Bulimia nervosa

Definition

Bulimia nervosa is a serious and sometimes life-threatening eating disorder affecting mainly young women. People with bulimia, known as bulimics, consume large amounts of food (binge) and then try to rid themselves of the food and calories (purge) by fasting, excessive exercise, vomiting, or using laxatives. The behavior often serves to reduce stress and relieve anxiety. Because bulimia results from an excessive concern with weight control and self-image, and is often accompanied by depression, it is also considered a psychiatric illness.

Description

Bulimia nervosa is a serious health problem for over two million adolescent girls and young women in the United States. The bingeing and purging activity associated with this disorder can cause severe damage, even death, although the risk of death is not as high as for anorexia nervosa, an eating disorder that leads to excessive weight loss.

Binge eating may in rare instances cause the stomach to rupture. In the case of purging, heart failure can result due to loss of vital minerals such as potassium. Vomiting causes other serious problems, including acid-related scarring of the fingers (if used to induce vomiting) and damage to tooth enamel. In addition, the tube that brings food from the mouth to the stomach (the esophagus) often becomes inflamed and salivary glands can become swollen. Irregular menstrual periods can also result, and interest in sex may diminish.

Most bulimics find it difficult to stop their behavior without professional help. Many typically recognize that the behavior is not normal, but feel out of control. Some bulimics struggle with other compulsive, risky behaviors such as drug and alcohol abuse. Many also suffer from other psychiatric illnesses, including clinical depression, anxiety, and obsessive-compulsive disorder (OCD).

Most bulimics are females in their teens or early 20s. Males account for only 5-10% of all cases. People of all races develop the disorder, but most of those diagnosed are white.

Bulimic behavior is often carried out in secrecy, accompanied by feelings of guilt or shame. Outwardly, many people with bulimia appear healthy and successful, while inside they have feelings of helplessness and low self-esteem.

Causes & symptoms

Causes

The cause of bulimia is unknown. Researchers believe that it may be caused by a combination of genetic and environmental factors. Bulimia tends to run in families. Research shows that certain brain chemicals, known as neurotransmitters, may function abnormally in acutely ill bulimia patients. Scientists also believe there may be a link between bulimia and other psychiatric problems, such as depression and OCD. Environmental influences include participation in work or sports that emphasize thinness, such as modeling, dancing, or gymnastics. Family pressures also may play a role. One study found that mothers who are extremely concerned about their daughters' physical attractiveness and weight may help to cause bulimia. In addition, girls with eating disorders tend to have fathers and brothers who criticize their weight.

Symptoms

According to the American Anorexia/Bulimia Association, Inc., warning signs of bulimia include:

• Eating large amounts of food uncontrollably (bingeing)
• Vomiting, abusing laxatives or diuretics, or engaging in fasting, dieting, or vigorous exercise (purging)
• Preoccupation with body weight
• Using the bathroom frequently after meals
• Depression or mood swings
• Irregular menstrual periods
• Onset of dental problems, swollen cheeks or glands, heartburn or bloating.

Diagnosis

Bulimia is treated most successfully when diagnosed early. But because the bulimic may deny there is a problem, getting medical help is often delayed. A complete physical examination in order to rule out other illnesses is the first step to diagnosis.

According to the American Psychiatric Association, a diagnosis of bulimia requires that a person have all of the following symptoms:

• Recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months).
• A feeling of lack of control over eating during the binges.
• Regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise.
• Persistent over-concern with body shape and weight.

Treatment

Early treatment is important; otherwise bulimia may become chronic, with serious health consequences. A comprehensive treatment plan is called for in order to address the complex interaction of physical and psychological problems in bulimia. A combination of drug and behavioral therapies is commonly used.

Behavioral approaches include individual psychotherapy, group therapy, and family therapy. Cognitive-behavioral therapy, which teaches patients how to change abnormal thoughts and behavior, is also used. Nutrition counseling and self-help groups are often helpful.

Antidepressants commonly used to treat bulimia include desipramine (Norpramin), imipramine (Tofranil), and fluoxetine (Prozac). These medications also may treat any co-existing depression.

In addition to professional treatment, family support plays an important role in helping the bulimic person. Encouragement and caring can provide the support needed to convince the sick person to get help, stay with treatment, or try again after a failure. Family members can help locate resources, such as eating disorder clinics in local hospitals or treatment programs in colleges designed for students.

Alternative treatment

Light therapy--exposure to bright, artificial light--may be useful in reducing bulimic episodes, especially during the dark winter months. Some feel that massage may prove helpful, putting people in touch with the reality of their own bodies and correcting misconceptions of body image. Hypnotherapy may help resolve unconscious issues that contribute to bulimic behavior.

Prognosis

Bulimia may become chronic and lead to serious health problems, including seizures, irregular heartbeat, and thin bones. In rare cases, it may be fatal.

Timely therapy and medication can effectively manage the disorder and help the bulimic look forward to a normal, productive, and fulfilling life.

Prevention

There is no known method to prevent bulimia.

Key Terms

Binge

To consume large amounts of food uncontrollably within a short time period.

Diuretic

A drug that promotes the formation and excretion of urine.

Neurotransmitters

Certain brain chemicals that may function abnormally in acutely ill bulimic patients.

Obsessive-compulsive disorder (OCD)

A disorder that may accompany bulimia, characterized by the tendency to perform repetitive acts or rituals in order to relieve anxiety.

Purge

To rid the body of food and calories, commonly by vomiting or using laxatives.

Further Reading

For Your Information

Books

• Cassell, Dana K. The Encyclopedia of Obesity and Eating Disorders. New York, NY: Facts on File, Inc., 1994.
• Jablow, Martha M. A Parent's Guide to Eating Disorders and Obesity. New York, NY: Dell Publishing, 1992.
• Kubersky, Rachel. Everything You Need to Know about Eating Disorders. New York, NY: The Rosen Publishing Group, Inc., 1992.

  Periodicals

• Berg, Frances M. "Eating Disorders Affect Both the Mind and Body." Healthy Weight Journal 9/2 (1995): 27-31.
• Cismoski, Janet, et al. "Teen Nutrition." Whose Kids?...Our Kids! Issue 6 (1995).
• Levine, Michael P. "10 Things Men Can Do and Be to Help Prevent Eating Disorders." Healthy Weight Journal 9/1 (1995): 15.

  Organizations

• American Anorexia/Bulimia Association, Inc., 293 Central Park West, Suite IR, New York, NY 10024. (212) 501-8351.
• Anorexia Nervosa and Related Eating Disorders, Inc., PO Box 5102, Eugene, OR 97405. (541) 344-1144.
• Center for the Study of Anorexia and Bulimia, 1 W. 91st St., New York, NY 10024. (212) 595-3449.
• Eating Disorder Awareness & Prevention, Inc., 603 Stewart St., Suite 803, Seattle, WA 98101. (206) 382-3587.
• National Association of Anorexia Nervosa and Associated Disorders, Box 7, Highland Park, IL 60035. (708) 831-3438.
• National Eating Disorders Organization, 6655 South Yale Ave, Tulsa, OK 74136. (918) 481-4044.

Gale Encyclopedia of Medicine. Gale Research, 1999.