Psychological factors. Certain personality types
appear to be more vulnerable to developing bulimia.
People with bulimia tend to have poor impulse con-
trol. They are of often involved in risky behavior
such as shoplifting, drug and alcohol abuse and
risky sexual activities. People with bulimia have
low-self worth and depend on the approval of others
to feel good about themselves. They are aware that
their behavior is abnormal. After a binge/purge ses-
sion, they are ashamed and vow never to repeat the
cycle, but the next time they are unable to control the
impulse to eat and purge. They also tend to have a
black-or-white, all-or-nothing way of seeing situa-
tions. Major depression, obsessive-compulsive disor-
der, and anxiety disorders are more common among
individuals who are bulimic.
Social factors. The families of people who develop
bulimia are more likely to have members who have
problems with alcoholism, depression, and obesity.
These families also tend to have a high level of open
conflict and disordered, unpredictable lives. Often
something stressful or upsetting triggers the urge to
diet stringently and then begin binge/purge behav-
iors. This may be as simple as a family member as
teasing about the person’s weight, nagging about
eating junk food, commenting on how clothes fit,
or comparing the person unfavorably to someone
who is thin. Life events such as moving, starting a
new school, and breaking up with a boyfriend can
also trigger binge/purge behavior. Overlaying the
family situation is the false, but unrelenting, media
message that thin is good and fat is bad; thin people
are successful, glamorous, and happy, fat people are
stupid, lazy, and failures.
Signs and symptoms
Binge/purge cycles have physical consequences.
These include:
teeth damaged from repeated exposure to stomach
acid from vomiting; eroded tooth enamel;
swollen salivary glands; sores in mouth and throat
dehydration
sores or calluses on knuckles or hands from using
them to induce vomiting
electrolyte imbalances revealed by laboratory tests
dry skin
fatigue
irregular or absent menstrual cycles in women
weight, heart rate and blood pressure may be normal
DiagnosisDiagnosis is based on several factors including a
patient history, physical examination, the results of
laboratory tests, and a mental status evaluation. A
patient history is less helpful in diagnosing bulimia
than in diagnosing many diseases because many peo-
ple with bulimia lie about their bingeing and purging
and their use of laxatives, enemas, and medications.
The patient may, however, complain about related
symptoms such as fatigue or feeling bloated. Many
people with bulimia express extreme concern about
their weight during the examination.
A physical examination begins with weight and
blood pressure and moves through the body looking
for the signs listed above. Based on the physical exam
and patient history, the physician will order labora-
tory tests. In general these tests will include a complete
blood count (CBC), urinalysis, and blood chemistries
(to determine electrolyte levels). People suspected of
being exercise bulimic may need to have x rays to look
for damage to bones from over-exercising.
Several different evaluations can be used to exam-
ine a person’s mental state. A doctor ormental health
professional will assess the individual’s thoughts and
feelings about themselves, their body, their relation-
ships with others, and their risk for self-harm.Treatment
Treatment choices depend on the degree to which
the bulimic behavior has resulted in physical damage
and whether the person is a danger to him or herself.
Hospital impatient care may be needed to correct
severe electrolyte imbalances that result from repeated
vomiting and laxative abuse. Electrolyte imbalances
can result in heart irregularities and other potentially
fatal complications. Most people with bulimia do not
require hospitalization. The rate of hospitalization is
much lower than that for people with anorexia nerv-
osa because many bulimics maintain a normal weight.
Day treatment or partial hospitalization where
the patient goes every day to an extensive treatment
program provides structured mealtimes, nutrition
education, intensive therapy, medical monitoring,
and supervision. If day treatment fails, the patient
may need to be hospitalized or enter a full-time resi-
dential treatment facility.
Outpatient treatment provides medical supervi-
sion, nutrition counseling, self-help strategies, and psy-
chotherapy. Self-help groups receive mixed reviews
from healthcare professionals who work with bulimics.
Some groups offer constructive support in stopping theBulimia nervosa