Diseases & Conditions

Binging-Purging - Bulimia

Overview, Causes, & Risk Factors

Bulimia is a chronic eating disorder. It is characterized by periods of eating and then trying to avoid weight gain.

What is going on in the body?

Individuals with bulimia secretly eat large amounts of food in a short period. This is called binge eating. They then try to avoid weight gain. They may do this by one of the following methods:

  • fasting
  • inducing vomiting
  • using laxatives to have bowel movements
  • taking diuretics, or water pills
  • What are the causes and risks of the condition?

    Bulimia is thought to be a result of social, psychological, and biological factors. Genetics may contribute. Mood disorders are more common in family members of those who develop bulimia.

    Social factors play a major role. Some societies emphasize thinness. Family problems, self-esteem, and identity conflicts are also factors. Bulimia is most common in females in adolescence or young adulthood.

    Symptoms & Signs

    What are the signs and symptoms of the condition?

    Symptoms of bulimia may include the following:

  • amenorrhea, which refers to decreased or absent menstruation
  • denial of the behavior
  • excessive exercise, even if the person is underweight
  • fear of gaining weight or becoming fat
  • feeling of disgust or self-loathing
  • need for frequent weighing
  • overachievement in a variety of areas
  • periods of not eating followed by eating binges
  • problems with body image
  • purging
  • unusual eating habits and rituals

  • Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis of bulimia begins with a history and physical exam. The healthcare provider may order tests to check the person's health status, including:

  • blood tests, such as a CBC
  • an ECG, to check for heart problems
  • urinalysis, to check for dehydration and infection
  • chest X-ray to check for rib fractures, heart problems, or lung infection
  • abdominal X-ray to look for digestive tract problems

  • Prevention & Expectations

    What can be done to prevent the condition?

    There are no specific ways to prevent bulimia. Promoting good nutrition and self-esteem are important. Changes in society's attitudes about thinness would help.

    What are the long-term effects of the condition?

    Bulimia can cause dehydration, malnutrition, and salt imbalances. It can affect the brain and muscles. It can damage the reproductive tract, bowels, stomach, and other body organs. It can cause serious heart problems, including:

  • arrhythmias
  • congestive heart failure
  • sudden death
  • Someone with bulimia may have trouble developing healthy relationships. The person also may be limited in the ability to succeed at school or work.

    Treatment & Monitoring

    What are the treatments for the condition?

    A team approach to treatment is most effective. This includes:

  • aggressive medical management
  • nutritional rehabilitation and counseling
  • individual, group, and family psychotherapy
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  • Bulimia may be treated in the hospital, or on an outpatient basis. The person's weight, cardiac status, and overall health influence the treatment choice. Some people become so malnourished that they need to be fed through tubes to stay alive. They will have strict rules about eating and weight management.

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  • Cognitive therapy helps individuals identify and question the reality of their beliefs about eating and weight.
  • Behavioral therapy is designed to help change the behaviors that keep the illness going.
  • Family therapy helps family members learn about the illness. They learn what they can do to help their loved ones recover. Sometimes, family problems need to be addressed before recovery can begin.
  • Medications are rarely used to treat bulimia. If the person has significant depression, antidepressants may be used.

    What are the side effects of the treatments?

    If antidepressants are used, they may cause drowsiness, dry mouth, and constipation.

    What happens after treatment for the disease?

    Psychotherapy usually continues for at least one year after treatment starts. Some individuals may need 5-6 years of therapy. People who recover from bulimia need to be aware that this illness can recur.

    How is the disease monitored?

    The individual will have regular visits with the healthcare provider. Any new or worsening symptoms should be reported to the provider.


    Author:Ann Reyes, Ph.D.
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:06/01/01
    Reviewer:Brenda Broussard, RD, CDE
    Date Reviewed:06/01/01