Individuals with bulimia nervosa have repeated episodes of binge eating. That is, they eat much larger amounts of food than most individuals would eat in a similar time under similar circumstances.
The amount considered excessive for a normal meal may differ from the amount considered excessive for a holiday meal.
Emotional stress often triggers the binges, which are usually done in secret.
Binge eating, which is accompanied by a feeling of a loss of control, usually includes eating when not hungry and eating to the point of physical discomfort.
Individuals tend to consume sweet, high-fat foods, such as ice cream and cake.
The amount of food consumed varies and sometimes involves thousands of calories.
Binges may occur as often as several times a day.
In an attempt to counteract the effects of the excess food, individuals use various means to compensate:
- Purging, for example, by:
- Making themselves vomit (self-induced vomiting); or
- Taking laxatives or diuretics (drugs that cause the kidneys to excrete more water);
- Rigorously dieting or fasting;
- Overexercising; and
- Any combination of the above.
Many also take diuretics to treat perceived bloating.
Unlike in anorexia nervosa, the body weight of individuals with bulimia nervosa tends to fluctuate around normal. Only a few are overweight or obese.
Unlike in binge eating disorder, individuals with bulimia nervosa try to compensate for excessive eating by purging or other means.
Self-induced vomiting can erode tooth enamel, enlarge the salivary glands in the cheeks (parotid glands), and inflame the esophagus. Vomiting and purging can lower potassium levels in the blood, causing abnormal heart rhythms.
Sudden death can result from an abnormal heart rhythm in individuals who repeatedly take large quantities of ipecac to induce vomiting. Rarely, during a binge or purge, the stomach ruptures or the esophagus tears, leading to life-threatening complications.
Individuals with bulimia nervosa are be preoccupied with and judge themselves based on their weight and body shape. Their self-esteem is largely based on their body weight and shape.
Compared with individuals who have anorexia nervosa, those who have bulimia nervosa tend to be more aware of their behaviour and to feel remorseful or guilty about it.
They are more likely to admit their concerns to a medical professional or other confidant.
Generally, people with bulimia nervosa are more outgoing. They also are more prone to impulsive behaviour, drug or alcohol abuse, and depression.
They are anxious about their weight and about participation in social activities.