Bulimia nervosa is an eating disorder. People who have bulimia eat very large amounts of food (called binging) and many also use inappropriate means (vomiting, laxatives, water pills) to rid their bodies of the food (called purging). Affected individuals eat compulsively, then purge to prevent gaining weight. These behaviors last for more than three months for at least two times a week. Individuals are overly concerned with weight and body image. In some, excessive exercise or fasting may replace or supplement purging.
Causes
The cause of bulimia nervosa is unknown. Several factors may contribute to this condition:
Cultural bias toward thinness
Dieting or restricted eating
Changes in the level of brain chemicals
Emotional stress
Physical changes in the digestive system, including:
An enlarged stomach
A stomach that empties slowly
Decreased production of a digestive hormone
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
The doctor will also perform a physical exam and check your teeth for signs of erosion.
Tests may include:
Blood tests—to look for chemical imbalances
Electrocardiogram
(ECG or EKG)—to look for heart problems due to purging
Drug screening—to check for drug use
A mental-health professional may also perform a psychiatric exam and/or psychological tests.
Treatment
The goals of treatment are:
To stop binging and purging
To focus self-esteem away from body weight and shape
Treatments include:
Psychotherapy
A 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 problem
Recognize what triggers binging and purging
Develop new coping skills
Learn and practice stress-management techniques
Talk about feelings
Develop a more appropriate idea of thinness
Develop healthier attitudes about eating
Learn to eat regularly to reduce the urge to binge
Medications
Antidepressant 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 concern—mostly 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 control
You think you may be developing an eating disorder
If you have a friend who may have bulimia, encourage him/her to get help.
RESOURCES:
Bulimia Nervosa Resource Guide for Family and Friends http://www.bulimiaguide.org
National Association of Anorexia Nervosa and Associated Disorders http://www.anad.org
National Eating Disorders Association http://www.nationaleatingdisorders.org
CANADIAN RESOURCES:
Anorexia Nervosa and Bulimia Association (ANAB) http://www.phe.queensu.ca/anab/
Canadian Mental Health Association http://www.ontario.cmha.ca/index.asp
References:
Beers MH, et al.
The Merck Manual of Medical Information—Home Edition.
2nd ed. Simon and Schuster, Inc; 2003.
Cecil Textbook of Medicine.
21st ed. WB Saunders Company; 2000.
Please 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.
