Bulimia nervosa



Definition

Bulimia nervosa is a serious and sometimes life-threatening eating disorder affecting mainly young women. People with bulimia, known as bulimics, consume large amounts of food (binge) and then try to rid themselves of the food and calories (purge) by fasting, excessive exercise, vomiting , or using laxatives . The behavior often serves to reduce stress and relieve anxiety . Because bulimia results from an excessive concern with weight control and self-image and is often accompanied by depression, it is also considered to be a psychiatric illness.

Description

Bulimia nervosa is a serious health problem for over 2 million adolescent girls and young women in the United States. The bingeing and purging activity associated with this disorder can cause severe damage, even death, although the risk of death is not as high as for anorexia nervosa , an eating disorder that leads to excessive weight loss.

In rare instances, binge eating may cause the stomach to rupture. In the case of purging, heart failure can result due to loss of vital minerals such as potassium. Vomiting causes other serious problems, including acid-related scarring of the fingers (if used to induce vomiting) and damage to tooth enamel. In addition, the tube that delivers food from the mouth to the stomach (the esophagus) often becomes inflamed, and salivary glands can become swollen. Irregular menstrual periods can also result, and interest in sex may diminish.

Most bulimics find it difficult to stop their behavior without professional help. Many typically recognize that the behavior is not normal, but they feel helpless to control it. Some bulimics struggle with other compulsive, risky behaviors such as drug and alcohol abuse. Many also suffer from other psychiatric illnesses, including clinical depression, anxiety, and obsessive-compulsive disorder (OCD).

Bulimic behavior is often carried out in secrecy, accompanied by feelings of guilt or shame. Outwardly, many people with bulimia appear healthy and successful, while inside they have feelings of helplessness and low self-esteem .

Demographics

Most bulimics are females in their teens to early 20s. Males account for only 5 to 10 percent of all cases. People of all races develop the disorder, but most of those diagnosed are white.

Causes and symptoms

The cause of bulimia is as of 2004 unknown. Researchers believe that it may be caused by a combination of genetic and environmental factors. Bulimia tends to run in families. Research shows that certain brain chemicals, known as neurotransmitters, may function abnormally in acutely ill people with bulimia nervosa. Scientists also believe there may be a link between bulimia and other psychiatric problems, such as depression and OCD. Environmental influences include participation in work or sports that emphasize thinness, such as modeling, dancing, or gymnastics. Family pressures also may play a role. One study found that mothers who are extremely concerned about their daughters' physical attractiveness and weight may in part cause bulimia in them. In addition, girls with eating disorders tend to have fathers and brothers who criticize their weight. Bulimia tends to run in families.

According to the American Anorexia/Bulimia Association Inc., warning signs of bulimia include the following:

  • eating large amounts of food uncontrollably (bingeing)
  • vomiting, abusing laxatives or diuretics, or engaging in fasting, dieting, or vigorous exercise (purging)
  • preoccupation with body weight
  • using the bathroom frequently after meals
  • depression or mood swings
  • irregular menstrual periods
  • onset of dental problems, swollen cheeks or glands, heartburn, or bloating

When to call the doctor

A healthcare professional should be consulted at the first sign of behaviors associated with bulimia.

Diagnosis

Bulimia is treated most successfully when diagnosed early. However, because the bulimic may deny there is a problem, getting medical help is often delayed. A complete physical examination in order to rule out other illnesses is the first step to diagnosis.

According to the American Psychiatric Association, a diagnosis of bulimia requires that a person have all of the following symptoms:

  • recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months)
  • a feeling of lack of control over eating during the binges
  • regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
  • persistent over-concern with body shape and weight

Treatment

Early treatment is important; otherwise, bulimia may become chronic, with serious health consequences. A comprehensive treatment plan is called for in order to address the complex interaction of physical and psychological problems in bulimia. A combination of drug and behavioral therapies is commonly used.

Behavioral approaches include individual psychotherapy, group therapy, and family therapy . Cognitive-behavioral therapy, which teaches people how to change abnormal thoughts and behavior, is also used. Nutrition counseling and self-help groups are often helpful.

Antidepressants commonly used to treat bulimia include desipramine (Norpramin), imipramine (Tofranil), and fluoxetine (Prozac). These medications also may treat any co-existing depression.

In addition to professional treatment, family support plays an important role in helping the bulimic person. Encouragement and emotional support may convince the sick person to get help, stay with treatment, or try again

(Table by GGS Information Services.)
(Table by GGS Information Services.)

