Bulimia nervosa is an eating disorder that involves a cycle of strict dieting and strong urges to eat in excess, followed by intense efforts to avoid gaining weight.
The signs and symptoms of the disease can vary, but most individuals have a normal body weight. The effects of the purging after a binge-eating session often lead to the most prominent signs and symptoms of the condition.
Cycle of Stages
People with bulimia nervosa tend to go through a cycle of stages that characterizes the condition and includes:
- Strict dieting and obsession or fear about gaining weight
- Cravings for prohibited foods and resulting tension and anxiety
- An episode of binge eating where individual consumes large quantities of food (approximately 3000-5000 calories within one hour.)
- Purging to avoid weight gain by inducing vomiting, doing intense exercise or using laxatives or diuretics.
- Shame or disgust about binge eating and reinforcement of strict diet to control weight.
This cycle can continue indefinitely with affected individuals feeling like they have reduced control over their consumption of food. This often causes them to enforce a stricter diet to manage body weight, which leads to undernourishment, a greater obsession with food and an increased likelihood of binge eating as a natural response.
Signs and Symptoms
When an individual is affected by bulimia nervosa, several changes can occur in the body that may become evident.
As a result of malnutrition, frequent vomiting, or use of laxatives or diuretics, the concentration of electrolytes (e.g. potassium, magnesium and sodium) in the blood can be altered. This can cause consequent effects such as changes in the rhythm of the heart (arrhythmias). Other symptoms linked to the cardiovascular system include decreased muscle mass in heart, heart failure, hypotension, bradycardia and anemia.
The gastrointestinal system can also be affected and patients may have abdominal pain or cramping, bloating or stomach ulcers. Additionally, irregular bowel motions, constipation or diarrhea is particularly common in individuals that use laxatives as a purging mechanism.
Most people with bulimia are normal weight or slightly overweight, due to the binge eating and purge habits. It is also common for the body weight to fluctuate considerably. This is because the purging methods are not entirely effective at eliminating the calories of a binge eating session, as the body begins to absorb the food as soon as it is eaten. It is estimated that vomiting removes less than half of the calories and other methods (e.g. laxatives or diuretics) even less at approximately 10%.
Many patients with bulimia nervosa are also affected by psychological symptoms as a result of the condition. They may have an intense fear of gaining weight or issues with anxiety, in addition to feeling of shame and low self-esteem linked to their dietary patterns. Affected individuals are also more likely to become depressed and experience other mental health issues.
Signs of Frequent Vomiting
Not all patients with bulimia nervosa follow binge-eating sessions with vomiting, and they may resort to other methods such as intense exercise or the use of laxatives or diuretics. However, frequent vomiting is a common characteristic of individuals with bulimia and can cause specific signs and symptoms of the condition. These may include:
- Scarred or callused hands from inducing vomiting with fingers in throat
- Swollen or puffy cheeks
- Discolored teeth from stomach acid in mouth
- Sore throat or hoarseness
- Gum disease
- Sensitive teeth