What do you know about : Bulimia Nervosa

What Is It?

Bulimia nervosa is an eating disorder that involves repetitive binge eating: eating large quantities of food at one sitting, regardless of hunger. During the binge, the person feels out of control of the eating and cannot stop. Individuals with this disorder may develop strategies aimed at controlling weight, such as purging (self-induced vomiting). They may also abuse laxatives, suppositories, enemas or diuretics. Or they may go on an extended fast or exercise furiously.

Many people with bulimia also have some of the symptoms of anorexia nervosa . In both bulimia and anorexia, a person may be preoccupied with weight and be very self-conscious about size and shape.

The typical person with bulimia is a teenage girl. Indeed, bulimia most often starts between ages 15 and 20, and 85 percent to 90 percent are women. The condition affects up to 4 percent of women at some point in life. But the disorder can also develop in men usually the nonpurging form. And it does occur in young children and older adults.

People with bulimia can eat huge quantities of food, sometimes up to 20,000 calories at a time. Binge foods tend to be "comfort" foods that are sweet, salty, soft or smooth, and generally high in calories. Examples are ice cream, cake and pastries. People with bulimia may binge a few times a week or as frequently as several times a day. Although people with bulimia fear becoming fat, and some are severely underweight or overweight, most are of normal weight or only slightly overweight.

Like anorexia, bulimia is unhealthy for the body. It can lead to dehydration from purging, chronic gastrointestinal problems from laxative use, and tooth decay from excessive vomiting. At its most destructive, bulimic behavior can lead to an irregular heartbeat, permanent heart damage and even death.

People with bulimia usually feel ashamed of their binging and purging behaviors. Since they often have trouble controlling their impulses, some have other addictive behaviors. They also may have major depression, , anxiety, panic, or social phobia .

The disorder runs in families. Therefore bulimia is presumed to be influenced by genetic inheritance. But the biological cause is not specifically known. Most experts believe that brain pathways that control appetite are involved in the disorder.

Symptoms

Symptoms of bulimia include:

• Extreme concern over body weight or body shape
  
• Eating large quantities of food over a short period (binge eating), usually in secret
  
• Binge eating that is followed by self-induced vomiting, medication use (laxatives, diuretics, enemas or suppositories) or with fasting, restrictive dieting or excessive exercise.
  

Bulimia can lead to:

• Apathy, poor concentration
  
• Tooth erosion and decay
  
• Constant sore throat
  
• Muscle weakness
  
• Bone pain with exercise
  
• Low blood pressure
  
• Irregular heartbeat
  
• Swollen salivary glands
  
• Constipation or other bowel problems
  
• Gastrointestinal problems, such as bloating, heartburn or acid reflux
  
• Fertility problems
  

Diagnosis

The central characteristic of the disorder is a preoccupation with weight or body image. The manual of psychiatric diagnoses sets out criteria for making a diagnosis of bulimia severe eating binges at least twice a week for three months, along with compensating behavior such as purging, exercise or excessive dieting. But you don't need a precise count to justify getting help. See a doctor if you feel worried about your thoughts and behaviors connected to food and weight.

Your doctor will ask you about your medical history and do a physical examination to check your general health. He or she may also order blood tests to check for problems associated with vomiting or laxative use.

Your doctor will also explore whether you have any other areas of mental distress, such as obsessive compulsive disorder or an anxiety or mood disorder.

Expected Duration

Bulimia can last for a short time or can continue for many years. About a quarter of individuals with bulimia get better without treatment. With treatment, more than half improve.

But even after successful treatment, bulimia can return. Estimates of frequency and severity vary widely.

Prevention

There is no known way to prevent bulimia. Treatment can be easier if the problem is detected early.

Treatment

An eating disorder is a complex mix of physical and emotional problems. Therefore, health care providers try to organize a treatment that can address these problems comprehensively.

The goals of treatment are to

• help the patient meet her (or his) goals
  
• reduce or eliminate binge eating and purging
  
• treat any physical complications
  
• provide education and motivate the individual to restore healthy eating
  
• help the individual understand and change harmful thought patterns related to the disorder
  
• identify and treat any associated mental disorders (for example, depression or anxiety)
  
• encourage and develop family support
  
• prevent relapse
  

Treatment includes nutritional counseling, psychological counseling, and medication such as antidepressants. It is often most helpful to combine a few of these approaches. As long as there is no acute medical danger, the person with bulimia should be encouraged to establish personal goals.

Nutritional counseling usually involves developing a structured meal plan and learning to recognize body cues and urges to binge and purge.

Psychotherapy aims to help people with bulimia improve their body image, understand and deal with their emotions, modify their obsessive-compulsive behaviors related to food, and gain healthy eating behaviors. Cognitive behavior therapy (CBT) is the best studied approach, and it is known to be effective. Family and group psychotherapy can be helpful, too. In practice, therapists tend to combine elements of CBT, interpersonal therapy and psychodynamic therapy. Self-help groups and homework guided by a professional can also be good supplements to a treatment plan.

With or without psychotherapy, medication can reduce the urge to binge and purge. Fluoxetine (Prozac) has been most frequently studied and is effective, as is sertraline (Zoloft). People with bulimia may need doses higher than are usually given for depression. Because mood and anxiety disorders are often present, medication may be aimed specifically at those disorders.

When To Call a Professional

Contact a health care professional (physician, counselor, psychiatrist) if you think you have, or are at risk of, bulimia. If you do not feel comfortable doing this, talk to a trusted friend or family member about your concerns and ask them to contact someone for you.

If someone you know shows signs of bulimia, encourage him or her to contact a physician or mental health professional. Confronting someone with bulimia can be difficult. He or she may deny the problem or become defensive. For more information on how to talk to someone you suspect is bulimic, see the Additional Information section below.

Prognosis

Many people with bulimia recover, especially if their condition is recognized early. In long-term follow-up studies, as many as 70 percent of people with this disorder completely stop having bulimia symptoms. Some do continue to struggle with eating problems of varying degrees of severity. Treatment improves chances of improvement. Prognosis is better if the illness starts in adolescence. Prognosis is worse if the person has other psychiatric problems, such as obsessive-compulsive disorder, a mood problem or a personality disorder.