Bulimia nervosa — an eating disorder that affects three times as many women as men — can be deadly. Individuals with the disorder “binge and purge,” meaning they ingest large quantities of food and then undertake drastic measures to get rid of extra calories. Although bulimia typically begins in adolescence through the 20s, the disorder can be found in all age groups.

Signs & Symptoms

Many factors can lead to the development of bulimia. One that is often talked about is Western culture's obsession with being thin. In a study published this month in the American Journal of Public Health Researchers, scientists found that more than 80 percent of weight-loss web sites examined “provided overt suggestions on how to engage in eating-disordered behaviors.”

Media used as “thinspiration” can influence impressionable young people, adults with low self-esteem and minorities concerned with adapting to a new environment.

Genetics may also play a role in the disorder. Risk of bulimia increases if an individual’s mother or sister suffered from bulimia, according to the Mayo Clinic. Existing psychological problems, such as low self-esteem, and behaviors, such as rigid dieting, can also increase the risk of a person developing the disorder.

Unlike an individual suffering from anorexia, someone with bulimia may appear to be a normal weight. Bulimics will often binge and purge in private, and purging may even occur after a normal-size meal. Still, there are signs and symptoms that friends and family can be alert to — and that can help bulimics recognize a problem exists.

Behaviors to watch for are depression, anxiety and frequent trips to the restroom after eating. Not all bulimics purge by vomiting or misusing laxatives; some fast or exercise for excessive periods of time to get rid of ingested calories.

Physical signs of bulimia include damaged teeth and gums, mouth sores, irregular menstrual cycle, abnormal bowel movements and abnormal heartbeat.

Diagnosis & Tests

A diagnosis of bulimia is made after a physical exam, blood and urine tests and a psychological evaluation are completed. The physician may also decide to examine the heart, lungs and bones.

Because bulimia is classified as a mental disorder, doctors use criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, to determine a diagnosis. The DSM states that someone who is bulimic engages in repeated binging, with lack of control, and purging at least two times each week in a three-month period. Moreover, the DSM notes that the individual's self-worth is abnormally influenced by feelings about body shape and weight.

Treatments & Medications

Much like anorexia, bulimia is a tough disorder to treat because part of the problem is a distorted self-image. Even individuals who recover from bulimia may experience periods of relapse throughout their lives.

Typically, treatment involves a combination of therapy, medication, nutrition education and support groups.

Therapy, or counseling, may consist of cognitive behavioral therapy or family therapy. Cognitive behavioral therapy aims to teach individuals how to recognize harmful behavior and thoughts. Family therapy may be used for younger bulimics, or those who don't respond to cognitive therapy. Family therapy relies on the support of siblings and parents to encourage a bulimic to engage in healthy eating behaviors.

Antidepressants may be prescribed to treat any depression and anxiety associated with bulimia.

A dietician can help develop a healthy diet and counsel about normal eating habits. For bulimics that are over- or underweight, a dietician can assist in creating a program to get the individual back to a normal weight range.

Some individuals may require hospitalization, especially if there are health complications from the disorder. There are many options including inpatient treatment and day treatment at hospitals or clinics.

In addition to the above, yoga may also be helpful as a way of reducing binging and purging triggers, such as stress. Still, there is not much research on the effects of this type of exercise.

Tips for Parents and Concerned Friends

Parents and friends that notice behaviors like over-exercising, overuse of laxatives and weight-loss products, unusual eating habits and complaining about body shape should attempt to speak with their loved one about their concerns.

Instead of telling the individual they need help — and possibly putting them on the defensive — parents and friends may offer to help find a doctor or counselor. Parents can talk with adolescents about the dangers of binging and purging, and can ask how to help reduce triggers of these extreme behaviors.