Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by overeating (bingeing) and then purging to get rid of the calories consumed. A person with bulimia fears gaining weight, yet has an uncontrollable compulsion to binge on foods. After bingeing, the person employs unhealthy methods to rid the body of the calories: vomiting; frequent use of laxatives, water pills, or enemas; fasting; or extreme exercise. Purging after bingeing begins as a means of weight-control, but the bingeing and purging behaviors paradoxically become habitual and out of control.

Signs and symptoms of bulimia?

People who have bulimia are very secretive about their bingeing and purging, so others may not notice the signs and symptoms of the eating disorder. Some symptoms of bulimia are so subtle that only a medical professional would notice them. Surprisingly, being underweight is not a characteristic sign of bulimia, even though people with bulimia are afraid of being too fat. Individuals with bulimia often are of normal weight or overweight because they eat a lot.

The warning signs and symptoms of bulimia include:

• Secrecy surrounding eating and the time period after eating, to allow for bingeing and then purging. Frequent trips to the bathroom after meals, signs and/or smells of vomiting, evidence of laxatives or diuretics. Going to the kitchen after everyone else has gone to bed to binge. Going for unexpected walks or drives at night. Excessive desire for privacy in the bedroom or bathroom.
• Odd eating behaviors, such as avoidance of eating with others; unpredictable and sudden dietary likes and dislikes; skipping of meals; taking very small portions when eating with others; consuming a lot of water or diet soda (to make vomiting easier); cutting food into very small bites; chewing food excessively; separating different types of food on the plate; strange pairings of foods.
• Eating unusually large amounts of food, with no apparent change in weight. The disappearance of large amounts of food, or numerous empty wrappers or containers in the garbage.
• Excessive, rigid exercise regimen – However, it is difficult to distinguish a serious athlete from an athlete with bulimia. Both may train excessively and not eat enough to compensate for the caloric usage
• Complex lifestyle schedules or rituals to make time for binge-and-purge sessions. Typical behaviors are using mints or gum to cover up the smell of vomit, running water in the bathroom to conceal the sound of vomiting, or always going to the bathroom after meals.
• Poor body image; preoccupation with body weight, weight loss, dieting, and control of food – Wearing of baggy clothes to hide the body. A distorted body perception. Avoidance of looking in mirrors.
• Discolored or callused finger joints or backs of the hands – Jamming the fingers down the throat to induce vomiting may damage the outer surfaces of the hands.
• Tooth and mouth problems, such as discolored and decalcified teeth, and sensitive, swollen, and bleeding cheeks and gums. These are caused by vitamin deficiencies and by the stomach acid that comes up with vomit.
• Stomach pain and intestinal irregularities, such as constipation and diarrhea.
• Irregular or nonexistent menstrual periods (in females).

Types of bulimia

There are two types of bulimia, based on how the person with bulimia compensates for the binge eating:

• Purging type of bulimia - The person induces vomiting or uses a diuretic, laxative, or enema to purge food from the body, as a compensation for bingeing.
• Nonpurging type of bulimia - The person with bulimia does not purge food from the body, but instead fasts or engages in excessive exercise to use up calories.

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