Bulimia Diagnosis, Effects & Treatment Considerations

Contributed Article by Jeanne Rust, PhD – Mirasol Treatment Center

The good news is that recovery from bulimia is possible, but to stop the cycle of binging and purging (or over-exercising, or taking diuretics), it’s important to seek treatment to resolve the underlying emotional issues.

Bulimics routinely “binge,” consuming large amounts of food in a very short period of time, and immediately “purge,” ridding their bodies of the just-eaten food by self-inducing vomiting, taking enemas, or abusing laxatives or other medications.

If treatment for bulimia is delayed, bulimia nervosa can lead to serious and even life-threatening problems, such as depression, anxiety disorders, heart damage, kidney damage, injury to the digestive system, and severe dental damage. Bulimics are also at risk for impulsive, self-destructive behaviors, such as kleptomania, self-mutilation, alcohol and/or drug abuse, and sexual promiscuity. Bulimia is the second highest cause of death for adolescent girls.

Bulimia nervosa typically begins during adolescence, and while it most often occurs in women, it also affects men. Individuals with the disorder usually feel out of control while binging and purging. Afterwards they experience intense feelings of shame and guilt. Embarrassed by their behavior, they typically “binge and purge” in secret, and often succeed in hiding their problem from others. Even family members and close friends may have difficulty detecting bulimia nervosa in someone they know.

Some of the symptoms of bulimia are:

  1. obsessive preoccupation with food
  2. excessive concern about body shape and weight
  3. episodes of binging, consuming excessively large amounts of food in a short period of time (usually within two hours)
  4. episodes of purging to immediately get rid of just-consumed food using self-induced vomiting, taking enemas, or abusing laxatives or other medication
  5. binge/purge behavior at least twice a week for a period of three months or longer
  6. excessive exercise, often accompanying periods of fasting to counteract or prepare for binge episodes
  7. disparaging self-criticism, depression, feelings of shame and guilt during and after episodes of binging and purging

Although binging and purging usually occurs in secret, the signs that a person has bulimia nervosa eventually become detectable. Because poor body image and low self-esteem are a part of what underlies bulimia, psychotherapy is an important aspect of treatment for bulimia. Many people with bulimia feel isolated and shamed by their behavior, and therapists can help with these feelings.

While the exact cause of bulimia is still unknown, bulimia nervosa is likely brought on by a complex interplay of factors which can include emotional and personality disorders, family stress, possible genetic or biologic susceptibilities, and a culture that is obsessed with body image and thinness.

New research led by Dr. Walter H. Kaye of the University of Pittsburgh School of Medicine, suggests that women with a history of bulimia show distinct differences in the brain’s regulation serotonin, a hormone that controls mood and appetite, suggesting an inherent susceptibility to the eating disorder.

The researchers found that the bulimic patients’ brains showed a reduction in the ability of the chemical serotonin to bind to receptors in certain brain regions. They also found that these women did not show the normal decline in serotonin binding that comes with aging. This is why medications such as Prozac, a serotonin uptake inhibitor, can be so effective with certain bulimics.

Dr. Kaye’s research could lead us to the conclusion that many eating disorders are genetic, and a result of a chemical imbalance in the brain. However, other data suggests that certain traits, such as anxiety, may occur in childhood in people who later develop bulimia, according to Dr. Kaye.

The first thing a person with bulimia should do is to seek help from a physician to diagnose and treat any physical problems. Underweight or overweight individuals often suffer from medical complications, especially if the person is using laxatives or vomiting as a method of controlling their over-eating behaviors.

Treatment for eating disorders like bulimia is most effective when it focuses less on the eating behaviors-although they are important-but instead examines the causes of those behaviors, such as poor self-perception. Often negative self-image is created by specific traumatic events or memories within the individual’s developmental stages of childhood.

The treatment of choice for bulimia is generally cognitive-behavioral therapy. Cognitive-behavioral therapy targets the unhealthy eating behaviors of bulimia and the unrealistic, negative thoughts that drive them. Cognitive-behavioral therapy for bulimia involves two phases:

  1. The first phase of treatment for bulimia is to stop the addictive cycle of binging and purging and restore normal eating patterns. Patients learn to monitor their eating habits, avoid situations that make them want to binge, cope with stress in ways that don’t involve food, eat regularly to reduce food cravings, and fight the urge to purge.
  2. The second phase of treatment for bulimia focuses on identifying and changing dysfunctional beliefs about weight, dieting, and body shape. Patients challenge their “all-or-nothing” attitudes about eating, explore the connection between emotions and eating, and rethink the idea that self-worth is based on weight.

In addition to cognitive-behavioral therapy, interpersonal psychotherapy can help people in treatment for bulimia solve relationship issues and interpersonal problems that contribute to their eating disorder. Interpersonal psychotherapy also treats the depression and low self-esteem that goes along with bulimia.

Group therapy as part of treatment for bulimia involves education about the eating disorder and strategies for overcoming it. It can also provide bulimics with the support they need to help them become well.

Finally, when combined with effective therapy, antidepressant medications can help reduce binge eating by reducing the preoccupation with weight and body image, as well as the depression that often accompanies bulimia.

Published Date: 2010
Last Reviewed By: Jacquelyn Ekern, MS, LPC on August 22, 2011
Page last updated: June 12, 2012
Published on EatingDisorderHope.com, Information on Eating Disorders