Bulimia nervosa is a disorder marked by repeated binge-eating (eating large amounts of food while feeling out of control) and some attempt to counteract the eating by dieting, exercise, or other extreme behaviours (such as self-induced vomiting or laxative misuse). Often, people with bulimia nervosa feel dissatisfied with their bodies and are very sensitive to changes in their weight. It is also common for people with bulimia nervosa to feel ashamed of their symptoms. They may therefore try to keep the symptoms hidden from others. For some people, bulimia nervosa is a mild to moderate problem and can be short-lasting. For others, bulimia nervosa can be a very severe problem that drastically interferes with their lives.

Who gets bulimia nervosa?

Although girls and women are most often affected, boys and men can also suffer from bulimia nervosa. The first symptoms of bulimia nervosa often begin during the late teenage years. For some, the illness begins earlier and for others, the illness does not begin until adulthood. Sometimes bulimia nervosa can develop in a person who has previously had anorexia nervosa. Often, bulimia nervosa begins after a period of dieting behaviour. It is a relatively common problem in young women and about 1-3 % of women develop bulimia nervosa in their lifetime.

What causes bulimia nervosa

Some people appear to be prone to developing bulimia nervosa. Binge-eating is more likely to occur when a person attempts to drop their body weight below their "natural weight" (the weight at which a person's body is most naturally set). There is a very wide variation in natural body shapes and sizes; however, most people's bodies are not meant to take the pencil thin shape seen in many fashion model photographs. When a person diets in an attempt to lose weight and cuts back on the amount of food eaten, the body is more susceptible to binge-eating behaviour. Often, the person who is dieting becomes more responsive to food cues and finds it more difficult to control starting and stopping eating behaviour. Thus, dieting may lead some people to binge-eat and feel out of control. For many people, the binge-eating and feeling of being out of control is very distressing and, as a result, they will desperately attempt to counteract the binge-eating. Thus, a vicious cycle of binge-eating and counteracting behaviour begins. Additionally, people are more likely to develop bulimia nervosa if they are under some emotional stress.

What physical problems accompany bulimia nervosa?

Because people with bulimia nervosa often eat irregularly, they may experience gastrointestinal problems (such as pain or discomfort in the stomach and constipation or diarrhea). If a person is inducing vomiting or using laxatives regularly, serious gastrointestinal damage can result. Stomach acids can be harmful to the esophagus, mouth, and teeth, and the physical forces of vomiting can cause tears and bleeding. Laxatives can cause long term damage to the bowel. In addition, vomiting and laxative use result in the loss of important salts and minerals that are needed by the body for healthy function. As a result, people with bulimia nervosa who are vomiting or using laxatives may experience problems with their muscles (cramping), heart (pain and irregular heartbeat), and brain (poor concentration and seizures).

What psychological problems accompany bulimia nervosa?

When people first develop symptoms of bulimia nervosa, they may feel "good"; however, as time progresses a number of psychological problems usually occur. It is very common for people with bulimia nervosa to feel irritable and edgy, and they will often find they cannot concentrate as well as usual. These psychological symptoms are mostly a result of inadequate nutrition. Because people with bulimia nervosa often become preoccupied with dieting and losing weight, they are often uncomfortable with others at meals or restaurants. As a result, it is common for people with bulimia nervosa to spend less time with friends and family, which may sometimes lead to loneliness and isolation. Many people with bulimia nervosa end up feeling sad and depressed.

Elliot Goldner, MD, 
in association with the MediResource Clinical Team