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Bulimia nervosa is a life-threatening eating disorder that commonly co-occurs with other mental health issues, such as PTSD, anxiety and substance abuse. Characterized by recurring episodes of binge-eating followed purging behaviors, such as self-induced vomiting, the disorder affects millions of Americans every year. Many do not seek help, despite feeling unable to control the binge-purge impulse. Here’s what to know about the disorder and how to get help for yourself or a loved one.  

Who is at Risk for Bulimia?

Bulimia occurs most commonly during adolescence and young adulthood. It affects individuals across all genders, races, and socioeconomic backgrounds. Over a lifetime, between 0.5% of men and 1.5% of women report suffering from bulimia at some point. These percentages convert to about 1.5 million men and 4.7 million women in the United States.

While no group is excluded, some groups will have higher rates of exposure to this eating disorder than others. Athletes who face pressure to maintain a certain physique, such as gymnasts, wrestlers, or dancers, are at higher risk than others. Actors, public figures and others who face public scrutiny of their appearance are also at higher-than-average risk. But internal factors are powerful as well.  

Bulimia commonly co-occurs with mental health disorders, particularly depression, anxiety and obsessive compulsive disorder (OCD). Victims of complex trauma are also at a higher risk of developing eating disorders like bulimia. 

Recognizing Bulimia

Early signs of bulimia may include fluctuations in weight, strict adherence to an exercise regimen, withdrawal from social activities, or a reluctance to eat in front of others. Sufferers might also binge publicly, using exercise or a missed meal to explain the quantity. Over time, secondary behaviors may emerge, such as heavy drinking or use of appetite suppressants such as amphetamines. Notably, many individuals who struggle with bulimia maintain a normal weight. Appearance alone will therefore rarely help friends and family recognize the disorder within a loved one.     

Health Effects of Bulimia 

Long-term, the effects of bulimia are life-threatening. Dehydration and electrolyte imbalance from purging can lead to dizziness, fatigue, low blood pressure, and low heart rate. Other effects from regularly vomiting include a sore throat, tooth decay, gum disease, and stomach ulcers. Women who use bulimia to reduce their weight below healthy levels may experience a lack of menstruation and hormonal imbalance that can lead to hair loss and chronic fatigue. It is important to know that in the long-term, this illness is deadly. Nearly 4% of people with bulimia will not survive. This rate excludes the higher rates of suicide in people who suffer with eating disorders as a whole.

For Friends & Family

If you suspect that a loved one suffers from bulimia, there are some other signs, aside from the physical side effects, to which you can pay close attention. Your loved one may appear uncomfortable eating around other people, disappear after eating a meal, or frequently use mouthwash or chewing gum. He or she may also have an intense concern with physical appearance, demonstrate fluctuating mood swings, or have difficulty concentrating.

Other noticeable signs include feeling cold a majority of the time, contract illnesses frequently, or having a wound that takes a longer time than normal to heal.  

Suffering from a stressful eating disorder has both behavioral and physical signs that are consistent with malnutrition, anxiety, depression, and addiction. If you see any behaviors exhibited that prevent your loved one from functioning well during the day, it is important to seek advice from a professional about how to move forward and get them help.  

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Treatment for Bulimia

Both inpatient and outpatient treatment programs have proven to be effective, but in either case, treatment programs should include an emphasis on behavioral therapy in addition to physical recovery. Cognitive behavioral therapy (CBT), for example, helps clients develop healthy coping mechanisms in response to binge triggers and identify new ways to handle stress. Through behavioral therapy, clients can also explore the subconscious beliefs they harbor that contribute to self-destructive behaviors.  

When bulimia co-occurs with mental health disorders or other behavioral health issues, it is important to seek dedicated treatment at a facility equipped to manage co-occurring disorders. If you or a loved one suffers from bulimia alongside depression, anxiety, substance use, or other disorders, call us to learn more about our experience and treatment approach to co-occurring disorders. 

Written By: Sprout Editorial Team

The Sprout Health Group editorial team is passionate about addiction treatment, recovery and mental health issues. Every article is expert-reviewed.