Bulimia nervosa – causes, symptoms, diagnosis, treatment & pathology


Bulimia nervosa, often just called bulimia,
is a disorder that is characterized by rapid, out-of-control binge eating past the point
of fullness or comfort, followed by purging either by self-induced vomiting done manually
or sometimes with ipecac syrup, by taking laxatives, or by using diuretics. To fit the diagnosis, these cycles of binging
and purging must repeat consistently at least once a week for a period of 3 months, but
can happen as often as multiple times per day. The onset of bulimia typically happens around
adolescence, usually in individuals with low self-esteem who have a strong desire to have
control over key aspects of their life including their weight. They are often fixated on food, which includes
the amount that they consume as well as the calorie and fat content. The pattern of bulimia is often cyclical with
someone setting unrealistic goals for themselves (like getting a 100 percent on every exam
they take), and when they don’t reach those goals, they binge, and then they purge to
try to ‘fix’ the binging. Individuals with bulimia will also try to
control their weight in other ways—by taking stimulants, by going on extreme diets such
as “water fasts” where they consume only water, and by exercising excessively. These symptoms of binging and purging with
bulimia nervosa can be confused with another eating disorder—anorexia nervosa, where
they might also binge and purge, but the main distinction between these two disorders doesn’t
have to do with this act of binging and purging, but actually has to do with an individual’s
weight. People with bulimia are usually normal weight
or overweight, whereas people with anorexia are underweight. Because of this, people can more easily hide
the fact that they suffer from bulimia, and can also potentially start out with bulimia,
and then develop to anorexia over time. The binging and purging cycles associated
with bulimia can result in a number of serious side effects. Repeated vomiting can lead to erosion 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, and if the vomiting
is forceful enough it can lead to tears of the distal esophagus and stomach itself, which
is called Mallory Weiss syndrome, which can cause abdominal pain and blood to come up
in the vomit, called hematemesis. Over time, vomiting can cause dehydration
and lead to hypotension—a blood pressure below 90/50, as well as tachycardia or a fast
heart rate over 100 heart beats per minute. The purging involved in bulimia can also cause
a depletion of electrolytes which leads to a low level of sodium, chloride, magnesium,
phosphate, and potassium, as well as a general metabolic alkalosis. The low potassium or hypokalemia is particularly
worrisome because it can lead to muscle weakness and even cardiac arrhythmias, the latter of
which can lead to death. Bulimia can also lead to endocrine changes,
the most common of which is menstrual irregularities in women, who might even develop amenorrhea,
where either the normal menstrual cycle stops or menstruation doesn’t start by age 15. In addition, individuals with bulimia are
at higher risk of developing diabetes mellitus, which makes for a particularly dangerous combination. And that’s because the purging part of the
bulimia cycle is a form of food restriction that causes a starvation state for the body’s
cells, and on top of that diabetes makes it more difficult for glucose to enter the body’s
cells at a cellular level, which worsens that starvation state. As far as causes of bulimia go, it’s been
shown to have a genetic component, based on twin and adoption studies. In addition, though, there is also evidence
for a strong social component. Bulimia typically begins in teen years or
in young adulthood, which is a time when individuals usually start to pay attention to the media,
and rates of bulimia are higher for individuals and in societies that have higher exposure
to media. Also, although bulimia is more common in women,
it’s worth mentioning that men suffer from bulimia as well, and in both genders it can
often be seen among athletes and professionals who are keenly focused on their body weight
and percent body fat, like with dancers, models, and wrestlers. Finally, bulimia is also commonly associated
with other conditions like obsessive-compulsive disorder, depression, and anxiety, all of
which have overlapping symptoms and risk factors. Medical treatment with careful nutrition and
weight management is important. But it’s also important to use tools like
psychotherapy and cognitive behavioral therapy to help the individual and his or her family
structure a new relationship around food. For example, teaching a person to eat just
a small amount of a ‘forbidden food’ and then consciously noticing the absence of severe
consequences. Bulimia is sometimes also treated with antidepressant
medications, like SSRIs or selective serotonin reuptake inhibitors, and typically a combination
of therapy with the medication works best for severe cases. Alright so as a quick recap, bulimia is when
somebody goes through cycles of binging and purging at least once a week for 3 months,
but are typically still normal weight or overweight. Thanks for watching, you can help support
us by donating on patreon, or subscribing to our channel, or telling your friends about
us on social media.

100 comments

  1. People can be anorexic and overweight, too. I had been diagnosed with binge eating disorder for a while, but once I stopped, I swung back into Anorexia. I'm overweight but dropping very quickly. I also have all of the signs of Anorexia Nervosa, too.

  2. im overweight but i dont binge or purge but i force myself to not eat for about 6`7 hours and adviod meat or rice during dinner time, and i dont eat breakfast

  3. I didn’t eat anything until like 5 p.m. and I binged then I purged. Then about at 7 I binged again and purged again…I don’t know what the hell is wrong with me…

  4. I don't binge eat as I eat really less but even that, due to my GERD, I had to go and purge each time, couple of hours after every meal !

