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Bulimia Nervosa: Signs, Symptoms, and Treatments

Friday, August 8, 2008 - 3:47pm

By Donna Feldman, MS, RD

Thanks to the recent publicity about starving fashion models, there has been plenty of media coverage on the dangers of eating disorders. Most people could recognize the skeletal look of anorexia. However, the equally serious eating disorder, bulimia nervosa, is notoriously hard to spot. Friends and parents may be suspicious, but without clear symptoms, may be unable to recognize bulimia.

Bulimia Basics

A bulimic tries to control food intake and body weight by establishing all manner of rigid rules on types and amounts of food to eat or avoid. She could spend all day thinking about this. When any of these rules are broken, an out-of-control binge-eating episode can result. After bingeing, the feelings of self-loathing lead to vomiting or laxative abuse, or compensatory exercise. The vicious cycle starts over, as the bulimic returns to the rigid food rules, and inevitably spirals into another binge.

Finds Books on Bulimia:

- Treating Bulimia
- Understanding Bulimia
- Teens and Bulimia
- Eating Disorders

The binge eating and purging are secretive behaviors. There are few outward signs of bulimia. Unlike with anorexia, the bulimic person is probably normal weight, or even slightly overweight. What is similar is the obsession with weight and body image, and the extreme desire to restrict eating. Bulimia is not simply an alternative method of dieting. It is considered a mental illness. It is related to depression and is worsened by chaotic family or social circumstances.

Diagnostic Criteria

The diagnostic criteria used by health professionals who work with suspected bulimia nervosa patients include:
- Recurrent episodes of binge eating, or eating an amount in a short period of time that is clearly larger than what a normal person would eat and being embarrassed by the amount.
- Recurrent compensatory behaviors after bingeing to prevent weight gain, such as vomiting, laxative abuse, enemas, fasting, or excessive exercise.
- These episodes occur at least twice a week for 3 months.
- Fixation with body weight and shape, with sense of self-worth based on weight or shape. 1,2

The one health care professional who can see unmistakable signs of bulimia is the dentist.  Frequent vomiting erodes tooth enamel, especially on the back of the upper teeth. There may be other signs of irritation in the mouth as well. While many dentists will discuss these issues with the patient, or with parents, many do not. Dentists are not obligated to report suspected bulimia to parents. Some bulimics avoid visiting the dentist in order to hide their condition. A concerned parent should be proactive and request the dentist’s opinion.

Other Signs of Bulimia

Friends and family members may suspect someone is bulimic based on other signs and behaviors:

  • Hiding in the bathroom after meals, with water running to mask sounds.
  • Fixation on weight, shape, and appearance in conversation.
  • Rigid food rules and/or periodic fasting.
  • Entire life structured around eating and exercise.
  • Compulsive or excessive exercise.
  • Empty laxative packages.
  • The smell of vomiting.

Some of these signs could be due to the temporary food fetishes of a typical teenager, or could be misinterpreted by worried parents. An athletic teenager in training for a sport may seem to be compulsively exercising, but is not. Some signs, like the smell of vomit or empty laxative packages, clearly are significant.  

What to Do?

Uncontrolled bulimia is not a benign problem. Severe electrolyte imbalances caused by vomiting can lead to dangerous medical conditions. Do not fail to act because you are embarrassed by what other people might think about the behaviors. Some therapists recommend opening a non-judgmental discussion with the bulimic person, expressing your own worry about what you have noticed.

Meanwhile, investigate local resources for psychological and medical intervention, including local treatment centers or referral lists. Sometimes school systems have resources for parents. All eating disorders should be treated by a team of health professionals, led by a mental health expert who specializes in eating disorders. The team should also include a physician and registered dietitian.


Bulimia nervosa is just as serious as anorexia. The stigma associated with purging and binge eating makes it more embarrassing. The bulimic may deny there is a problem. Friends and family have to be persistent and diplomatic, while encouraging appropriate and necessary professional intervention.

*This article is intended for general information purposes only, is not individual-specific, nor is it intended to replace the advice of your healthcare team.

The Final Frontier......uh.....Plateau

Submitted by Carolyn on Tue, 05/06/2008 - 9:30am.

Good Tuesday Morning:

I've been stuck (as you all know) at a weight plateau for sometime now. So I focused on reading labels and going back to what worked before - "cleaning and dancing". I had gotten away from that enjoyable pasttime due to outside commitments. I have greatly reduced the number of fat grams that I consume daily as I have learned that not all calories are equal. Those dreaded fat calories go right to my....well, let's just call it the old fat farm. Lots of protein, fiber and good carbs. I've now expanded my music library to include not only the Eagles, but Matchbox 20 and Hootie and the Blowfish. My neighbors are loving it I'm sure.

The BIG 58!!!!

Submitted by Carolyn on Tue, 04/29/2008 - 7:47am.

OK.......so tomorrow is a big day for more than one reason. It is the "cut off" date for chocolates and I'm SAFE until Halloweeen. From May through the end of October it is way too hot for chocolate in Florida and there are no summer holidays that celebrate dark chocolate. It's now fresh fruit and refreshing sugar free beverages for me!!!!

It's also my 58th birthday. It's time to take a look back at the last year. I'm still trying to move forward and let go of the bad habits that kept me from living and enjoying life.

After my husband's death, I promised myself that I would live everyday as if it was my last. This meant being GOOD to myself, taking care of my health, losing weight (PERMANENTLY) and maybe, on a really good day, help someone do the same. The last year has presented many opportunities to get the word out, including the Today Show appearance and my Diet Channel blog. I also realized that my weight loss story is my new "purpose". I have been given this opportunity to help others and I have a new found passion.

Why I Love Mexico

Submitted by Carolyn on Wed, 04/02/2008 - 7:28am.

If you've ever been to Mexico, you know that the weather is perfect, the people are warm and wonderful, the beaches are fabulous and the food is, for the most part, fresh out of the sea and very unique. I've had the opportunity over the past two years to visit various locations in Mexico with my personal favorites being San Jose del Cabo and Todos Santos. San Jose del Cabo is a beautiful city on the Sea of Cortez with a very quaint downtown area that includes art galleries, restaurants, churches and fishing. I have learned to enjoy fishing and can add "having caught a 142 pound blue marlin" to my resume.

Spring Into Action

Submitted by Carolyn on Fri, 03/28/2008 - 8:27am.

OK - NO MORE EXCUSES. The chocolate holidays are behind us, the spring flowers are in bloom (tulips are my favorite) and the weather dictates that hiding under sweats and long sleeves will only cause heat rash!!!! Let's take a long, hard look at our short term AND realistic goals. I have always held to the belief that I have TEN POUNDS to lose. Yes, it's true, I have lost ten pounds ten times but I never looked at the overwhelming prospect of losing 100 pounds. Let's look at a ten pound weight loss with a REALISTIC goal of May 15th. This is a little more than a pound a week. To break that down even further, it's about 4000 calories LESS per week.