What are the Signs and Symptoms of Bulimia?

Women with symptoms of bulimia (bulimia nervosa) will demonstrate signs of preoccupation with weight and body shape. As with women suffering from other eating disorders, bulimics often judge themselves severely and harshly for perceived flaws, and feel a strong sense of guilt or shame related to their relationship with food.

Because many women with bulimia are of normal weight or even slightly overweight, their eating behaviors may go unrecognized or minimized, instead of being accurately identified as symptoms of a serious medical problem. A person suffering from bulimia engages in episodes of bingeing and purging. She will eat a large amount of food and then try to rid herself of the extra calories by vomiting, abusing laxatives or diuretics, periods of starving, or excessively exercising to avoid weight gain. The woman with bulimia may eat until she's painfully full, and then engage in some method of purging. Some bulimics feel a need to purge after eating only a small snack or a normal-size meal.

Despite a bulimic's efforts to conceal the symptoms of an eating disorder, certain emotional and behavioral signs of bulimia may become visible to loved ones:

• constant dieting
• feeling that eating behavior can't be controlled
• eating until the point of discomfort or pain
• eating much more food in a binge episode than in a normal meal or snack
• exercising for hours on end
• overuse of laxatives, diuretics or enemas
• preoccupation body shape and weight
• having a distorted, excessively negative body image
• going to the bathroom after eating or during meals
• hoarding food
• depression
• anxiety
• social isolation

As her disease progresses, a woman will likely experience one or more physical symptoms of bulimia nervosa, such as:

• abnormal bowel functioning
• damaged teeth and gums
• swollen salivary glands in the cheeks (chipmunk cheeks)
• sores in the throat and mouth
• bloating
• dehydration
• fainting
• seizure
• fatigue
• dry skin
• irregular heartbeat
• sores, scars or calluses on the knuckles or hands
• menstrual irregularities or loss of menstruation (amenorrhea) The line between the two types of bulimia nervosa often blurs or overlaps, and in either type, signs and symptoms are similar. Bulimia is categorized in two ways:
• Purging bulimia involves self-induced vomiting or the misuse of laxatives, diuretics or enemas to compensate for binges.
• A person with non-purging bulimia will make use of other methods to prevent weight gain, such as fasting or over-exercising, which is sometimes called exercise bulimia.

What are the Effects of Bulimia Nervosa?

Bulimia is a potentially life-threatening disease that requires medical attention from an experienced eating disorder treatment professional.

A person with bulimia nervosa may feel trapped in an addictive relationship with food. It's common for her to feel as if she is living in a world of secrecy and shame, where food is at times her only comfort. Binges often occur in private. She may raid the cupboards when home alone, for instance. Or she may make the rounds of several fast-food restaurants during one bingeing episode, secretly eating in her car between stops. Her bulimia may compel her to eat an entire cake, rather than just a slice or two. Afterwards, she is overcome by feelings of self-disgust.

Bulimia nervosa is intimately related to self-image, and not just about food. Because of the complex feelings a woman develops about her relationship with food, bulimia can be one of the most difficult eating disorders to overcome. The health effects of bulimia are serious. Many people die every year from complications of bulimia.

What Causes Bulimia?

As with other eating disorders, the precise causes of bulimia nervosa are difficult to determine. Some women may be genetically vulnerable to developing bulimia. Young women with a biological sister or mother with an eating disorder are at higher risk, for example, suggesting a possible genetic link. There is some evidence that serotonin, a naturally occurring brain chemical, may influence eating behaviors because of its connection to the regulation of food intake.

People with bulimia may have other psychological and emotional characteristics that contribute to the onset and progression of the disease. They may have low self-worth, for instance, as well as perfectionism. They may have trouble controlling impulsive behaviors, managing moods or expressing anger. The families of people with bulimia may tend to have more conflicts, along with more criticism and unpredictability. There may be a history of sexual abuse at the root of feelings of worthlessness and self-loathing.

In addition, popular culture cultivates and reinforces a desire for thinness that may contribute to a woman's eating disorder. Success and worth are often equated with being thin, especially for women. Pressure from a peer group at school, work, or social circles can also fuel this desire to be thin, particularly among young girls. For other women, bulimia may begin later in life if they experience trauma or stress that overwhelms their ability to cope.

Additionally, bulimia nervosa is also frequently accompanied by other co-occurring disorders or addictions that may make it challenging for a woman to gain control of her emotions and develop a healthy relationship with food. Bulimia nervosa takes a toll on a woman's life very quickly, and so it's common for her to develop alcoholism or drug addiction, or begin to abuse prescription drugs, as she attempts to cope with her symptoms. Co-occurring mood disorders, anxiety disorders and personality disorders are also frequently recognized in women with symptoms of bulimia.

Bulimia nervosa is a very serious eating disorder, particularly if it is accompanied by co-occurring disorders. Like other eating disorders, bulimia is a medical disease that can result in irreversible health complications, including death. Learn more about bulimia treatment for women and adolescent girls at Timberline Knolls Residential Treatment Center.