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Bulimia nervosa, commonly referred to as bulimia, is a serious and potentially fatal eating disorder. People with bulimia may secretly binge, which means that they eat large amounts of food and lose control of their eating, and then vomit, in an attempt to get rid of the extra calories in an unhealthy way.

To get rid of calories and avoid weight gain, people with bulimia can use different methods. For example, they may regularly induce vomiting or inappropriately use laxatives, weight-loss supplements, diuretics, or enemas after the binge. Or they may use other ways to get rid of calories and avoid weight gain, such as fasting, strict dieting, or excessive exercise.

If you have bulimia, you are probably concerned about your body weight and shape. You may judge yourself harshly and severely for the perceived defects you have. Because bulimia is related to self-image, and not simply to food, it can be difficult to overcome. But effective treatment can help you feel better about yourself, adopt healthier eating patterns, and reverse serious complications.

Symptoms

The signs and symptoms of bulimia may include the following:

• Worrying about body shape and weight
• Living in fear of gaining weight
• Repeat episodes of eating excessive amounts of food at one time
• Feeling a loss of control during the binge, like you can't stop eating or can't control what you eat
• Force vomiting or over-exercising to keep from gaining weight after a binge
• Use laxatives, diuretics, or enemas after meals when not needed
• Fasting, restricting calories, or avoiding certain foods between binges
• Using dietary supplements or excess herbal products for weight loss

The severity of bulimia is determined by the number of times a week you purge, usually at least once a week for at least three months.

When you should consult a doctor

If you have symptoms of bulimia, seek medical attention as soon as possible. When left untreated, bulimia can have serious health effects.

Talk to your primary care provider or mental health professional about the feelings and symptoms of bulimia. If you don't want to seek treatment, talk to someone about what is happening to you. This may be a friend, a loved one, a teacher, a religious leader, or someone you trust. They will be able to help you take the first steps to successful treatment for bulimia.

Helping a loved one with bulimia symptoms

If you think a loved one has symptoms of bulimia, talk to them openly and honestly about what's bothering you. You can't force them to seek professional care, but you can encourage and support them. You can also help them find a trained doctor or mental health professional, ask for a consultation, and even go with them.

Since many people with bulimia are normal weight or slightly overweight, it may not be obvious to others that there is a problem. Warning signs that friends and family members may notice include the following:

• The constant worry or complaints about being fat
• Distorted and excessively negative body perception
• Repetitive consumption of large amounts of food at one time, especially foods that the person usually avoids
• Adopting strict diets or fasting after overeating
• Refusal to eat in public or in front of others
• Visits to the bathroom just after eating, during meals, or for long periods
• Excess exercise
• The presence of sores, scars, or calluses on the knuckles or hands
• Damage to teeth and gums
• The change in weight
• Swelling of the hands and feet
• Swelling of the face and cheeks due to glandular enlargement

Causes

The exact cause of bulimia is unknown. Many factors can influence the development of eating disorders, including genetics, biology, emotional health, social expectations, and more.

Risk Factors

Girls and women are more likely to have bulimia than boys and men. Bulimia usually begins during late adolescence and early adulthood.

Factors that may increase the risk of bulimia include the following:

Biology. People with first-degree relatives (siblings, parents, or children) with an eating disorder may be more likely to develop an eating disorder, indicating a possible genetic link. Being overweight during childhood or adolescence may increase the risk.

Psychological and emotional problems. Psychological and emotional problems, such as depression, anxiety disorders, or substance use are closely linked to eating disorders. People with bulimia may have negative feelings about themselves. In some cases, traumatic events and environmental stress may be contributing factors to the illness.

Diet. People who follow diets have a higher risk of developing eating disorders. Many people with bulimia severely restrict calories between binging episodes, which can trigger a need to binge again and then purge. Other triggers for binge eating include stress, poor body image, food, and boredom.

Complications

Bulimia can cause numerous serious and even life-threatening complications. Possible complications include the following:

• Negative self-esteem and problems with relationships and social functioning
• Dehydration, which can lead to major medical problems, such as kidney failure
• Heart problems, such as irregular heartbeat or heart failure
• Severe dental caries and gum disease
• Absent or irregular periods in women
• Digestive problems
• Anxiety, depression, personality disorder, or bipolar disorder
• Alcohol or drug abuse
• Self-injury, suicidal thoughts, or suicide

Prevention

Although there is no sure way to prevent bulimia, you can guide the person to healthy behavior or seek professional treatment before the situation gets worse. How you can help:

• Promotes and reinforces a healthy body image for your children, regardless of size or shape Help them build confidence in ways that are not related to appearance.
• Enjoy family meals on a regular basis.
• Do not talk about weight in the home. Instead, focus on having a healthy lifestyle.
• It discourages dieting, especially when it involves unhealthy weight control behaviors such as fasting, taking supplements or laxatives to lose weight or self-induced vomiting.
• Talk to your primary care provider. This professional will be able to identify the early signs of an eating disorder and help prevent its development.
• If you notice that a family member or friend has problems with food that might cause or indicate an eating disorder, try talking to them about these problems and asking them how you can help. 

Lifestyle and home remedies

In addition to professional treatment, follow these personal care tips:

• Follow your treatment plan. Don't skip therapy sessions and try not to deviate from meal plans, even if they cause you discomfort.
• Learn about bulimia. Education about your illness can give you the strength and motivation to follow your treatment plan.
• Receive proper nutrition. If you're not eating right or purging often, your body probably won't get all the nutrients it needs. Talk to your primary care physician or nutritionist about appropriate vitamin and mineral supplements. However, it is generally recommended that you get most of your vitamins and minerals from food.
• Keep in touch. Don't isolate yourself from your loving family members and friends who want to see you healthy. Understand that they have your best interests at heart and that rich, loving relationships are healthy for you.
• Be good to yourself. Resist the urge to weigh yourself and look in the mirror often. All you can do is encourage the desire to maintain bad habits.
• Be careful with exercise. Talk to your primary care doctor about what kind of physical activity, if any, is right for you, especially if you exercise excessively to burn calories after binges.

Alternative Medicine

People who have eating disorders may abuse dietary supplements and herbal products designed to decrease appetite or aid in weight loss. Weight loss supplements or herbs can have serious side effects and interact dangerously with other medications.

Weight loss supplements and other dietary supplements do not need Food and Drug Administration (FDA) approval to be marketed. Remember that natural does not always mean safe. If you choose dietary supplements or herbs, discuss the potential risks with your primary care provider.