Bulimia Nervosa

What is it?

Bulimia nervosa is an eating disorder characterized by out-of-control eating offset by fasting, extreme exercise, or purging (getting rid of food by self-induced vomiting or other means). Children with bulimia can have a healthy weight—or be overweight—but aren’t healthy. Like anorexia, girls are more often diagnosed with bulimia than boys. Societal norms of appearance promoted in the media could contribute to bulimia, which is typically diagnosed in late adolescence or early adulthood.

Signs and Symptoms

A child with bulimia nervosa may have a healthy weight for her age and appear to eat normally, but is secretive about her eating habits. Symptoms include dehydration and acid reflux from frequent vomiting, sore throat, swollen glands, and deteriorating teeth due to contact with stomach acids. A child with bulimia may excuse themselves suddenly from the dinner table or make regular trips to the bathroom right after eating. An unrealistic body image is a sign of bulimia, as with anorexia. Bulimics often binge and purge in private.

Diagnosis and Treatment

A child with bulimia nervosa consumes much more food than average (a binge eater) and feels out of control while binging (sometimes described as an “out-of-body” experience). Diagnosis requires that the child react to eating inappropriately, either by self-induced vomiting, off-label use of laxatives or diuretics, fasting, or excessive exercise. The binging and compensating behavior must occur about once a week for 3 months. The child’s self-image is dominated by body weight and appearance.

Behavioral management is the primary treatment for bulimia. A professional can address the purging and ensure that the patient is healthy before moving on to more long-lasting interventions. Therapy can help children learn how to change disturbing thoughts about body image and eating habits.

If behavioral therapy is not successful, antidepressant medications—particularly selective serotonin reuptake inhibitors (SSRIs)—can help. Nutrition education may be necessary to convince someone with bulimia of the disastrous effects of her disorder.

What are the risk factors for children?

Children with weight concerns, low self-esteem, and anxious temperaments are more likely to develop bulimia, as are children who have been sexually or physically abused. Childhood obesity and early puberty are risk factors. The disorder is more common among children with a family history of bulimia.

Children with bulimia are at increased risk for depression, obsessive compulsive disorder, and substance abuse. Like anorexia, the unhealthy behaviors associated with bulimia can lead to severe medical problems, even death or suicide. Associated conditions include irregular heartbeat and heart failure, tooth decay, and severe digestive problems. Individuals with bulimia are also susceptible to alcohol and drug abuse.

The onset of bulimia is later than anorexia. Anorexia presents around 14, while bulimia presents around age 18 or 19. It can show up earlier and later. Many people with bulimia find that they can effectively manage the desire to binge and purge after treatment, but it’s a lifelong undertaking.