From Matthew Tiemeyer,
Your Guide to Eating Disorders.
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About.com Health's Disease and Condition content is reviewed by Steven Gans, MD

Bulimia nervosa (bulimia) is a mental disorder marked by relatively frequent binge eating and some form of behavior to compensate for the binge eating and avoid weight gain. Most of the time (80-90%), compensation occurs through purging (vomiting), but a person with bulimia may use other methods.

Engaging in bulimic behavior is hard on the body in a variety of ways, but its most troubling symptoms may be the shame and guilt that follow a binge/purge cycle. Those who binge and purge feel out of control; some are not fully aware that they are eating as much as they are during a binge.

Diagnostic Criteria for Bulimia Nervosa

While most persons with bulimia nervosa purge to avoid weight gain, a person who purges after eating does not necessarily meet a diagnosis of bulimia. If the person also refuses to maintain a minimally healthy body weight, she (or he) may be diagnosed with anorexia nervosa, purging type. Knowing the difference can help professionals choose the best treatment methods.

• Diagnosis of bulimia nervosa

Physical Symptoms of Bulimia

Persons with bulimia nervosa can look relatively healthy. They usually are within a normal weight range, though some can be slightly over- or underweight. One has to look closer to see signs of bulimia, and those who struggle with the disorder are often very good at hiding them.

• Major symptoms of bulimia nervosa

Behavioral Changes

Those with bulimia encounter changes in their thinking and behavior. Behavioral change is often self-destructive, while mental changes often involve more negative emotions directed toward the self.

• Physical isolation (which provides safety for binging and purging)
• Overachieving behavior
• Guilt and shame
• Self-destructive behaviors
  • Smoking (popular because it is thought to help prevent weight gain)
  • Impulsive behaviors
    • Sexual promiscuity
    • Cutting and other forms of self-harm
    • Kleptomania (often in the form of shoplifting)

Statistics

Bulimia probably affects more people than you think.

• Bulimia nervosa statistics

Risk Factors

There is no definitive cause of bulimia nervosa (or any eating disorder), but there are many factors that increase the risk of becoming bulimic. The following have been linked to eating disorder development:

• Abuse and trauma
• Family issues
• Social isolation
• Genetic factors
• Cultural factors
• Dieting
• Having anorexia nervosa: Anorexia is often a prelude to bulimia or bulimic patterns.
• Interest in or preparation for a sport or occupation that requires strict attention to weight control--for example, modeling, ballet, gymnastics, figure skating, and even equestrian sports. Note that any sport that involves monitoring of body composition may be a risk factor.

• Dig deeper on bulimia nervosa's risk factors

Related Mental Disorders

Frequently, those who struggle with bulimia show signs of other mental disorders.

• Mood disorders are some of the most common disorders experienced by those with bulimia. Depression, which often deepens the symptoms of bulimia, is a frequent diagnosis. It may arrive before, with, or after bulimia.
• Anxiety disorders are also common. For example, people with bulimia feel anxious when forced to be in social situations that make purging more difficult. When the anxiety causes a high level of distress, an anxiety disorder may be diagnosed. Anxiety may also appear in the form of obsessive-compulsive disorder, or OCD.
• Personality disorders are more rare than mood and anxiety disorders, but they are not uncommon: Approximately one third of those with bulimia meet the criteria for one or more personality disorders. They are very severe and are usually more resistant to treatment. A personality disorder may be present when it seems that a person's character traits have been damaged. Several kinds of personality disorders are possible, but those with anorexia are most likely to deal with borderline personality disorder. Relationships for these persons are often highly chaotic and subject to dramatic swings.

• Understand more about mental disorders related to bulimia

Treatment Strategies

Treating bulimia usually involves multiple treatment strategies. Because bulimia involves physical damage, medical attention is a good place to start. A doctor can also rule out other gastric problems that may create symptoms that look like bulimia nervosa but are caused by some other disturbance. With adequate physical health, the person will be in a better position to address psychological, social, and spiritual issues. Ultimately, treating the entire person is vital.

• What to expect when you begin treatment
• Individual therapy options for bulimia
• A four-part treatment approach

• Discover more bulimia nervosa treatment options

Seeking Professional Help

Sadly, only 6% of those with bulimia receive mental health care. When a person does decide that it's time to get treatment, there are a lot of choices to make.

• How to build your own treatment team
• Find a qualified therapist

• Covering all options for finding help for bulimia nervosa

_Sources:

American Psychiatric Association (APA), 1994. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, D.C., American Psychiatric Association.

Anorexia Nervosa and Related Eating Disorders (ANRED), Inc. "Statistics: How Many People Have Eating Disorders?" Accessed 13 December 2006.

National Eating Disorders Association. "Statistics: Eating Disorders and their Precursors." Accessed 13 December 2006.

Thomson Gale. "Bulimia Nervosa." Accessed 13 December 2006.

University of Maryland Medical Center. "How Serious Is Bulimia Nervosa Without Serious Weight Loss (Anorexia)?" Accessed 9 December 2006.