Causes of Bulimia

Bulimia nervosa is an eating disorder that affects 0.5% of males and 1.5% of females in the United States and is characterized by binging and purging behavior. Binging is described as eating an excessive amount of food within two hours while purging is the self-induced behavior to rid the body of calories consumed during the binge. Bulimia nervosa, like other eating disorders, are multifactorial, meaning there are many causes of bulimia that can contribute to this disease and they can include genetic factors, neurochemical imbalances, and environmental stressors such as exposure to trauma or abuse. Other psychological and emotional issues such as an anxiety disorder, depression, and low self-esteem are also known triggers in a person who is predisposed to having an eating disorder. The nature of our culture that is hyperfocused on thin-ideal internalization and general social pressure for thinness can also serve as a trigger for susceptible individuals. Other risk factors that have been identified for bulimia nervosa include substance abuse, feelings of inadequacy, experiencing early puberty, having too little to eat during childhood, psychiatric symptoms, and low appetite and emotional awareness. Individuals may be up to 10 times their daily nutritional value during one binge episode. Self-induced vomiting, laxative use, diuretic use, and excessive exercise are examples of purging mechanisms associated with bulimia nervosa.

Complications associated with bulimia nervosa

  • Electrolyte abnormalities (from laxative and diuretic abuse as well as vomiting)
  • Fluid loss resulting in dehydration (from laxative and diuretic abuse as well as vomiting)
  • Gastric reflux disease (from self-induced vomiting)
  • Internal bleeding secondary to esophageal and gastric tears (from self-induced vomiting)
  • Severe fluctuations in weight
  • Nutrient depletion (from laxative and diuretic abuse as well as vomiting)
  • Rebound constipation (from laxative use)
  • Digestion complications (from laxative use)
  • Dental cavities (from self-induced vomiting)
  • Excoriations on back of hands (from self-induced vomiting)
  • Cardiac complications from electrolytes abnormalities
  • Amenorrhea (loss of menstruation)
  • Sore throat (from self-induced vomiting)
  • Hoarse voice (from self-induced vomiting)
  • Swollen salivary glands (from self-induced vomiting)

Risk factors and warning signs for bulimia nervosa

Individuals with bulimia nervosa will often try to hide their disorder out of fear of being judged or rejected by others, and therefore it may be difficult to recognize if a suspected eating disorder is present within this population unless you are well versed in recognition of the warning signs and risk factors.

  • Social isolation
  • Change in mood or personality
  • Refusing to eat in front of people
  • Continually talking about weight or food
  • Impulsive behaviors
  • Excessive or new substance or alcohol use
  • Striving for perfectionism
  • Intense fear of weight gain
  • Obsession with body image
  • Compulsive behaviors such as counting calories and tracking weight
  • Distorted body image
  • Participating in ritualistic behaviors while eating a meal
  • Frequently weighing oneself
  • Isolating oneself from the outside world
  • Refusing to wear revealing or bright colored clothing
  • Food hiding or hoarding
  • Obsession with neutral and baggy clothing