Bulimia Nervosa

Bulimia can develop after a person has followed a very restrictive diet. Binging may also be triggered by a stressful event, when food gives you a sense of comfort. Feeling guilty and ashamed of binging can cause you to purge to avoid weight gain. This starts the cycle of binging and purging that becomes a habit.

As bulimia develops, you may not eat at the beginning of the day. But later you may binge to comfort yourself, especially at the end of a stressful day.

Vomiting causes the body to release endorphins, which are natural chemicals that make you feel good. Eventually you may make yourself vomit even if you have not overeaten so that you can feel good. Soon you lose control over the binge-purge cycle. Repeated vomiting, fasting, exercising too much, or misusing Reference laxatives, Reference diuretics Opens New Window, Reference ipecac syrup, or Reference enemas Opens New Window will eventually cause serious, long-term health problems.

After bulimia becomes a pattern, it is very hard to return to normal eating without help. Unhealthy eating behaviors can continue for many years before a person seeks treatment.

If not treated, bulimia can lead to serious, long-term health problems. It is common for people to hide the condition from others for years. By the time others discover the disorder, many people with bulimia already have serious problems. These range from mild to severe, depending on the type of purging behaviors and how long they have continued. Health problems caused by bulimia include:

• Tooth decay, toothaches, swollen gums, gum disease (gingivitis), and erosion of Reference tooth enamel Opens New Window. These are caused by acid in the mouth from vomiting.
• Reference Osteoporosis Opens New Window.
• Reference Electrolyte imbalances Opens New Window and changes in Reference metabolism Opens New Window that can lead to heart problems, such as Reference arrhythmia Opens New Window and even death.
• Dehydration, which can lead to weakness, fainting, or kidney damage.
• Inflammation or tears of the Reference esophagus Opens New Window, which may cause bloody vomit.
• Swollen Reference salivary glands Opens New Window.
• Fainting or loss of consciousness, usually because of low blood pressure.
• Low body temperature.
• Reference Suicide risk when feeling discouraged about having bulimia or a relapse or about ongoing body image issues.
• Long-term problems with bowel movements because of laxative abuse.

Overuse of medicine (such as ipecac syrup) to cause vomiting can lead to diarrhea, weakness, low blood pressure, chest pain, and trouble breathing. A person can die from prolonged overuse of these medicines.

Other mental health problems often occur along with bulimia, which may make treatment take longer or make bulimia harder to treat.^{Reference 1} These conditions include:

• Reference Depression Opens New Window, which commonly occurs with eating disorders and increases related feelings of guilt, anxiety, and obsession.
• Reference Substance abuse Opens New Window, which occurs in about one-fourth of those with bulimia.
• Reference Borderline personality disorder Opens New Window, which more commonly occurs with bulimia than with other eating disorders.
• Reference Anxiety and anxiety disorders Opens New Window.
• Reference Obsessive-compulsive disorder Opens New Window.
• Reference Social anxiety disorder Opens New Window or other Reference phobias Opens New Window.
• Reference Panic disorder Opens New Window or Reference panic attacks Opens New Window.

Although bulimia is a long-term disorder linked to serious health problems, it can be successfully treated. Most people who seek treatment for bulimia get better. About half of people with bulimia recover completely with treatment. ^{Reference 2}

Although treatment is usually successful, bulimia is a long-term disorder, and setbacks can occur. A return of symptoms (relapse) might happen. But with ongoing treatment and patience, most people can eventually overcome bulimia.

Bulimia among teens with type 1 diabetes is becoming more common. These teens often lose weight before their diabetes is discovered, then quickly gain weight when treatment begins. Some learn that they can lose weight by skipping insulin doses. This causes poor control of their diabetes and can result in serious problems that can lead to blindness or kidney failure.

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