Bulimia nervosa
Criteria
SOURCE : Diagnostic and Statistical Manual of Mental Disorders IV .
1. Recurrent episodes of binge eating, which is characterized by 1) consumption of an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances AND 2) a sense of lack of control over eating during the episode.
2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or enemas, or other medications; or fasting or excessive exercise.
3. Binge eating and compensatory behaviors both occur an average of twice a week for three months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Purging type: Regular episodes of self-induced vomiting or misuse of laxatives, diuretics, or enemas.
Nonpurging type: No regular episodes of self-induced vomiting or misuse of laxatives, diuretics, or enemas. Patient uses fasting or excessive exercise to avoid weight gain.

after a failure. Family members can help locate resources, such as eating disorder clinics in local hospitals or treatment programs in colleges designed for students.

Light therapy—exposure to bright, artificial light—may be useful in reducing bulimic episodes, especially during the dark winter months. Some feel that massage may prove helpful, putting people in touch with the reality of their own bodies and correcting misconceptions of body image. Hypnotherapy may help resolve unconscious issues that contribute to bulimic behavior.

Prognosis

Bulimia may become chronic and lead to serious health problems, including seizures, irregular heartbeat, and thin bones. In rare cases, it may be fatal. Timely therapy and medication can effectively manage the disorder and help the bulimic live a normal, productive, and fulfilling life.

Prevention

There is as of 2004 no known method for preventing bulimia. However, parents can promote healthy eating habits in their children and encourage them to embrace realistic, rather than overly thin, body images.

Nutritional concerns

Abnormal food intake and purging may result in abnormal nutrition. Purging may lead to a loss of potassium and other essential metabolic ions. These can become life threatening.

Parental concerns

Parental remarks about body size and shape often trigger bulimia. Parents of bulimics must be supportive and participate in treatment if the condition is to be successfully treated.

KEY TERMS

Binge —A pattern of eating marked by episodes of rapid consumption of large amounts of food; usually food that is high in calories.

Diuretics —A group of drugs that helps remove excess water from the body by increasing the amount lost by urination.

Neurotransmitters —Chemicals in the brain that transmit nerve impulses.

Obsessive-compulsive disorder —An anxiety disorder marked by the recurrence of intrusive or disturbing thoughts, impulses, images, or ideas (obsessions) accompanied by repeated attempts to supress these thoughts through the performance of certain irrational and ritualistic behaviors or mental acts (compulsions).

Purge —To rid the body of food and calories, commonly by vomiting or using laxatives.

See also Binge eating disorder .

Resources

BOOKS

Bendich, Adrianne, and David J. Goldstein. Management of Eating Disorders and Obesity , 2nd ed. Totawa, NJ: Humana Press, 2004.

Litt, Iris F. "Anorexia Nervosa and Bulimia." In Nelson Textbook of Pediatrics , 17th ed. Edited by Richard E. Behrman, et al. Philadelphia: Saunders, 2003, pp. 652–3.

Smith, Grainne. Anorexia and Bulimia in the Family: One Parent's Practical Guide to Recovery. New York: Wiley & Sons, 2004.

Walsh, B. Timothy. "Eating Disorders." In Harrison's Principles of Internal Medicine , 15th ed. Edited by Eugene Braunwald, et al. New York: McGraw Hill, 2001, pp. 486–90.

West, Delia Smith. "The Eating Disorders." In Cecil Textbook of Medicine , 22nd ed. Edited by Lee Goldman, et al. Philadelphia: Saunders, 2003, pp. 1326–35.

PERIODICALS

Burns, M., and N. Gavey. "Healthy weight at what cost? Bulimia and a discourse of weight control." Journal of Health Psychology 9, no. 4 (2004): 249–65.

Crow, S. J., et al. "Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa." International Journal of Eating Disorders 36, no. 2 (2004): 220–3.

Hinney A., et al. "Genetic risk factors in eating disorders." American Journal of Pharmacogenomics 4, no. 4 (2004): 209–23.

Morad, M., I. Kandel, and J. Merrick. "Anorexia and bulimia in the family." International Journal of Adolescent Medicine and Health 16, no. 2 (2004): 89–90.

ORGANIZATIONS

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211–2672. Web site: http://www.aafp.org/.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098. Web site: http://www.aap.org/default.htm.

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Web site: http://www.psych.org/.

American Psychological Association. 750 First Street NW, Washington, DC, 20002–4242. Web site: http://www.apa.org/.

National Eating Disorders Organization (NEDO). 6655 South Yale Ave, Tulsa, OK 74136. Web site: http://www.NationalEatingDisorders.org.

WEB SITES

"Bulimia." National Alliance for the Mentally Ill. Available online at http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=7638 (accessed November 2, 2004).

"Bulimia." National Library of Medicine. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000341.htm (accessed November 2, 2004).

"Bulimia and Related Disorders." Northern Arizona University. Available online at http://dana.ucc.nau.edu/~kdk2/bulimia.html (accessed November 2, 2004).

"Bulimia Nervosa." Internet Mental Health. Available online at http://www.mentalhealth.com/dis/p20-et02.html (accessed November 2, 2004).

L. Fleming Fallon, Jr., MD, DrPH



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