• Constant worry about how you look and how much you weigh
• Feeling the need to use weight loss supplements all the time
• Using diuretics, laxatives, and enemas regularly
• A fear of gaining weight
• Unable to control eating
• Consuming more than normal amounts of food
• Excessive exercise after eating
• Self-induced vomiting after eating

If you think someone close to you may be suffering from bulimia, the following are the signs of bulimia to watch for:

• Going to the bathroom after meals, sounds of vomiting/smell of vomit
• Packages of laxatives or diuretics
• Missing food, hidden food wrappers, abnormally large food consumption at meals
• Exercising even if they are sick, or injured
• Marks on the hands left from teeth while inducing vomiting
• Stained teeth
• Overly obsessed with exercise, weight loss, and food
• Very strict lifestyle and schedule centered around weight loss and food

There are many different causes of bulimia and it is hard to pinpoint just one. Usually, it is a combination of factors including:

Self-esteem issues. Poor self-esteem with feelings of worthlessness or uselessness. These issues usually stem from a home environment that is overly critical, child abuse, perfectionism, or depression.

Professions based on appearance or body weight. Being involved in a profession or hobby that requires a certain body image or weight such as dancing, gymnastics, acting, singing, modeling, or running.

Body image issues due to peer pressure or media. Peer pressure and the media tend to

dictate what people should look like or weigh and can lead to unrealistic expectations.

Life stressors. When a person feels like they have lost control of their life they may turn to bulimia as a coping mechanism – as a way to create the illusion of control in their life via their weight. Situations like a death in the family, loss of a relationship, moving, or even puberty can be triggering.

Tests for bulimia involve both a medical examination and a mental evaluation:

Medical Evaluation

• Medical history and physical examination
• Lab testing (complete blood count, electrolytes, liver function tests)
• Electrocardiogram (ECG or EKG), chest x-ray, and other imaging tests as needed

Psychological Evaluation

• Eating habits and how you feel about food in general
• If you eat large amounts of food and feel like you cannot stop eating at times
• If you make yourself vomit, exercise too much, fast, use laxatives and/or diet pills
• If the behaviors above have occurred a minimum of two times a week for three months
  Your self-worth depends on how you look
• They will ask about severe restrictive eating behaviors, which are a sign of anorexia

If bulimia has made you physically ill, you may need to be hospitalized until you are stable. You may need IV infusions to replace anything lost from vomiting. Electrolyte disturbances can be fatal. Once you are stable your treatment plan may include:

Cognitive-behavioral therapy (CBT).CBT can help to change eating behaviors, improve self-esteem, and encourage healthy attitudes toward food. They can either be done in a group setting or one-on-one with a therapist that specializes in CBT. Programs typically last around four months.

Antidepressant medication. In some cases, you may need an anti-depressant to help relieve emotional triggers like depression or anxiety.

Nutritional therapy. A nutritionist who specializes in nutritional therapy can help put together a meal plan.

With your doctors okay, these practices may complement your treatment plan:

• Meditation
• Yoga
• Hypnosis
• Biofeedback
• Acupuncture
• Massage

Note: Some alternative medicines and herbal remedies may contain ingredients that are used for weight loss. They do have side effects and drug interactions that could cause harm. Always talk to your doctor about herbal remedies and supplements.

Modeling behaviors. As a parent, model healthy eating and exercise behaviors for your kids. Eat healthily and practice moderation in both eating and exercise.

Avoid negative image comments. Never talk about being too thin, too fat, or say that children need to look a certain way. Never link weight or body image with being accepted in society.

Eat healthy meals on a normal schedule. Choose healthy foods and eat at regular times throughout the day.

Start walking after meals. After each mealtime, take a short walk to relax and burn just a few calories to replace any vigorous exercising.

Learn to talk about things. Do not keep feelings bottled up inside. Talk to a trusted friend, family member, or counselor. Food issues are often the result of emotional distress that is not shared.

Try writing in a journal. If you have trouble talking about things, start keeping a journal of emotions. This will help you see where you can make some changes in your life.

Think positive. Give yourself positive self-talk. Practice positive mantras each day like, “I am beautiful for who I am”. Write down positive and encouraging words and put them around your house.

Complications can be life-threatening including:

• Severe electrolyte imbalances disrupt the heart rhythm and can cause death
• Damage to the esophagus from gastric acids
• Tooth decay
• Bowel issues from laxative abuse
• Arrhythmia (irregular heart beat)
• Heart failure
• Gum disease
• Absent or irregular periods

It is important to catch the signs of bulimia early and seek treatment to prevent complications.

If you are worried your loved one is suffering from an eating disorder, gently open the door to communication and let him/her/they that you are concerned. If you are struggling with an eating disorder, help is available at the National Eating Disorders Association website. Follow this link here.

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Freeman, C. & Downey, G. (2001). Self-help manual for bulimia nervosa. Retrieved from:https://keltyeatingdisorders.ca/wp-content/uploads/2016/03/Bulimia-Self-Help-Manual.pdf

Mayo Clinic Staff. Bulimia nervosa. Retrieved from:https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615

Mental Health Foundation. (2000). All about bulimia nervosa. Retrieved from:https://www.mentalhealth.org.uk/sites/default/files/all_about_bulimia.pdf

Morris, A. M. (2003). The impact of the media on eating disorders in children and adolescents. Paediatrics and Child Health, 8(5), 287-289. Retrieved from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792687/