What is Bulimia nervosa, its symptoms and what prevention?


Bulimia nervosa is an eating behaviour disorder (ED) characterised by people who suffer from it tend to binge recurrently, in which they eat large amounts of food quickly. 

Bulimia is a disease with a great female predominance. It affects about nine women for every man, whose appearance has been slightly advanced in time and usually appears between 16 and 20 years of age. 

In the last decade, the prevalence and incidence have remained stable. Bulimia nervosa is estimated to affect approximately 2% of the population. In addition, around 4% of the population has unspecified eating disorders, of which “some engage in binge eating or purging behaviours, but do not have the complete diagnostic criteria for bulimia nervosa.   

People with bulimia tend to restrict their eating to lose weight. However, hunger and impulsiveness, as part of a deeper psychological malaise, lead them to binge drink. “This generally occurs in the afternoon-night,” says Díaz Marsa. Precisely the foods that star binge eating and that they eat in large quantities are usually those they try to avoid: sweets, pastries, pasta, and bread.

Binge eating leads to a great feeling of guilt, “which leads them to consume laxatives, exercise excessively or carry out purging behaviours. The latter produces a loss of electrolytes, such as sodium and potassium, which can put them at risk of cardiac disorders, hypotension, and physiological changes that can be life-threatening or have serious physical consequences.


Bulimics try to hide purging behaviours, so the disease usually goes unnoticed for a long time as they do not present weight reductions as large as anorexia. The typical symptoms of bulimia are the following:

Binge eating or overeating: The person eats a large amount of food in a very short time and has no control over the intake. The goal of binge eating is to fill yourself up. Patients try to avoid places where there is food and try to eat alone, so their behaviour is usually asocial. They tend to isolate themselves, and food is their only topic of conversation. In addition, the lack of control over food produces great feelings of guilt and shame.

Use of laxatives: To prevent weight gain and compensate for binge eating or excessive eating, the patient causes vomiting, uses laxatives, diuretics, drugs, or resorts to other means to control his weight, such as the abusive practice of sports activities.

Repetition: Cycles of binge eating and vomiting occur twice a week.

Low self-esteem.

In addition, the general manifestations can be distinguished:

psychological alterations

Patients with bulimia nervosa are characterised by high impulsiveness and low self-control. This can cause that, in addition to binge eating, bulimics tend to get into dangerous situations or get into arguments easily, having big mood swings.

Also, how often does low self-esteem lead to symptoms of depression and anxiety and alcohol and drug abuse or non-substance addiction?  

physical symptoms

The physical signs that show the disease are weakness, headaches; swelling of the face due to the increase in the salivary glands, especially the parotid glands, problems with the teeth, dizziness, hair loss, menstrual irregularities, and sudden increases and decreases in weight, although they generally do not suffer a weight oscillation as important as the manifested in anorexia. Bulimia can be accompanied by other disorders, such as sexual promiscuity.

The clinical consequences are:

  • Arrhythmias can lead to heart attacks.
  • dehydration
  • Irritable bowel and megacolon.
  • Gastroesophageal reflux.
  • hiatal hernia
  • Dental cavities.
  • Bone loss.
  • Oesophageal perforation.
  • Gastric ruptures.
  • Pancreatitis.

Warning signs for families

According to the head of the Unit for Eating Disorders at the Clinical Hospital in Madrid, certain behaviours can make parents suspect a problem in their children related to bulimia. These would be: 

  • Go to the bathroom immediately after eating.
  • The disappearance of food in the home.
  • Avoid sitting down to eat with the family but eat later in secret and impulsively.
  • Avoid social contacts if they are accompanied by food.

Alterations in dental enamel. On many occasions, the dentist alarms that there may be a picture of bulimia when checking the deterioration in the dental enamel -produced as a result of purging behaviours- in a routine visit or for other reasons.

Character changes.

“Patients are emotionally unstable. They can show other impulsive behaviours, such as self-harm or excessive shopping, which often translates into emotional and character instability and irritability, which their families can detect.


The prevention of bulimia has to be carried out with a multidisciplinary approach. The specialists highlight the importance of social prevention and the collaboration of models, designers, television presenters, advertisers and athletes, among other professions, to reduce the messages sent to the population that irresponsibly affect weight loss. And misleading and in clothing sizes.

At the family level, it is advisable to insist that families follow a balanced diet, such as the Mediterranean diet. However, that obsession with diet, weight or body image is avoided.

On the other hand, it is recommended that parents do not overprotect their children. This will facilitate the adolescent’s autonomy, and he will be able to solve problems and make his own decisions.

Finally, children can be educated about food and nutrition and foster self-esteem and social and communication skills.

Bulimic people are characterised by great impulsiveness and low self-control: they cannot stop eating.

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