Bulimia nervosa

Overview

Bulimia nervosa, usually referred to as bulimia, is defined as uncontrolled episodes of overeating (bingeing) and usually followed by purging (self-induced vomiting), misuse of laxatives, enemas or medications that cause increased production of urine, fasting, or excessive exercise to control weight. Bingeing, in this situation, is defined as eating much larger amounts of food than would normally be consumed within a short period of time (usually less than two hours).

All westernized industrial countries have reported incidence of bulimia, including nearly 1% of the U.S. population. The majority of bulimics are female, adolescent and from a high socioeconomic group. Adolescents who develop bulimia are more likely to come from families with a history of eating disorders, physical illness, and other mental health problems, such as mood disorders or substance abuse. Other mental health problems, such as anxiety disorders, or mood disorders, are commonly found in persons with bulimia.

Family, friends, and health care providers may have difficulty detecting bulimia in someone they know because they binge and purge in secret. Often, they are able to maintain normal or above normal body weight, but hide their problem from others for years. Many individuals with bulimia do not seek help until they reach ages between 30 to 50, when  their eating behavior is deeply ingrained and more difficult to change.

Most people with eating disorders share certain personality traits and use abnormal eating rituals as a means of handling stress and anxiety. Personality traits often include low self-esteem, feelings of helplessness and fear of becoming fat.

People with bulimia (and binge eating disorder) typically consume huge amounts of food -- often junk food -- to reduce stress and relieve anxiety. Binge eating is usually followed with feelings of guilt and depression, but purging brings a temporary relief. Individuals with bulimia are usually impulsive and more likely to engage in risky behaviors, such as abuse of alcohol and drugs.

Risks

Medical complications that may result from bulimia include, but are not limited to, the following:

  • Stomach rupture
  • Purging may result in heart failure due to loss of vital minerals
  • Vomiting causes other less deadly and serious problems including:
    • Degradation of teeth due to acid in vomit
    • Scarring on the backs of hands when fingers are pushed down the throat to induce vomiting
    • Inflammation of the esophagus
    • Swelling of glands near the cheeks
    • Irregular menstrual periods
  • Diminished libido
  • Individuals may struggle with addictions and/or compulsive behavior
  • Many people with bulimia suffer from clinical depression, anxiety, obsessive-compulsive disorder and other psychiatric illnesses
  • Increased risk for suicidal behavior

Causes

The cause of bulimia is not known. Factors believed to contribute to the development of bulimia include cultural ideals, social attitudes toward body appearance, self-valuation based on body weight and shape and family problems.

Because eating disorders tend to run in families, and female relatives are the most often affected, genetic factors are believed to play a role in the disorders.

But, other influences, both behavioral and environmental, may also play a role. Consider these facts from the National Institute of Mental Health:

  • Although most victims of anorexia and bulimia are adolescent and young adult women, these illnesses can also strike men and older women.
  • Anorexia and bulimia are found most often in Caucasians, but the illnesses also affect other ethnicities.
  • People pursuing professions or activities that emphasize appearance, such as modeling, dancing, gymnastics, wrestling and long-distance running, are more susceptible to these disorders.

Preventive measures to reduce the incidence of bulimia are not known at this time. But early detection and intervention can reduce the severity of symptoms, enhance the process of normal growth and development and improve the quality of life experienced by adolescents with bulimia. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.

Symptoms

People may have different experiences, but the most common symptoms of bulimia include:

  • Usually a normal or low body weight
  • Recurrent episodes of binge eating coupled with fearful feelings of not being able to stop eating during the bingeing episodes
  • Self-induced vomiting (usually secretive)
  • Excessive exercise or fasting
  • Peculiar eating habits or rituals
  • Inappropriate use of laxatives, diuretics or other cathartics
  • Irregular or absence of menstruation
  • Anxiety
  • Discouraged feelings related to dissatisfaction with themselves and their bodily appearance
  • Depression
  • Preoccupation with food, weight and body shape
  • Scarring on the back of the fingers from the process of self-induced vomiting
  • Overachieving behaviors

The symptoms of bulimia may resemble other medical problems or psychiatric conditions. Always consult your healthcare provider for a diagnosis.

Types

There are two subgroups of bulimic behavior aimed at reducing caloric intake, including the following:

  • Purging type - This type regularly engages in self-induced vomiting or misuse of laxatives, diuretics, enemas or other cathartics
  • Nonpurging type - This type uses other inappropriate behaviors, like fasting or excessive exercise, to reduce caloric absorption by the body.

Diagnosis

Many people with the disorder initially keep their illness very private and hidden. Parents, family members, spouses, teachers, coaches and instructors may be able to identify an individual with bulimia. A detailed history of the individual's behavior, clinical observations of the person's behavior and sometimes psychological testing contribute to the diagnosis. Family members who note symptoms of bulimia in a loved one can help by seeking an evaluation and treatment early.

Early treatment can often prevent future problems. Consult your healthcare provider for more information.

Treatment

Specific treatment for bulimia will be determined by your healthcare provider based on:

  • Your age, overall health and medical history
  • Extent of the symptoms
  • Your tolerance for specific medications, procedures or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Bulimia treatment should always be based on a comprehensive evaluation of the individual and family. It is usually treated with a combination of individual therapy, family therapy, behavior modification and nutritional rehabilitation. Individual therapy usually includes both cognitive and behavioral techniques while family also plays a vital supportive role in the treatment process.

Medication (usually antidepressants or antianxiety medications) may be helpful if the person with bulimia is also anxious or depressed. The frequent occurrence of medical complications during the course of rehabilitative treatment requires both your health care provider and a nutritionist to be active members of the management team.

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