Bulimia is an illness in which a person has regular episodes of overeating (bingeing) and feels a loss of control. The person then uses different ways, such as vomiting or laxatives (purging), to prevent weight gain.
Many people with bulimia also have anorexia nervosa.
Many more women than men have bulimia. The disorder is most common in adolescent girls and young women. The person usually knows that her eating pattern is abnormal and may feel fear or guilt with the binge-purge episodes.
The exact cause of bulimia is unknown. Genetic, psychological, trauma, family, society, or cultural factors may play a role. Bulimia is likely due to more than one factor.
With bulimia, eating binges may occur as often as several times a day for many months. The person often eats large amounts of high-calorie foods, usually in secret. During these episodes, the person feels a lack of control over the eating.
Binges lead to self-disgust, which causes purging to prevent weight gain. Purging may include:
Purging often brings a sense of relief.
People with bulimia are often at a normal weight, but they may see themselves as being overweight. Because the person's weight is often normal, other people may not notice this eating disorder.
Symptoms that other people can see include:
A physical exam may also show:
People with bulimia rarely have to go to the hospital, unless they:
Most often, a stepped approach is used for patients with bulimia. Treatment depends on how severe the bulimia is, and the person's response to treatments:
Patients may drop out of programs if they have unrealistic hopes of being "cured" by therapy alone. Before a program begins, you should know that:
Support groups like Overeaters Anonymous may help some people with bulimia. The American Anorexia/Bulimia Association is a source of information about this disorder.
Bulimia is a long-term illness. Many people will still have some symptoms, even with treatment.
People with fewer medical complications of bulimia and those willing and able to take part in therapy have a better chance of recovery.
Bulimia can be dangerous. It may lead to serious medical complications over time. For example, vomiting over and over puts stomach acid in the esophagus (the tube from the mouth to the stomach). This can permanently damage this area.
Possible complications include:
Call for an appointment with your health care provider if you (or your child) have symptoms of an eating disorder.
Bulimia nervosa; Binge-purge behavior; Eating disorder - bulimia
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, Va: American Psychiatric Publishing. 2013.
Rosen DS, American Academy of Pediatrics Committee on Adolescence. Clinical report -- identification and management of eating disorders in children and adolescents. Pediatrics. 2010;126:1240-1253.
Sim LA, McAlpine DE, Grothe KB, Himes SM, Cockerill RG, Clark MM. Identification and treatment of eating disorders in the primary care setting. Mayo Clin Proc. 2010;85(8):746-751.
Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583-593.
Hay PPJ, Bacaltchuk J, Stefano S, Kashyap P. Psychological treatments for bulimia nervosa and binging. Cochrane Database Syst Rev. 2009;(4):CD000562.
Updated by: Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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