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BULIMIA NERVOSA

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

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DIAGNOSTIC CRITERIA

According to the DSM-5, the official diagnostic criteria for bulimia nervosa are:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

    • Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

    • A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).

  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.

  • Self-evaluation is unduly influenced by body shape and weight.

  • The disturbance does not occur exclusively during episodes of anorexia nervosa.

 

WARNING SIGNS & SYMPTOMS OF BULIMIA NERVOSA

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Emotional and behavioral 

  • In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns 

  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food  

  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics 

  • Appears uncomfortable eating around others 

  • Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch) 

  • Skips meals or takes small portions of food at regular meals 

  • Disappears after eating, often to the bathroom

  • Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

  • Fear of eating in public or with others

  • Steals or hoards food in strange places  

  • Drinks excessive amounts of water or non-caloric beverages  

  • Uses excessive amounts of mouthwash, mints, and gum  

  • Hides body with baggy clothes  

  • Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories  

  • Shows unusual swelling of the cheeks or jaw area  

  • Has calluses on the back of the hands and knuckles from self- induced vomiting 

  • Teeth are discolored, stained  

  • Creates lifestyle schedules or rituals to make time for binge-and-purge sessions  

  • Withdraws from usual friends and activities 

  • Looks bloated from fluid retention  

  • Frequently diets  

  • Shows extreme concern with body weight and shape  

  • Frequent checking in the mirror for perceived flaws in appearance

  • Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating  

  • Purges after a binge (e.g. self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)  

  • Extreme mood swings

 

Physical 

  • Noticeable fluctuations in weight, both up and down 

  • Body weight is typically within the normal weight range; may be overweight

  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.) 

  • Difficulties concentrating 

  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate) 

  • Dizziness 

  • Fainting/syncope 

  • Feeling cold all the time 

  • Sleep problems 

  • Cuts and calluses across the top of finger joints (a result of inducing vomiting)

  • Dental problems, such as enamel erosion, cavities, and tooth sensitivity 

  • Dry skin 

  • Dry and brittle nails 

  • Swelling around area of salivary glands 

  • Fine hair on body 

  • Thinning of hair on head, dry and brittle hair (lanugo) 

  • Cavities, or discoloration of teeth, from vomiting 

  • Muscle weakness 

  • Yellow skin (in context of eating large amounts of carrots) 

  • Cold, mottled hands and feet or swelling of feet 

  • Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period) 

  • Poor wound healing 

  • Impaired immune functioning

 

Many people with bulimia nervosa also struggle with co-occurring conditions, such as:

  • Self-injury (cutting and other forms of self-harm without suicidal intention)

  • Substance abuse

  • Impulsivity (risky sexual behaviors, shoplifting, etc.)

  • Diabulimia (intentional misuse of insulin for type 1 diabetes)

Learn more about co-occurring conditions >

 

HEALTH CONSEQUENCES OF BULIMIA NERVOSA

The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.  

 

The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.

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