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Bulimia nervosa fact sheet

• What is bulimia?
• Who becomes bulimic?
• What causes bulimia?
• What are signs of bulimia?
• What happens to someone who has bulimia?
• Can someone with bulimia get better?
• Can women who had bulimia in the past still get pregnant?
• How does bulimia affect pregnancy?
• What should I do if I think someone I know has bulimia?
• More information on bulimia nervosa

What is bulimia?

Bulimia nervosa (buh-LEE-me-ah nur-VOH-suh), often called bulimia, is a type of eating disorder. A person with bulimia eats a lot of food in a short amount of time (binging) and then tries to prevent weight gain by getting rid of the food (purging). Purging might be done by:

• Making yourself throw up
• Taking laxatives (pills or liquids that speed up the movement of food through your body and lead to a bowel movement)

A person with bulimia feels he or she cannot control the amount of food eaten. Also, bulimics might exercise a lot, eat very little or not at all, or take pills to pass urine often to prevent weight gain.

Unlike anorexia, people with bulimia can fall within the normal range for their age and weight. But like people with anorexia, bulimics:

• Fear gaining weight
• Want desperately to lose weight
• Are very unhappy with their body size and shape

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Who becomes bulimic?

Many people think that eating disorders affect only young, upper-class white females. It is true that most bulimics are women (around 85-90 percent). But bulimia affects people from all walks of life, including males, women of color, and even older women.  It is not known for sure whether African American, Latina, Asian/Pacific Islander, and American Indian and Alaska Native people develop eating disorders because American culture values thin people. People with different cultural backgrounds may develop eating disorders because it's hard to adapt to a new culture (a theory called "culture clash"). The stress of trying to live in two different cultures may cause some minorities to develop their eating disorders.

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What causes bulimia?

Bulimia is more than just a problem with food. A binge can be triggered by dieting, stress, or uncomfortable emotions, such as anger or sadness. Purging and other actions to prevent weight gain are ways for people with bulimia to feel more in control of their lives and ease stress and anxiety. There is no single known cause of bulimia, but there are some factors that may play a part.

• Culture. Women in the U.S. are under constant pressure to fit a certain ideal of beauty. Seeing images of flawless, thin females everywhere makes it hard for women to feel good about their bodies.
• Families. If you have a mother or sister with bulimia, you are more likely to also have bulimia. Parents who think looks are important, diet themselves, or criticize their children's bodies are more likely to have a child with bulimia. 
• Life changes or stressful events. Traumatic events (like rape), as well as stressful things (like starting a new job), can lead to bulimia.
• Personality traits. A person with bulimia may not like herself, hate the way she looks, or feel hopeless. She may be very moody, have problems expressing anger, or have a hard time controlling impulsive behaviors.
• Biology. Genes, hormones, and chemicals in the brain may be factors in developing bulimia.

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What are signs of bulimia?

A person with bulimia may be thin, overweight, or have a normal weight. Also, bulimic behavior, such as throwing up, is often done in private because the person with bulimia feels shame or disgust. This makes it hard to know if someone has bulimia. But there are warning signs to look out for. Someone with bulimia may use extreme measures to lose weight by:

• Using diet pills, or taking pills to urinate or have a bowel movement
• Going to the bathroom all the time after eating (to throw up)
• Exercising a lot, even in bad weather or when hurt or tired

Someone with bulimia may show signs of throwing up, such as:

• Swollen cheeks or jaw area
• Calluses or scrapes on the knuckles (if using fingers to induce vomiting)
• Teeth that look clear
• Broken blood vessels in the eyes

People with bulimia often have other mental health conditions, including:

• Depression
• Anxiety
• Substance abuse problems

Someone with bulimia may also have a distorted body image, shown by thinking she or he is fat, hating her or his body, and fearing weight gain.

Bulimia can also cause someone to not act like her or himself. She or he may be moody or sad, or may not want to go out with friends.

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What happens to someone who has bulimia?

