Your Health - Bulimia Nervosa

Bulimia Nervosa

(Bulimia)

Definition

Bulimia nervosa is an eating disorder. People who have it eat very large amounts of food (binging) and many also use inappropriate means to rid their bodies of the food (purging). Purging may be caused by vomiting, laxatives, or water pills. Individuals use this cycle 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 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

Factors that increases your chance of developing bulimia include:

Sex: female
Age: 11-20 years old
History of obesity
Anxiety
Mood disorder
Family members who have been obese
Family members who have had a mood disorder
Compulsive dieting
Low self-esteem
Unhappiness with weight and size
Career in which physical appearance is important

Symptoms

Behavioral symptoms include:

Eating unusually large amounts of food at one time
Feeling like eating is out of control
Making yourself throw up
Taking laxatives, enemas, water pills, or diet pills
Excessive exercising
Mood swings
Depression
Trouble controlling impulses
Alcohol or drug abuse

Physical symptoms include:

Abdominal pain
Menstrual problems
Swollen cheeks and jaw
Sore throat
Swollen salivary glands
Bloating
Stained or chipped teeth, due to contact with stomach acid
Cuts 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 vomiting
Changes in body chemistry and fluids due to vomiting and abuse of laxatives or water pills

Symptoms of these complications include:

Dizziness
Feeling faint
Thirst
Muscle cramps
Weakness
Constipation
Irregular heartbeat
Heart 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 disorder
Drug and alcohol abuse or dependence

Diagnosis

The doctor will ask about:

Your medical and psychological history
The amount of food you eat
The ways you to try to rid your body of food

The doctor will also perform a physical exam. They will 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

EKG

Bulimia can lead to severe heart problems.

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:

Nutritional Consult

You may be referred to a registered dietitian. A dietitian can help you learn more about the components of a healthy diet, reasonable weight and calorie goals.

Psychotherapy

Cognitive behavioral therapy can be very effective. It 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 these behaviors.

FDA Public Health Advisory for Antidepressants

The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose.

Although the warning is for all antidepressants, of most concern are the SSRI class such as:

Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram)

For more information, please visit: http://www.fda.gov/cder/drug/antidepressants/

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 your friend 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:

Bulimia Anorexia Nervosa Association
http://www.bana.ca/

Canadian Mental Health Association
http://www.ontario.cmha.ca/index.asp/

References:

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Published May 22, 2009. Accessed July 15, 2009.

Beers MH, et al. The Merck Manual of Medical Information—Home Edition. 2nd ed. Simon and Schuster, Inc;2003.

Bulimia nervosa. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/eating-disorders/bulimia-nervosa.shtml. Accessed July 11, 2008.

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Last reviewed November 2009 by Rosalyn Carson-DeWitt, MD

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.