Bulimia Nervosa

Symptoms Behavioral symptoms include: Eating unusually large amounts of food at one timeFeeling like eating is out of controlMaking yourself throw upTaking laxatives, enemas, water pills, or diet pillsExcessive exercisingMood swingsDepressionTrouble controlling impulsesAlcohol or drug abuse Physical symptoms include: Abdominal painMenstrual problemsSwollen cheeks and jawSore throatSwollen salivary glandsBloatingStained or chipped teeth, due to contact with stomach acidCuts or scars on back of hands, from scraping skin on teeth during forced vomiting Bulimia may lead to other problems, including: Dental and throat problems from stomach acid that rises during vomitingChanges in body chemistry and fluids due to vomiting and abuse of laxatives or water pills Symptoms of these complications include: DizzinessFeeling faintThirstMuscle crampsWeaknessConstipationIrregular heartbeatHeart problems, including sudden death People with bulimia have a high incidence of personality disorder and of treatable psychiatric conditions, including: Depression , often with rapid and wide swings in mood Anxiety and panic disorderDrug and alcohol abuse or dependence Diagnosis The doctor will ask about:

Your medical and psychological historyThe amount of food you eatThe ways you to try to rid your body of foodThe doctor will also perform a physical exam and check your teeth for signs of erosion. Tests may include: Blood teststo look for chemical imbalancesElectrocardiogram (ECG or EKG)to look for heart problems due to purging Drug screeningto check for drug useA mental-health professional may also perform a psychiatric exam and/or psychological tests. Treatment The goals of treatment are: To stop binging and purgingTo focus self-esteem away from body weight and shapeTreatments include: PsychotherapyA type of therapy known as cognitive behavioral therapy can be very effective in eliminating or reducing binging and purging. Cognitive behavioral therapy may be particularly effective when combined with drug treatment. Other therapies may be less effective, but can help patients: Gain insight into the problemRecognize what triggers binging and purgingDevelop new coping skillsLearn and practice stress-management techniquesTalk about feelingsDevelop a more appropriate idea of thinnessDevelop healthier attitudes about eatingLearn to eat regularly to reduce the urge to binge MedicationsAntidepressant drugs, particularly selective serotonin reuptake inhibitors (SSRIs), have proven effective in helping reduce binging and purging behaviors.

Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there is an increase or decrease in the dose. The medications of concernmostly SSRIs (Selective Serotonin Re-uptake Inhibitors)are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants/default.htm . Prevention Healthy attitudes about food and your body help prevent bulimia nervosa. Suggestions include:

Maintain a rational approach to dieting and food.Accept a realistic body image.Take pride in what you do well.Set realistic goals. Talk to your doctor or a mental health professional if: You think your quest for thinness may be getting out of controlYou think you may be developing an eating disorderIf you have a friend who may have bulimia, encourage him/her to get help. RESOURCES: Bulimia Nervosa Resource Guide for Family and Friendshttp://www.bulimiaguide.org National Association of Anorexia Nervosa and Associated Disordershttp://www.anad.org National Eating Disorders Associationhttp://www.nationaleatingdisorders.org CANADIAN RESOURCES: Anorexia Nervosa and Bulimia Association (ANAB)http://www.phe.queensu.ca/anab/ Canadian Mental Health Associationhttp://www.ontario.cmha.ca/index.asp References: Beers MH, et al. The Merck Manual of Medical InformationHome Edition. 2nd ed. Simon and Schuster, Inc; 2003. Cecil Textbook of Medicine. 21st ed. WB Saunders Company; 2000. Conn's Current Therapy 2001 . 53rd ed. WB Saunders Company; 2001. Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment . 8th ed. St. Louis, MO: Mosby; 2006.

Goldman L. Cecil Textbook of Medicine. 22nd ed. Philadelphia, PA: Saunders; 2004. Griffith's 5-Minute Clinical Consult . Lippincott Williams & Wilkins; 1999. Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet . 2005;366:665-675. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/ . Primary Care Medicine. 4th ed. Lippincott Williams & Wilkins; 2000. Psychiatry. WB Saunders Company; 1997. Last reviewed November 2007 by Theodor B. Rais MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.