  5. I don't purge, I often just skip meals, or eat a little amount until I give up and binge.

    I do set really far goals, like becoming the weight of 102 lbs, but I binge when I give up

  6. Any good advice for helping me stop my bulimia I’ve been purging for almost 5 months now when I have told my friends they only say “stop doing that” but I need a good advice someone who would like to help a stranger

  7. i hate that i restrict myself and yet when i actually do decide to eat i just end up committing everything out because the guilt of taking in calories just gets to me

  8. If you consider binge eating 2000 calories or over then i don’t binge eat. But i make myself throw up whenever I eat over 1400 calories or some days i just feel really guilty and make myself throw up. but i never binge eat ..

  9. So informative, thank you. After watching this I realised I need help and got some. Thank you again for helping me realise

  10. I was bulimic for over 7 years . I didn't need my fingers to purge. The food came out on its own. So it took over me for years but I learned about the vegan diet so it helped with my bulimia let's say 6 months I have done better but sometimes when I eat junk my stomach knows so i have to get rid of it if not I feel sick so I stick to vegan diet strict healthy food non fried foods or sweets

  11. Not true, anorexics can be overweight, normal weight, or underweight. Anorexia is a mental disorder. It does not matter what size you are, it is still just as valid.

  12. I’m so confused. I don’t binge but I do purge. I have a restricted 500 cal diet. What does this mean?? I thought this video might be helpful but now I’m just more confused.

  13. I started purging the food I eat since the last three days. It's all started when there's this classmate of mine ask my weight in the classroom 'what is your weight, if you don't mind ..wait you're not mad right if I ask you how heavy you're? You know there's people who don't like to share & ashamed to tell sometimes' ,it's petty if I say I'm mad because of that so I said 'I'm 80kg' then she look at me up & down 'i gain 2 kg when I weighed myself last night it's 52kg, my body felt so heavy I don't think i should eat anything for lunch today even if there's chicken rice set' she laugh then class start… And her word stuck in my head since then… 'I shouldn't eat anything..' 'my body felt heavy' 'you're not mad right if I ask how heavy you're?… '

  14. Has anyone been able to stop on their own? I am way too ashamed to admit it to my family yet really can't handle doing this to myself anymore (it's been 2 years now).
    So if someone has tips on self control that would help me tremendously

  15. I really don’t know what’s going on with me tbh. My friend showed me this video because she knows what I do to myself but the only thing I can do is ask my parents if I could check up with the doctor because they know I purge but they think it’s just a “depression phase” so I have been like this for the past 11 months and I haven’t known what to do since. To make it clear to you I’m 13 and I have no idea what I’m doing with my life and I’m failing my school life miserably so what’s the point?

  16. I really wanna stop purging, I don't binge eat but whenever i eat, I just make myself puke almost everyday. I have lost atleast 8kg and I am glad but I don't wanna lose weight this way

  17. Can you please make a lecture about Anorexia Nervosa ?

    I know it sound the same and the symptoms are similar but they have a slightly difference or can you compare the differences between bulimia nervosa and Anorexia nervosa 😊

  18. I’m worried because my friend has bulimia, and is getting really bad grades, so her bulimia is getting worse. I’m so scared for her

  19. So wait a sec if I don’t purge every single day, how ever I do take laxatives every single day with out a fail, am I bulimic???

  20. The thing is I don't binge…I eat normal sized meals (or the one meal I eat) I just throw it up anyways so I don't feel the disgusting feeling of being "full"

  21. Something bad happens J got really upset so I threw up my food and I did it earlier that day coz I ate alot and I've done it 3 other times

  22. I feel alone in my situation. I don't make myself stop eating or throw up because I hate my body. I do it as a form of self harm. Cutting just didn't work for me anymore. Now It's addicting to throw up after I eat

  23. why don’t u lose weight i don’t understand. In 2 years I have purged after ever meal, I didn’t really lose weight (didn’t gain any either, but I binge quite a lot)

    Like it’s probably better this way, I am already damaging my body enough, but it just doesn’t really make sense..

  24. I think this is what i have. Ive been told that i have very bad eating habits and i didnt know about disorders. I looked into it and this one makes the most sence to me

  25. hiya, can anyone who sees this comment snapchat me as i feel alone atm going throught this and i dont want anyone else to… @ruby.millerr

  26. I don’t wish bulimia also known as HELL on anyone. I’m going on 10 years now. I repeat..TEN YEARS of this torture. I feel for whoever is currently going through this catastrophic depressive situation.

  27. Purging can also be done by excessive exercise or fasting to "fix" a binge.
    Also, anorexia is a different disorder and it also isn't always defined by weight. You could be spreading dangerous misinformation.

  28. I have everything they. Said exept purging i have extrme binging,exersing but do have bulimia then?I don't know if i have bulimia then can anybody tel me

  29. I’m so scared. Lately I haven’t been eating. I only eat dinner and then I try to work out or go to the bathroom. I’m so scared I’m going to get an eating disorder or already have one. Even my friends have started noticing I don’t eat at lunch and all I can say is that I’m not hungry. How can I tell my parents about this?

  30. i binge after every time i eat, it’s getting very out of control and i need help but i don’t know who to go to, but at the same time i don’t want help because i want to keep losing weight…know what i mean?

