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Bulimia Nervosa

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 bulemia include:

  • Sex: female
  • Age: 11 to 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:

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

Heart EKG

Bulemia can lead to severe heart problems.

© 2008 Nucleus Medical Art, Inc.

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

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.

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.

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.

Cecil RL, Goldman L, Bennett JC. Cecil Textbook of Medicine. 21st ed. Philadelphia, PA:WB Saunders Company;2000.

Conn HF, Rakel RE. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: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.

Goroll AH, Mulley AG. Primary Care Medicine. 4th ed. Philadelphia, PA:Lippincott Williams & Wilkins;2000.

Griffith HW. Griffith's 5-Minute Clinical Consult. Baltimore, MD:Lippincott Williams & Wilkins;1999.

Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet. 2005;366:665-675.

Tasman A, Kay J, Lieberman JA. Psychiatry. Philadelphia, PA:WB Saunders Company;1997.



Last reviewed November 2007 by Theodor B. Rais 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.


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