same sort of health problems in an individual as clinical obesity. This may include high blood pressure, high levels of cholesterol, type two diabetes, and even gall bladder disease.

Causes of Bulimia

Experts are not in complete agreement regarding what causes the disorder but they believe it is a combination of genetic, psychological, and environmental factors. In our article What Is Binge Eating And What Does It Do To Your Child?, we delve deeper into some of the causes of binge eating. Those who have bulimia are more likely to have psychological disorders or suffer from substance abuse. The disease is sometimes thought to start with a person’s lack of satisfaction with his or her body. As a person continues to have a distorted body image, they may then begin to engage in behaviors such as binging and purging.

Being bullied is also thought to be one of the causes and may be related to a person feeling dissatisfied with his or her body. According to Eating Disorder Hope, bullying can contribute to an individual developing an eating disorder. This may be especially true if the bullying is directly related to a person’s weight or body shape. Finally, some experts believe bulimia may have its root cause in the neurotransmitters within the brain. Specifically, bulimia may be related to the neurotransmitter serotonin in a person’s brain.

Who is at Risk?

While anyone can be bulimic, there are certain risk factors and individuals who are more prone to suffer from the disorder. An individual is at greater risk of having this disorder if someone in their immediate biological family has also been bulimic. This could include a parent, brother, or sister. Those who have a family history of substance abuse are also at a higher risk. Certain individual characteristics such as being a perfectionist may also make a person more susceptible to this disease, as well as other eating disorders. This page on explains more about the biological and genetic causes of bulimia.

Some people believe that eating disorders such as bulimia are primarily suffered by female Caucasians in higher socioeconomic groups. However, there are studies that have shown bulimia to occur at higher rates than previously thought among a variety of racial and economic groups. has concluded that eating disorders such as bulimia are perhaps more associated with culture than previously believed. Western culture places a great emphasis on maintaining a thin figure. Other cultures find plump, curvaceous figures more appealing than those that are rail thin. In fact, being heavier is sometimes associated with fertility and economic prosperity.

In the age of the internet, those who are more susceptible to eating disorders may unfortunately find encouragement to continue in their destructive behaviors online. There are actually websites and blogs that give encouragement and advice about how to continue in the eating disorder. Parents and loved ones of those who are suffering from diseases such as bulimia need to be aware of online sites such as these.


Individuals suffering from bulimia are sometimes able to hide the disorder for quite some time. It is often more difficult to tell if someone is bulimic than if the person has anorexia nervosa because those with bulimia usually maintain a normal weight. There are, however, several symptoms that occur when a person is suffering from bulimia. Some of the more obvious symptoms are eating an excessive amount of food in one sitting, vomiting after eating, or an abnormal use of laxatives or enemas. A few other symptoms may include an intense fear of gaining weight, being obsessed with body image, and exercising excessively. Physical signs include having Russell’s Sign, which you can read more about on this page on

There are some signs to look for if a person thinks a loved one is binge eating. A large amount of food might “disappear” in a relatively short amount of time. There may also be wrappers or other food containers hidden in various places around the house or stuffed in the trash in a way so it won’t obviously be noticed. According to this page on Psychology Today a bulimic can sometimes consume over 3,000 calories in approximately an hour. Someone suffering from this disorder may consume up to 20,000 calories in an eight-hour time frame.

Specific signs of purging might include consistently going to the bathroom right after eating. Sometimes a person may keep water running in the bathroom to hide the sounds of throwing up. They may use an excessive amount of mouthwash or perfume to hide the smell of vomit. Besides purging themselves with laxatives or vomiting, those with bulimia may use a sauna to try to sweat out any excess weight. Some outward physical signs from excessive vomiting may include swollen cheeks or broken blood vessels in the eyes.

