Bulimia nervosa

Bulimia nervosa, or simply bulimia, is a condition characterized by rapid, out-of-control binge eating beyond the point of fullness or comfort, followed by compensatory behaviors to prevent weight gain. These include self-induced vomiting, fasting, excessive exercise, or misuse of laxatives or diuretics. To fit the diagnosis, cycles of binge eating and inappropriate compensatory behaviors must repeat consistently at least once a week for 3 months, though they can occur several times per day.

Bulimia usually begins in adolescence or young adulthood, usually in individuals with low self-esteem who focus heavily on their body shape and weight when evaluating themselves. Often, they experience poor emotional regulation, as well as traits of impulsivity, perfectionism, or compulsivity, which contribute to the condition.

Now, in bulimia nervosa, you can think of binge eating as an unhealthy way of coping with stress and overwhelming emotions. After binge eating, individuals use inappropriate compensatory behaviors to "fix" what they've done and prevent weight gain. Most commonly, they turn to self-induced vomiting, which is also known as purging.

Additionally, they may try to control their weight in other ways, like taking stimulants, following calorie restrictive diets, fasting, or exercising too much. However, when a person reduces calorie intake, they trigger feelings of hunger, increasing the likelihood of additional binge eating episodes, which in turn trigger compensatory behaviors and further caloric restriction. In other words, instead of “fixing” the problem, these behaviors only keep the cycle going.

Now, it’s important not to confuse bulimia nervosa with another eating disorder—anorexia nervosa. The main distinction between the two is that people with anorexia nervosa have an intense fear of gaining weight, so they end up restricting their energy intake to the point of significant weight loss. Eventually, this leads to an abnormally low body weight compared to other people of the same age and sex. On the other hand, people with bulimia are usually normal weight or overweight. Because of this, these individuals can more easily hide the fact that they are struggling with an eating disorder. Finally, keep in mind that in some cases, a person might start with bulimia nervosa and, over time, eventually develop anorexia.

Repeated unhealthy behaviors to avoid weight gain can result in a number of serious side effects. Repeated vomiting can cause erosions of dental enamel; sialadenosis, which is swelling of the parotid gland; and halitosis, or very bad breath. The back of the knuckles can get calloused from using the hand to induce vomiting, which is called Russell’s sign. Additionally, forceful vomiting and retching can damage the mucosal lining of the lower esophagus and upper stomach, causing abdominal pain and blood to come up in the vomit, known as hematemesis. And, when the person is not vomiting, the blood reaches the stomach, where red blood cells break down and hemoglobin gets oxidized. Eventually, this process results in extremely black, tarry stools called melena. This tear in the esophageal lining due to vomiting or retching is also known as Mallory-Weiss syndrome.

Over time, vomiting can cause dehydration and lead to hypotension—a blood pressure below 90/60, as well as tachycardia or a fast heart rate over 100 heart beats per minute.