Bulimia - Medical Experts

Bulimia is a mental illness and belongs to the group of eating disorders. Colloquially, it is known as “binge-purge disorder.” In the World Health Organization’s (WHO) ICD-10 diagnostic classification, bulimia is coded under code F50.2. 

The disorder primarily affects women; estimates put the proportion at 90–95 percent. Teenage girls and young women in particular (risk group: ages 15 to 35) are prone to this disorder. Bulimia is often accompanied by an increased focus on achievement and self-doubt. As a result, those affected are under increased pressure.

In some cases, bulimia follows a period of anorexia that has been overcome. Or anorexia patients repeatedly experience bulimic episodes because they are unable to stick to their strict diet regimen.

While patients with anorexia voluntarily restrict their food intake, bulimia leads to binge-eating episodes. During a binge, those affected consume foods that are particularly high in fat and sugar. In doing so, they may consume as many as 10,000 calories.

To prevent weight gain, patients use various strategies:

• Inducing vomiting
• Taking laxatives or appetite suppressants
• Fasting
• Excessive exercise

Between binge-eating episodes, those affected reduce their food intake, which is why they tend to experience weight fluctuations. Unlike anorexia, patients with bulimia nervosa are often of normal weight.

During binge-eating episodes, those affected experience a loss of control. When they induce vomiting, they feel a brief sense of relief. Generally, people with bulimia are ashamed of their eating behavior and suffer from feelings of guilt. Their self-esteem declines. It is a vicious cycle.

Psychological symptoms of bulimia include:

• Emotional outbursts of an aggressive or desperate nature
• Withdrawal
• Depression
• Boredom (inner emptiness)
• Severe inner tension

Patients with bulimia usually experience a constant sense of shame or guilt. This leads to a distorted, negative self-image.

Binge eating followed by vomiting is typical of bulimia @ Monkey Business /AdobeStock

Bulimia is not immediately obvious because patients with binge-purge disorder are predominantly of normal weight. Nevertheless, there are typical signs that may indicate the onset of bulimia nervosa:

• Increased interest in nutrition and the calorie content of food
• Eating only “healthy” foods
• Patients avoid main meals
• Dissatisfaction with one’s figure and appearance
• Performance orientation
• Increased physical activity
• Social withdrawal
• Menstrual irregularities

If you know someone who exhibits these signs, please talk to them about it. Alternatively, you can also confide in your family doctor.

If you’re not sure how to bring up the topic, visit the website of the Federal Center for Health Education. You’ll find comprehensive information there.

It often takes a long time before a patient receives a diagnosis of bulimia nervosa. The reason: Although those affected suffer greatly from the illness, they avoid seeing a doctor because they feel ashamed.

A specialist or psychologist can make a reliable diagnosis. To do so, they first take a detailed medical history (anamnesis).

To diagnose bulimia, the person must experience two binge-eating episodes per week over a period of at least three months. At the same time, the patient resorts to various measures to prevent weight gain.

In medicine, bulimia is classified into purging and non-purging types:

• Those with the purging type, for example, use appetite suppressants, diuretics, or induce vomiting regularly to compensate for their binge eating.
• The non-purging type uses fasting, dieting, or intense exercise to maintain their weight.

Distinguishing bulimia from other eating disorders (differential diagnosis) can sometimes be difficult. Some patients with anorexia also experience episodes of bulimia, for example, when they are unable to maintain their strict food restriction.

The specialist must rule out other mental disorders (depression, anxiety disorders, suicidal ideation). In addition, the doctor assesses the patient’s physical condition. To do this, the doctor orders, among other things, a comprehensive blood test and checks heart function using an ECG.

The course of treatment can be monitored using psychological assessment tools such as the “Structured Interview for Anorexia and Bulimia Nervosa.”

Bulimia nervosa has serious consequences:

• Regular vomiting corrodes the mucous membranes in the mouth and esophagus. It also promotes reflux (acidic stomach contents flow back into the esophagus). The teeth are also damaged by stomach acid.
• Laxatives disrupt the function of the gastrointestinal tract and may lead to nutrient deficiencies. Potassium loss, in particular, is dangerous; it can trigger life-threatening cardiac arrhythmias. Diuretics damage the kidneys.
• In addition to the medical aspects, the long-term consequences (such as yellow or decayed teeth) create additional psychological and financial burdens.

In many cases, inpatient therapy at a psychosomatic clinic is recommended. The treatment of bulimia nervosa consists of various components (multimodal treatment):

• The focus is on individual and group psychotherapy sessions. Patients receive comprehensive information about their condition (psychoeducation). 
• In addition, the goal is to critically examine one’s own expectations and values and to build a positive self-image. Those affected learn to recognize their needs and feelings and to deal with them appropriately. 
• Nutrition and exercise play an important role in this process. For example, cooking groups are held where participants eat together. The participants support one another to avoid falling back into old patterns. Specialized staff accompany and support the group during this phase.
• In exercise groups, physical therapists guide patients back toward moderate and healthy physical activity.
• For some patients, attending a self-help group can be helpful. There, participants can share experiences and offer each other support. When choosing a group, pay attention to who leads it. Suitable leaders include professionals or individuals who have recovered from the condition and are now stable. Otherwise, there is a risk that the group will exacerbate the illness rather than combat it.

The success of treatment depends, on the one hand, on the severity of the bulimia and, on the other hand, on the extent of any comorbid conditions. People with bulimia usually also suffer from panic disorders, social phobias, depression, or substance use disorders.

An important factor in whether the patient recovers is their recognition of the illness. Those affected must acknowledge the problem and be willing to break the vicious cycle. 

In some cases, antidepressants are also prescribed. These not only affect mood but also alleviate binge-eating and purging episodes. In the long term, those affected are able to lead a normal life.

Since eating disorders cannot be clearly distinguished from one another, the information on anorexia and eating disorders may also be helpful to you.