Side Effects

The medical consequences that often occur due to bulimia can be staggering. Vomiting excessive food on a regular basis can damage the enamel on teeth. Frequent vomiting can also destroy the lining of the esophagus. It can specifically cause inflammation and tearing. A tear in the esophagus can result in death. Those who purge by using laxatives can damage the intestines and can cause bowel movements to become irregular. Constipation may also happen after chronic laxative abuse. Purging on a regular basis can cause the body to be depleted of essential minerals. This can cause a dangerous electrolyte imbalance. This imbalance can eventually cause heart problems, which can lead to heart attacks or death.

A side effect of this disorder that many people may not realize is that individuals who binge and purge on a regular basis often end up gaining weight. Even though the goal is to lose or maintain weight, purging doesn’t rid the body of all the extra calories that have been consumed. The body begins to consume calories the moment food is eaten. Vomiting usually eliminates at most only half of the calories a person has eaten. Using laxatives eliminates even less. People may think they have lost weight after purging because the number on the scale may have gone down. This temporary weight loss usually indicates nothing more than a loss of water.

Getting Help

Like other eating disorders, bulimia is a complicated physical and psychological disease. Knowing how to stop is difficult, but possible. People with bulimia can get better with treatment. It takes a team of medical professionals including doctors, therapists, and nutritionists to help treat a person who has the disorder.

If you think someone you know may be suffering from bulimia, there are certain things you can do, and not do, to help. Simply talking with the individual is often a good place to start. Pick a time and a place where you won’t be interrupted. Tell the person you are concerned but don’t blame or be judgmental. If the person admits to binging and purging on a regular basis, suggest that he or she probably needs professional assistance. If the person gets agitated and doesn’t admit that there is a problem, it’s wise not to push the issue. It’s best to avoid conflicts if possible. Tell the person you will be there to give support or just listen if he or she ever wants to talk.

If you are the one living with bulimia, there are several steps you can take to get on the road to recovery. The first, and perhaps the most difficult, is to admit that you have a problem. If you keep telling yourself that life will be better once you lose a little more weight or finally get control over your eating, you probably have a distorted relationship with food.

After admitting you have a problem, the next step is talking to someone. A trusted friend or relative, someone who will listen and be there for you is an ideal person to go to. An attempt should be made to stay away from places or people who may trigger you to binge and purge. Staying away from other individuals who are struggling with eating disorders and away from websites that encourage destructive behaviors is essential to recovery. Finally, with the support of friends and family, seek out professional treatment so you can learn to eat healthy and develop positive attitudes regarding food.


There are several different types of treatments that can be used when a person is trying to recover from the disease. Two of the treatments that are most often used is cognitive behavior therapy and interpersonal therapy. This page on Mayo also lists dialectical behavior therapy and family-based treatment as two other options that may be used. Dialectical therapy teaches behavioral skills that will enable individuals to better tolerate stress, control their emotions, and better relate to other people. Family treatment would help parents with adolescents living at home. This therapy would teach the parents ways to intervene and help their teen develop better eating habits. It would also help the family develop better personal relationships among each other.

For most people suffering from bulimia, treatment usually does not involve staying for an extended time in a hospital. Although this may sometimes be needed depending on the case. Some individuals who have suffered from the disorder for a long period of time may be suffering from serious health related problems that need medical attention.

Treatment for bulimia can sometimes be broken down into two segments; there is the initial treatment phase, followed by ongoing treatment. In the initial phase, immediate medical needs would be treated first. Treatment for bulimia usually consists of a combination of some sort of psychological counseling and medications. Cognitive behavioral therapy is the most prominent type of therapy used when treating this eating disorder. The goals of this type of therapy are to teach a person how to change behavior and thinking patterns. A person will learn to develop a healthy body image and avoid triggers that may lead to binging and purging. Then, nutritional counseling would define and teach a person the proper way to eat. Often, antidepressants are the types of medications used in conjunction with the counseling. How long a person would receive ongoing treatment would depend on how long the individual has suffered from the disease and how severe it had become.

Recognizing this disorder and helping an individual get the help he or she needs is not always easy. It is crucial for family and loved ones to recognize the symptoms and side effects, and then encourage treatment in a supportive, non-judgmental manner. Those who have suffered from bulimia can recover and go on to live healthy, productive lives.

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