  31. I was thinking of going bulimic but goddamn there is no goddamn way I will force myself to vomit fucking blood and on top of that fuck over eating when I’m full I’m fuckin full

  32. I wouldn’t wish this disorder on my worst enemy… my health has been slowly deteriorating. But I can’t stop. I can’t stand to look in the mirror anymore

  33. im only 13. i recently found out this was a thing. this started last summer. ive talk to very little people about it. i still dont know how to stop. i go to the gym almost everyday. i make myself vomit after every big event or big dinner or just whenever i feel i ate too much

  34. I started with bulimia for 4 months doing it 2 times a day. I hated myself and wanted to die, but somehow I kept going. My bulimia soon turned into anorexia and I started to loose a lot of weight. I wanted to look normal, but I just started to look less normal. I eat then it comes back up after meals. I still hate myself and have attempted suicide multiple times. I know I’m in a bad place, but I just want to be normal! I haven’t even told anyone, not even my parents about what has happened to me. I feel like life could never get worse, but it always does. I just want to give up.

  35. I eat everything and i drink 6 teabags of biofitea at then i have diarrhea somethimes i take 10 pills of bisacodyl i hate this life i'm ugly and fat my height is 150 cm and i'm 41 kg

  36. what the fuck? u can have eatimg disorder and still be a healthy weight. overweight or underweight your weight doesn’t play a role in diagnosing an ed, it’s ur habits and how u react to food

  37. I will eat regularly- not even binge, but then I feel guilty that I’ve eaten, so I throw up everything 😕.

  38. I think I have this. omg… I'm only 12. I don't know what to do. I don't wanna tell my parents cuz that always think I'm overreacting. I need help. guys, what do I do??

  39. Well isnt someone with anorexia it dosnt have to be physical. Its a mental thing. So couldnt someone have anorexia and bulimia… Orrr

  40. quick short story, back when i had long nails i suffered through bulimia, and whenever i shoved my fingers down my throat it'd hurt for hours and ugh, thinking about it hurts my throat.

  41. I used to binge and purge, but it ruined my teeth, and 3 years later I'm still dealing with it. So now I binge eat 1 day of the week and then eat next to nothing the rest of the week do undo the damage I have done from binge eating that one day

  42. It hurts for me to eat when it’s breakfast or lunch. I say I’m full but when I’m forced to eat I go to privacy and run almost a half marathon . I can’t help it it feels good

  43. I binge eat. I don’t even feel hungry and suddenly I have consumed sooo much food that I want to vomit. But I don’t purge. I’ll just go the following days without food and then binge eat again and feel disgusted and yeah the cycle repeats itself. Is this bulimia nervosa,?

  44. it doesn't have to do with the weight, u don't have to be underweight. i'm normal weight and i'm anorexic. yes u can't see it but it doesn't mean i don't have it. i don't eat anything but when i do i purge.

  45. I have literally all these symptoms and it's all been going on for a month now. I have been purging for two weeks and it just gets worse and worse. My menstruation cycle hasn't came in 2-3 months and I've been lying to my doctor cause I felt embarrassed. My mom doesn't believe me and won't get me the help I need . I want to kms

  46. Bro, I don’t make myself throw up, but I used to I told myself I’d stop. And I did. Now after a week or so, I don’t make myself throw up but I have this sensation in my upper chest ig and it like says if u don’t burp I’ll make it come up myself so I burp and then whatever I eat comes up. And this especially happens after I drink something, do I have bulumia?

  47. I use to be bulimic and you don’t even realize how sick you are until you get help. It’s hell and it ruined my teeth and I had such beautiful white straight teeth.. No matter how much you weigh you’ll never be happy unless you love yourself

  48. I had really bad mental heath problems, they're not as bad now but how I feel about my body isn't better, if anything it's worse. I'm watching this because I've been thinking about doing these things because I don't wanna put on any more weight I feel massive and when I look in the mirror I see something disgusting that I'm fed up of. I hope hearing the concequenes of how bad the disorder can get I hope I don't get these thoughts :((

  49. I have bulimia-I figures it out like two months ago, but like all of my friends joke when they see me eating something like a strawberry at lunch like ‘haha oh hey your eating for once” but they don’t know I have bulimia so irony’s on them ig

  50. I recon I used to have this, I would eat and then vomit then eat and vomit. It sucked very hard, randomly getting hungry and my stomach hurting during class. Using mylanta did help by making me less hungry but it kept happening. All I did was eat little snacks every hour or so and slept with a stacked pillow about 10cm up so you don’t sleep flat down. This lasted about 2 months and I think my body just remember how to god damn digest properly

  51. bulimia and anorexia is two different things. anorexic people tend to starve theirselves and NOT EAT while bulimic people tends to OVER EAT and purge after every meal ( not once a week ! ) .

    but of course when you make an anorexic person eat , he / she would purge it all out. also by saying bulimic and anorexic is differentiate by weight , is super misleading and can cause some people to get triggered.

  52. I binge eat try not to and this is so true about my my exam score and I fr binge eat when I get my test wrong I can’t stop but I swear I NEVER throw up

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