Symptoms

Physical Side Effects

Bulimia Nervosa is an intensely physical disorder, resulting in apparent changes to the body that can warn an individual is struggling, such as:

• Weight fluctuations.
• Chronically inflamed or sore throat.
• Swollen salivary glands around the neck and jaw.
• Worn tooth enamel/yellowing teeth and tooth sensitivity due to exposure to stomach acid.
• Severe dehydration due to fluid loss from purging.
• Puffy cheeks.
• Appearing bloated from fluid retention.
• Bright red eyes, bursting of blood vessels in eyes due to vomiting or straining in vomiting.

Behavioral Warning Signs

Behavioral red flags of bulimia are not as easily identifiable as the physical listed above; however, it is still possible to recognize behavioral changes that could indicate a problem, for example:

• Engaging in binge eating episodes.
• Distress over body shape-weight-size and-or negative body image.
• Expressing shame or guilt around eating.
• Frequently going to the bathroom during or immediately after meals.
• Increased irritability.
• Increased depression and suicidal ideation or self-harming behaviors.
• Uncomfortable eating food around others.
• Drinking excessive amounts of water.

Causes

Biological Factors

Bulimia nervosa, a complex eating disorder, is influenced by various genetic and biological factors. One significant contributor is a family history of eating disorders or bulimia nervosa, suggesting a genetic predisposition. Additionally, a family history of mental illness or substance use can play a role in its development. Individuals with a tendency towards impulsivity or struggle with impulse control are also more susceptible to this disorder. Binge eating, a key characteristic of bulimia nervosa, can be influenced by inherent predispositions. Moreover, certain neural sensitivities to rewards, particularly those related to food reward systems, may contribute to the manifestation of this eating disorder. Understanding these factors can aid in identifying at-risk individuals and improving treatment approaches for those affected by bulimia nervosa.

Psychological Factors

Bulimia nervosa is characterized by distinct behavioral patterns, which include prior mental health diagnoses, a tendency for impulsivity, and a history of abuse or trauma. Individuals affected by this eating disorder often struggle with negative body image or self-image, and they may exhibit impaired emotion regulation and distress tolerance capabilities. Additionally, low self-esteem is common among those with bulimia nervosa, and some may find themselves drawn to careers or hobbies that emphasize physical appearance. Recognizing these behavioral factors is crucial for early identification and targeted intervention to support individuals dealing with bulimia nervosa and promote their well-being.

Dieting Factors

The development of bulimia nervosa is intricately linked to the presence of dieting practices and involvement in diet culture behaviors. Individuals at risk for this eating disorder often experience dissatisfaction with their body weight, shape, or size, leading to a negative self-perception related to their appearance. A significant factor in the onset of bulimia nervosa is a history of engaging in various dieting behaviors. This may include restrictive eating patterns and cycles of bingeing, creating a harmful pattern. Additionally, the overvaluation of eurocentric beauty ideals can contribute to the development of this disorder, as individuals may feel pressured to conform to unrealistic standards. Core beliefs linking personal fulfillment to appearance can further exacerbate the risk of developing bulimia nervosa. Understanding these factors is essential for early recognition and implementing preventive measures to address the root causes and support those affected by this complex eating disorder.

Symptoms

Physical Side Effects

BED can be difficult to identify, as the resultant shame and guilt of binge episodes lead to secrecy. If you observe some of the below symptoms in a loved one or patient, consider them to be red flags and do not be afraid to ask more questions, such as:

• Eating unusually large amounts of food in a specific amount of time.
• Eating when one is not hungry or full.
• Eating at a fast pace.
• Eating alone or in secret.
• Hiding food.
• Eating until uncomfortably full.
• Reporting feelings of guilt or shame around eating.
• Loss of sexual desire.

Behavioral Warning Signs

Behavioral red flags of bulimia are not as easily identifiable as the physical listed above; however, it is still possible to recognize behavioral changes that could indicate a problem, for example:

• Engaging in binge eating episodes.
• Distress over body shape-weight-size and-or negative body image.
• Expressing shame or guilt around eating.
• Frequently going to the bathroom during or immediately after meals.
• Increased irritability.
• Increased depression and suicidal ideation or self-harming behaviors.
• Uncomfortable eating food around others.
• Drinking excessive amounts of water.

Anxiety, Depression , Other Co-Occurring

Anxiety Disorders

Many individuals that struggle with clinical anxiety present with disordered relationships to food. This could be a result of using food to cope with emotional dysregulation. It is also likely that the opposite is true and that the shame, guilt, secrecy, and feelings of loss of control that occur with binge eating result in increased anxiety symptoms.

