Feb 27

Bulimia Nervosa

Happy Monday, and welcome to Medical Mondays! February 23 to March 1 is National Eating Disorders Awareness Week here in the United States, so I’m going to talk about bulimia nervosa this week.

(Trigger warning!) As with anorexia nervosa, I’m only going to be going into the facts that I’ve learned about it.

Bulimia Nervosa

Bulimia nervosa is an eating disorder that involves binge eating combined with behaviors that are focused on counteracting weight gain. Although self-induced vomiting is the classic example, the use of laxatives, enemas, diuretics, or excessive exercise are also possible behaviors.

Persons with bulimia are often embarrassed by their binge eating, and are overly concerned with their body weight. Like with anorexia, bulimia nervosa is significantly more common in women (90-95%), and usually occurs in late adolescence or early adulthood, with a peak onset at ages 18-19.

This eating disorder is more common in developed countries, and there is a higher incidence of comorbid mood disorders, anxiety disorders, impulse control disorders, a history of sexual abuse, and/or substance abuse. There is often coexisting alcohol dependence and emotional lability, but they more readily seek help (as compared to persons with anorexia nervosa).

Bulimia nervosa must be distinguished from purging behavior, which is a behavior usually learned from peers and is short-lived, infrequent, and unassociated with physical symptoms (will be listed below).

There are two sub-categories:

  • Purging: involves vomiting, laxatives, enemas, diuretics
  • Non-purging: involves excessive exercise or fasting


  • Recurrent episodes of binge eating (excessive food intake within a 2-hour period with a sense of lack of control)
  • Recurrent + inappropriate attempts to compensate for overeating to prevent weight gain (e.g. laxative abuse, vomiting, diuretics, excessive exercise)
  • Binge eating + compensatory behaviors occur > 2x/week for 3 months
  • Perception of self-worth is excessively influenced by body weight + shape
  • Behavior doesn’t only occur during an episode of anorexia nervosa

Clinical/Lab Findings

  • Sialadenosis (salivary gland enlargement)
  • Dental erosions/caries (cavities due to self-induced vomiting)
  • Callouses/abrasions on dorsum (back) of hand – “Russell’s sign” from self-induced vomiting
  • Esophageal tears (Mallory-Weiss syndrome) and rupture (Boerhaave syndrome)
  • Petechiae (tiny pinpoint bruises)
  • Peripheral edema
  • Aspiration
  • Laxative abuse (e.g. bisacodyl, cascara, senna, high-fiber supplements) is very common in patients with bulimia nervosa, which can lead to severe constipation due to damaging effects on myenteric plexus
  • Caffeine, pseudoephedrine, phenylpropanolamine, Synthroid, + diuretics may also be used to try to increase metabolic rate, calorie + weight loss (less common than laxatives, which are available over-the-counter)
  • *Ask patients with bulimia about their use of natural herbal substances, as these agents can have profound effects on HR + BP


  • Nutritional rehabilitation
    • The patient should have regular, nutritionally balanced meals to replace the pattern of fasting, then binging with vomiting
    • This should be supplemented with nutritional counseling
  • Antidepressants + therapy (this combination is more effective in treating bulimia vs. anorexia)
    • First-line = SSRI [selective serotonin reuptake inhibitor])
    • Topiramate has been shown to be  helpful for refractory bulimia
  • Cognitive-behioral therapy, interpersonal psychotherapy, group therapy + family therapy
    • Teach patient to deal with the underlying thought processes that drive bulimia
    • Without psychotherapy, purging behaviors can return
  • Avoid Welbutrin (buproprion) + check medications to make sure the patient isn’t on any medications that could lower their seizure threshold

I came up with this design ages ago for our class t-shirt contest! :]
Disclaimer: The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)

Permanent link to this article: http://www.fairyburger.com/bulimia-nervosa/


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  1. Julie @ Running in a Skirt

    It’s so sad how many women/girls deal with this! Thanks for raising awareness!
    Julie @ Running in a Skirt recently posted…All Things Wedding Planning – Weekend Photo DumpMy Profile

    1. Farrah

      Agreed. :[ I’m glad there’s a lot more help available now though!

  2. Diana

    Thank you for sharing this!! I have struggled with eating disorders my entire life and am finally at a great point in my life , I try to focus on and promote Body acceptance, no matter what size. I am always available to support anyone that needs a shoulder to cry on, or just an ear 🙂 I have been there and the best thing I have done for myself, is admitting I had a problem <3

    Always love your meaningful and informative posts F!

    1. Farrah

      Thanks, Diana! I’m so glad that you’re at a good point in your life now, and that’s so awesome of you to offer your support/shoulder/ear–that makes such a big difference! <3
      Farrah recently posted…Turkey Sausage Mushroom Pizza with Sourdough CrustMy Profile

  3. Edye

    As someone who has struggled with disordered eating, I admire you for spreading awareness, Farrah! Wishing you a wonderful week <3
    Edye recently posted…FitSnack Unboxing – Jan ’17My Profile

    1. Farrah

      Thanks so much, Edye! <3 All the best to you as well!
      Farrah recently posted…Turkey Sausage Mushroom Pizza with Sourdough CrustMy Profile

  4. Kaylin@EnticingHealthyEating

    Just like Edye said, as someone else who has struggled with disordered eating in the past I appreciate your efforts to bring more awareness to these issues. It was partly due to reading others’ blogs and stories online about how they knew they were struggling with an eating disorder that helped me realize what I was doing was not healthy.
    Kaylin@EnticingHealthyEating recently posted…Frozen Fruit Salad CupsMy Profile

    1. Farrah

      Sending you lots of love! <3 I'm glad that you're in a good place now though, and I'm glad there are a lot more bloggers writing about their experiences online now–I think that's definitely been helpful with raising awareness!
      Farrah recently posted…Turkey Sausage Mushroom Pizza with Sourdough CrustMy Profile

  5. ShootingStarsMag

    Great post. Talking about eating disorders is really important, especially because you can have one without realizing it.

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    1. Farrah

      Farrah recently posted…Turkey Sausage Mushroom Pizza with Sourdough CrustMy Profile

  6. Mary

    Thank you for sharing this Farrah, bulimia nervosa is not a fun topic to discuss but I enjoy being educated and learning facts, not myths or opinions. Have a great week. 🙂
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    1. Farrah

      Thanks so much, Mary! I hope you have a great week as well!
      Farrah recently posted…Turkey Sausage Mushroom Pizza with Sourdough CrustMy Profile

  7. Esther

    Farrah, I can not thank you enough for sharing on this topic.
    It is near and dear to my heart. Today I am 9 years free and although it has not been easy, it has def been worth it!

    1. Farrah

      I’m so happy for you! Sending you much love, and thank you for your posts as well! <3
      Farrah recently posted…Turkey Sausage Mushroom Pizza with Sourdough CrustMy Profile

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