Bulimia is a well-documented eating disorder characterized by food binges, or regular episodes of overeating due to a feeling of a loss of control.

The bulimic then uses various unhealthy methods to attempt to prevent weight gain. The underlying causes of bulimia often lead the patient to experience severe guilt and anger about their condition. Bulimics often require professional help in order to overcome their disease.

Who Is at Risk?

The exact cause of bulimia has yet to be fully understood. Most researchers believe that genetic, traumatic, psychological, social or cultural factors play a role in the development of bulimia. The prevailing theory recognizes the possibility that there are numerous factors that contribute to bulimia.

The University of Maryland Medical Center (UMMC) identifies certain groups of people who have an increased risk of developing bulimia. They are:

  • Caucasian, middle-class women. Most of these women will be teenagers or college students.
  • Those with others in their family who have mood disorders or substance abuse issues. Exposure to a family member with bulimia also increases the risk of developing the disease.
  • Those with low-self esteem or those living in a high-pressure environment.

Signs and Symptoms

The most obvious sign of bulimia is the frequent eating binges that occur as often as several times each day for months.

Typically, the bulimic hides from others while eating large calorie meals. They eat in secret and at abnormal times, like at midnight or in the middle of the night. Bulimics are aware of their lack of control and often feel helpless while in the midst of an eating binge.

After the binge, bulimics often feel extreme guilt and self-disgust. They may try to alleviate these negative feelings by purging. In fact, most bulimics feel relief and are less stressed after purging. Most people equate purging to vomiting, but this is not the only way to purge food.

Some common purging strategies include:

  • Forced vomiting. Bulimics often go to the bathroom after an eating binge and force themselves to vomit. They believe that if they vomit directly after eating they will prevent any weight gain.
  • Using laxative or similar medications. Patients with bulimia often use excessive amounts of laxatives or an enema to cause a bowel movement. They may also use a diuretic (water pill) to cause frequent urination. As they have a bowel movement, bulimics feel as if they are losing weight despite their eating binges.
  • Excessive exercise. This form of purging is often overlooked. Some bulimics resort to hours and hours of exercise each day. They believe that if they work out enough, they can overcome their high-calorie binges. Though exercise is often beneficial, too much exercise can lead to muscle damage and other health problems.

Bulimics often have a normal body mass index (BMI), meaning they are not overweight. As bulimics are not overweight or extremely skinny, most family members will be unable to spot the disease.

However, bulimics often consider themselves overweight. They will often complain of gaining weight or being unhealthy. Even comments from friends and relatives will not help them understand that they are not gaining weight.

Other signs and symptoms of bulimia are:

  • Eating until uncomfortably full
  • Frequent changes in body weight
  • Gastrointestinal distress (such as diarrhea, constipation, gas and abdominal pain)
  • Dehydration (due to vomiting or excessive use of laxatives and diuretics)
  • Bad breath
  • Sore throat or frequent mouth sores
  • Missed periods or lack of menstrual periods
  • Depression


If left untreated, bulimia often leads to severe nutritional disorders and other potentially lethal complications, MedlinePlus, a service of the National Institutes of Health, warns.

Bulimics often develop dental cavities and other problems with their teeth. If they purge by vomiting, they expose their teeth to high levels of stomach acid as they purge. The acid damages the teeth and destroys the enamel, which is the protective layer surrounding the teeth. This allows bacteria to burrow into the teeth and cause cavities.

Severe dehydration is a possibly life-threatening consequence of bulimia. Bulimics tend to lose large amounts of water due to forced vomiting or the use of water pills and diuretics. Without water, the bulimic’s body is unable to function properly and will begin to shut down. In the worst cases, dehydration causes organ damage, loss of consciousness, coma and eventually death.

Electrolytes are minerals within your body that help in the conduction of electrical nerve impulses. Electrolytes, such as sodium, potassium, and chloride, are essential for the normal function of each cell, tissue and organ within the human body. Since bulimics often suffer from electrolyte imbalances, the body is unable to send signals as effectively.

In severe cases, electrolyte balance can cause the heart to beat erratically or even stop; it can also cause seizures, muscle tremors, kidney damage and liver failure.

Frequent vomiting often causes damage to the throat. The acidic nature of the vomitus causes inflammation in the esophagus and trachea (windpipe). In the trachea, inflammation can lead to swelling, which in turn leads to difficulty breathing. Inflammation in the esophagus can lead to more severe damage that can cause tearing of the esophagus. This is a dangerous complication of bulimia as there are many veins located in the esophagus. If these veins rupture, then the patient can die within minutes. Esophageal tearing is an emergency condition; if it is suspected, call 911 immediately.

Malnourishment is always a possible complication of bulimia. Bulimics may not be eating nutritious food, or are purging too much food out of their system. Malnutrition causes wasting of the muscles and damage to the body’s organs. Worst-case scenarios include severe confusion, kidney failure and heart disease.

Diagnosing Bulimia

Diagnosing bulimia early in the disease’s course is the best possible way to prevent life-threatening complications. Most bulimics are brought to medical professionals when friends or family members notice some distressing signs.

A thorough dental exam will discover many cavities, infections of the gums (gingivitis), and destruction of the enamel. Bulimics also have bad breath and inflammation of the soft palate and back of the throat.

A complete physical exam may reveal:

  • Broken blood vessels in both eyes, which is caused by intense straining while vomiting.
  • Swollen salivary glands that lead to pouch-like folds at the corner of the bulimic’s mouth. Salivary glands often swell due to damage caused by excessive purging.
  • Numerous abnormal rashes and the development of acne or multiple pimples.
  • Small abrasions or lacerations located across the upper finger joints. The patient’s teeth cause these small wounds, when they force themselves to vomit.

A doctor may also order a blood test called a chem-20. This test measures the amount of different chemicals found within your blood. For bulimia, the chem-20 test often reveals an electrolyte imbalance (like hyponatremia or hypokalemia) or some form of dehydration. From these findings as well as a history of the signs and symptoms of bulimia, a properly trained physician will be able to diagnose the condition.

Treatment and Prognosis

The treatment for bulimia is often a long-term regimen.

Most doctors recommend a stepped approach, the New York Times reports. This means that the type of treatment and therapy varies with the severity of the disease. This allows the bulimic to get the right kind of treatment without over- or under-treating the disease.

Patients with only mild symptoms of bulimia are often entered into support groups. This allows them to meet other bulimics at various stages of recovery. The members of the group help each other overcome their illness.

More severe cases of bulimia will require nutritional therapy, behavioral therapy, and possibly the use of select medications to help curb any psychological issues associated with the disease. Hospitalization is rarely required unless the patient is suffering from severe depression or suicidal, requires drugs to overcome withdrawal from purging, or is suffering from major health problems associated with bulimia.

No matter the type of treatment, most bulimics will have some symptoms throughout most of their lives, so recovery is truly a lifelong process.


For the best chances of recovery, bulimics must fully cooperate in the treatment process. This is a difficult task because most bulimics are unwilling to admit to their problems. They will avoid talking about their binges and deny any purging.

To overcome this denial, concerned friends or relatives often resort to staging an intervention. Interventions, especially if conducted by a trained interventionist, help the bulimic face his or her illness. Friends, family and respected associates often attend the intervention and share experiences that show the adverse effects of bulimia. The moderator or interventionist helps direct the discussion and provides an avenue for all intervention team members to express their feelings. The interventionist will also discuss possible treatment options with the bulimic and present a suitable treatment regimen.