Mood Disorders

Mood disorders, such as Major Depressive Disorder or Bipolar Disorder, are experienced by 46.4% of those with a BED diagnosis. This is unsurprising, as, similar to anxiety disorders, many individuals seek to cope with uncomfortable emotional states using food. This correlation may also occur due to an individual's self-view and self-worth being impacted by their binge eating behaviors. Binge eating episodes can also lead to feelings of hopelessness or despair as one feels they cannot control their behaviors.

Other Co-Occurring Diagnosis

The relationship between BED and other diagnoses are similar to those with mood and anxiety disorders, with the disorders fueling one another. Some other disorders that commonly co-occur with BED include impulse control disorders and substance use disorders.

Symptoms

Who gets rumination syndrome

Rumination syndrome has been long known to occur in babies and in people with developmental disabilities, but can occur in people of all ages. Children and adults with high levels of stress or anxiety may be at higher risk for rumination syndrome.

• Regurgitating and re-chewing food on a regular basis.
• Digestive problems, such as indigestion and stomach aches.
• Dental problems, such as bad breath and tooth decay.
• Weight loss.
• Chapped lips.

Causes

The exact causes of rumination syndrome are not known. Some people may develop this syndrome if they have emotional problems or if they are undergoing stressful events. Mechanically, one explanation is that food expands the stomach, which is followed by an increase in abdominal pressure and a relaxation of the lower esophageal sphincter (the juncture where the esophagus (food tube from)mouth meets the stomach). The sequence of events allows stomach contents to be regurgitated.

Symptoms

The sole symptom of pica is compulsively eating things that aren't food or have no nutritional value or benefit. Most people with this condition prefer a single type of non-food item they eat

However, pica can cause other conditions or issues, which have their own sets of symptoms. Other conditions that can happen because of pica include:

• Anemia (low iron).
• Ascariasis (roundworm infection) .
• Constipation.
• Electrolyte imbalance.
• Irregular heart rhythms (arrhythmias) .
• Lead poisoning.
• Small intestine and large intestine obstruction/blockage.

Causes

Experts don’t know exactly why pica happens. However, researchers know certain factors increase the risk of developing it.

• Cultural or learned behavior.

Certain types of pica are common, socially accepted behaviors in certain cultures and religions. A religious example of this is the practice of eating dirt at El Santuario de Chimayó, a Roman Catholic shrine in New Mexico, USA. A cultural example of this commonly happens in cities in the country of South Africa, where it’s a common practice among young women.

• Stress or anxiety.

Pica might be an outlet or coping mechanism for people with these issues.

• Negative conditions during childhood.

Pica is more common in children living in low socioeconomic situations (such as poverty), but why this happens is unknown. Some possible explanations include that pica is a coping mechanism for children to deal with situations of abuse or neglect. It also might be attention-seeking behavior, especially when one or both parents are absent for any reason.

• Mental health conditions.

These include conditions that a person might develop spontaneously, conditions they had at birth because of disruptions in how they developed in the womb and genetic disorders they inherited from their parents.

• Medical conditions .

Pregnancy and sickle cell anemia are two conditions that have connections to pica.

Symptoms

Behavioral

• Dramatic weight loss.
• Dresses in layers to hide weight loss or stay warm .
• Reports constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy.
• Reports consistent, vague gastrointestinal issues ('upset stomach', feels full, etc.) around mealtimes that have no known cause.
• Dramatic restriction in types or amount of food eaten .
• Fears of choking or vomiting.
• Lack of appetite or interest in food.

Physical

Because both anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar physical signs and medical consequences.

• Stomach cramps, other non-specific gastrointestinal complaints .
• Difficulties concentrating .
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)y.
• Postpuberty female loses menstrual period.
• Dizziness .
• Feeling cold all the time.
• Thinning of hair on head, dry and brittle hair.
• Muscle weakness.
• Cold, mottled hands and feet or swelling of feet.
• Poor wound healing.
• Impaired immune functioning.

Risk Factors

As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues. These factors may interact differently in different people, which means two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms. Researchers know much less about what puts someone at risk of developing ARFID, but here’s what they do know:

• People with autism spectrum conditions are much more likely to develop ARFID, as are those with ADHD and intellectual disabilities.
• Children who don't outgrow normal picky eating, or in whom picky eating is severe, appear to be more likely to develop ARFID.
• Many children with ARFID also have a co-occurring anxiety disorder, and they are also at high risk for other psychiatric disorders.