Bulimia: Characteristics, Symptoms and Treatment

Bulimia is a serious eating disorder. It is characterized by recurring binges followed by compensatory behaviors. It carries a series of physical and emotional complications.

Written and verified by el psicólogo Bernardo Peña.

Last update: 06 May, 2023

Bulimia is a serious eating disorder characterized by recurrent binge-eating episodes, followed by periods of compensatory behaviors.

These compensatory behaviors would include: inducing vomiting, using enemas and laxatives, excessive physical exercise, and prolonged fasting to compensate for excess food intake.

What is bulimia?

Bulimia nervosa, better known as bulimia, is an eating disorder that doesn’t follow a regular eating pattern, with episodes of excessive and disproportionate intake. It’s mainly characterized by distancing oneself from healthy food and consuming excess food through bingeing.

After the episode, a period of guilt follows that leads the patient to eliminate all the food that they have ingested through vomiting or other substances, as well as fasting or physical exercise. This behavior is carried out in order to lose or, at least, not gain more body weight.

People with this disorder share four things in common:

1. They don’t have adequate control regarding the proportion of food and bulimic episodes
2. They show compensatory behavior to maintain their weight or achieve a lower-than-normal body weight
3. They have obsessive thoughts about physical image and weight
4. They’re aware of the illness, unlike people with anorexia nervosa

One of the immediate results of vomiting is that the feeling of physical discomfort disappears. Therefore, the fear of gaining weight decreases. In a certain way, people who suffer from bulimia, generate a constant eating pattern, which is characterized by:

1. Refraining from eating food in the early hours of the morning.
2. Overeating as the evening rolls around.
3. Purging behavior. The next morning these feelings of guilt lead them to fortify food withdrawal, which triggers a series of aforementioned repetitions.

Bulimia: causes

Among the factors that predispose to the development of bulimia is the genetic factor. For example, if you have a family member with bulimia. It has also been shown that there’s a decrease in serotonin, which causes a lack of satiety and problems with mood.

In the family environment, we can find conflictive, unstructured families. There may also be parents who are dissatisfied with their image, which leads them to follow different rigorous diets.

In addition, they can express to their children their dissatisfaction with the physical, making them participate in their diets. On the other hand, it’s the same families that show hostile attitudes towards the emotional needs of people with this disorder.

Another important factor is the cultural one, from the media messages of happiness and success which are transmitted by a slim body. This fact can persuade some people to make drastic changes in their eating habits to adjust their image to the standards of the moment.

Bulimia: clinical symptoms

People with bulimia have a greater tendency towards depression, a propensity for substance abuse, irritability, symptoms of stress, the constant desire to lose weight, and low self-esteem.

The most significant complications of this type of disorder include alterations in the digestive, cardiovascular, respiratory, renal, hormonal, neurological, and muscular systems. In addition to irregular menstruation periods, anxiety, depression, urinary tract infection, dental problems, and sleep disorders.

Diagnostic criteria for bulimia

The DSM-5 establishes five criteria for the diagnosis of bulimia:

A. Recurring bouts of binge eating. An episode of binge eating is characterized by:

1. Eating in a specific period of time (for example, in a two-hour period) an amount of food well in excess of what most people would eat in that period of time and under similar circumstances.
2. A feeling of a lack of control over eating during the episode (for example, a feeling that one can’t stop eating or control what or how much one is eating).

B. Inappropriate recurring compensatory behavior in order to prevent weight gain, such as inducing vomiting, the misuse of laxatives and diuretics or other medications, and fasting or excessive exercise.

C. When both voracious eating and inappropriate compensatory behavior occur, on average, at least once a week for three months.

D. Self-assessment is excessively influenced by weight and body shape.

E. When the disodoesn’tsn’tt occur exclusively during episodes of anorexia.

Treatment of bulimia

Next, we’ll explain all about the treatment of bulimia. To help you understand, we’ll divide it into sections:

1. Treatment of bulimia: Main objectives

According to the American Psychiatric Association (2006), the goals of bulimia treatment include:

1. Reducing or eliminating binge eating and purging
2. Treating any type of physical complication
3. Motivating the patient to participate in the restoration of healthy eating patterns
4. Providing psychological education on nutrition and food
5. Identifying dysfunctional thoughts, moods, and conflicts associated with eating
6. Providing psychotherapy to address these issues
7. Getting family support and doing family therapy, if needed
8. Avoiding relapse

2. Medical-nutritional treatment of bulimia

In the initial evaluation of a patient with bulimia, it’s necessary to identify medical complications derived from purging, such as muscle weakness, cardiac arrhythmias, dehydration, and electrolyte imbalance. As well as gastrointestinal problems that affect the stomach or esophagus.

Similarly, there may be conditions that contribute to purging, such as GERD.

An important goal in treatment is to normalize the eating pattern and to cancel the binge/purge cycle. A three-food routine with one to three snacks a day is employed to break the disturbed eating pattern.

3. Psychological and psychiatric treatment of bulimia

In the treatment of this disorder, cognitive-behavioral therapy and the use of antidepressant medications such as SSRIs have been useful. Cognitive-behavioral approaches have also been used to help people with bulimia and binge eating disorders develop a sense of self-control.

Common components of cognitive-behavioral treatment plans encourage the consumption of three or more balanced meals a day, the reduction of rigid dietary norms and body image concerns, and the development of coping strategies.

Bulimia: final thoughts

In conclusion, bulimia is a serious misalignment of eating patterns in the patient. In fact, these imbalances are accompanied by other serious physical complications.

Therefore, the treatment of bulimia has to be multidisciplinary. In this way, the disorder will be approached from all fronts: psychological, psychiatric, medical, and nutritional. Finally, you must be ready for complex therapy and possibly at least a year.