Bulimia can be very harmful to the body. Look at the picture to find out how bulimia affects your health.

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Can someone with bulimia get better?

Yes. Someone with bulimia can get better. A health care team of doctors, nutritionists, and therapists will help the patient recover. They will help the person learn healthy eating patterns and cope with their thoughts and feelings. Treatment for bulimia uses a combination of options. Whether or not the treatment works depends on the patient.

To stop a person from binging and purging, a doctor may recommend the patient:

• Receive nutritional advice and psychotherapy, especially cognitive behavioral therapy (CBT)
• Be prescribed medicine

CBT is a form of psychotherapy that focuses on the important role of thinking in how we feel and what we do. CBT that has been tailored to treat bulimia has shown to be effective in changing binging and purging behavior, and eating attitudes. Therapy for a person with bulimia may be one-on-one with a therapist or group-based.

Some antidepressants, such as fluoxetine (Prozac), which is the only medication approved by the U.S. Food and Drug Administration (FDA) for treating bulimia, may help patients who also have depression and/or anxiety. It also appears to help reduce binge-eating and purging behavior, reduces the chance of relapse, and improves eating attitudes. ("Relapse" means to get sick again, after feeling well for a while.)

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Can women who had bulimia in the past still get pregnant?

Active bulimia can cause a woman to miss her period sometimes. Or, she may never get her period. If this happens, she usually does not ovulate. This makes it hard to get pregnant. Women who have recovered from bulimia have a better chance of getting pregnant once their monthly cycle is normal. If you're having a hard time getting pregnant, see your doctor.

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How does bulimia affect pregnancy?

If a woman with active bulimia gets pregnant, these problems may result:

• Miscarriage
• High blood pressure in the mother
• Baby isn't born alive
• Baby tries to come out with feet or bottom first
• Birth by C-section
• Baby is born early
• Low birth weight
• Birth defects, such as blindness or mental retardation
• Problems breastfeeding
• Depression in the mother after the baby is born
• Diabetes in the mother during pregnancy

If a woman takes laxatives or diuretics during pregnancy, her baby could be harmed. These things take away nutrients and fluids from a woman before they are able to feed and nourish the baby. It is possible they may lead to birth defects as well, particularly if they are used regularly.

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What should I do if I think someone I know has bulimia?

If someone you know is showing signs of bulimia, you may be able to help.

1. Set a time to talk. Set aside a time to talk privately with your friend.  Make sure you talk in a quiet place where you won't be distracted.
2. Tell your friend about your concerns. Be honest. Tell your friend about your worries about his or her eating or exercising habits. Tell your friend you are concerned and that you think these things may be a sign of a problem that needs professional help.
3. Ask your friend to talk to a professional. Your friend can talk to a counselor or doctor who knows about eating issues. Offer to help your friend find a counselor or doctor and make an appointment, and offer to go with him or her to the appointment.
4. Avoid conflicts. If your friend won't admit that he or she has a problem, don't push. Be sure to tell your friend you are always there to listen if he or she wants to talk.
5. Don't place shame, blame, or guilt on your friend.  Don't say, "You just need to eat." Instead, say things like, "I'm concerned about you because you won't eat breakfast or lunch." Or, "It makes me afraid to hear you throwing up."
6. Don't give simple solutions. Don't say, "If you'd just stop, then things would be fine!"
7. Let your friend know that you will always be there no matter what.

Adapted from "What Should I Say? Tips for Talking to a Friend Who May Be Struggling with an Eating Disorder" from the National Eating Disorders Association.

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More information on bulimia nervosa

For more information about bulimia nervosa, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

• Academy for Eating Disorders
  Phone: 847-498-4274
• American Psychological Association
  Phone: 800-374-2721
• National Association of Anorexia Nervosa and Associated Disorders
  Phone: 847-831-3438
• National Eating Disorders Association
  Phone: 800-931-2237
• National Institute of Mental Health (NIMH), NIH, HHS
  Phone: 866-615-6464

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Content last updated June 15, 2009.

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