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Bulimia Nervosa

Risk Factors
Commonly Prescribed Drugs
Treatment and Management
Doctors to Consult

Common name

Bulimia; binge-purge syndrome (Eng.)

Bulimia nervosa (BN) is an eating disorder characterized by several episodes of binge eating or overeating in a short period of time followed by a compensatory behavior for overeating. Patients commonly binge eat and purge (compensatory behavior to remove the calories consumed) 1 to 10 times a week. Most patients develop bulimia due to their fear of being overweight, stress buildup, depression, and psychological disorders such as tumors in the hypothalamus. Some patients develop bulimia during or after following a diet that leads to increased hunger causing them to overeat. Patients with BN are distinguished from patients with anorexia who binge and purge due to the normal or above normal body weights of BN patients.

Types of bulimia based on compensatory behavior:

  • Purging bulimia involves regular self-induce vomiting and excessive use of laxatives, diuretics or enemas after overeating.
  • Nonpurging bulimia uses other methods to remove the calories consumed such as fasting, strict dieting, and excessive exercising.

Diagnostic features of bulimia include repeated binge eating followed by a compensatory behavior, feeling of lack of control when overeating, occurrence of binge eating and purging at least once weekly for 3 months, and extreme concern regarding body shape and weight. BN can only be diagnosed as the disorder if symptoms of anorexia are not present. These can be determined through a physical exam and a psychological evaluation.


  • Eating large amounts of food in a short period of time
  • Feeling of uncontrolled eating behavior
  • Eating until the point of discomfort or pain
  • Scar or callus on back of the hands due to repeated trauma from the teeth
  • Loss of dental enamel and eventually chipping and erosion of front teeth
  • Going to the bathroom immediately after meals
  • Painless swelling of salivary glands on both sides of the face
  • Not eating in front of other people
  • Metabolic alkalosis or acidosis, depending on the compensatory behavior
Risk Factors
  • Sex. BN is more common in women
  • Age. BN usually starts in late teens and early adulthood
  • Psychological and emotional issues. Anxiety disorders, low self-esteem, stress, poor body self-image, restrictive dieting, boredom
  • Media and societal pressure. Use of thin actors or models by the media and portraying them as popular and successful
  • Nature of work. Athletes, actors, dancers, and models have increased risk for eating disorders
  • Overweight. Overweight patients are prone to start strict dieting to lose weight
Commonly Prescribed Drugs
  • Fluoxetine is the only antidepressant approved for managing bulimia. This can be given to bulimic patients with or without depression. Side effects: insomnia, headache, tremors, fatigue
Treatment and Management
  • BN is usually managed on an outpatient basis. Goals of the treatment include changing their eating habits, changing thoughts on food, and losing or gaining weight safely, if necessary.
  • Cognitive behavioral therapy (CBT) is recommended to manage the intense concern regarding body shape and weight, constant dieting, and the binge eating and purging cycle. Keeping a food diary might be advised to determine the triggers of a binge episode.
  • Interpersonal therapy (IPT) is another form of therapy for bulimic patients. The therapy is more focused on the patient's personal relationships to help the patient divert his/her thoughts from food and body weight.
  • Nutritionist-dieticians can educate on good eating habits and plan nutritious meals to achieve and maintain a healthy body weight.
  • Some patients are hospitalized due to dehydration or tear on the esophagus.
Home Remedies
Doctors to Consult
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