About bulimia nervosa

What is bulimia nervosa?

Bulimia nervosa facts

  • Bulimia is an eating disorder that is characterized by episodes of binging and purging the food and or associated calories.
  • Bulimia is a significant public-health problem, both because of the physical and mental health effects it can have. This illness often co-occurs with body dysmorphic disorder, depression, anxiety, and substance-abuse disorders.
  • While there is no known specific cause for bulimia, family history and environmental stressors are thought to contribute to the development of the illness.
  • Adolescents are most at risk for developing bulimia, as statistics show that about three-quarters of people who develop the illness do so before they reach 22 years of age, most often at 15 to 16 years of age.
  • Cognitive behavioral therapy is thought to be somewhat superior to other forms of psychotherapy in treating this eating disorder.
  • Medication, nutritional counseling, and family therapy are also often part of the treatment for bulimia.
  • The potential complications of bulimia can be severe and affect virtually every organ system.
  • Only about 45% of people with bulimia fully recover, but recovery is more likely with treatment.

What is bulimia?

Bulimia, also called bulimia nervosa, is one of a number of eating disorders. This mental illness is characterized by episodes of bingeing and somehow purging the food and/or associated calories in the pursuit of weight loss. About 1%-2% of adolescent girls in the United States develop bulimia. While bulimia and other eating disorders tend to occur most often in Caucasian females in this country, males and ethnic minorities are increasingly developing eating disorders. Bulimia is also often co-morbid (co-occurs with) body dysmorphic disorder, which involves the sufferer having a false sense that something is defective with their appearance beyond weight.

Women with eating disorders tend to have higher rates of infertility than women without an eating disorder, in that eating disordered women have lower rates of pregnancy and childbirth. When pregnancy is achieved, more than 7% of women suffer from some form of eating disorder during that time, with more than 2% engaging in both bingeing and some form of purging behaviors. Given the changes in body chemistry that such behaviors can cause, bulimia during pregnancy can pose significant health risks for the developing fetus.

This illness is a significant public-health problem both because of the physical and mental-health effects it can have. Bulimia often co-occurs with depression, anxiety, and substance-abuse disorders and results in a loss of productivity due to disability that is higher than that of disability caused by depression and anxiety combined.



What are the symptoms for bulimia nervosa?

Bulimia signs and symptoms may include:

  • Being preoccupied with your body shape and weight
  • Living in fear of gaining weight
  • Repeated episodes of eating abnormally large amounts of food in one sitting
  • Feeling a loss of control during bingeing — like you can't stop eating or can't control what you eat
  • Forcing yourself to vomit or exercising too much to keep from gaining weight after bingeing
  • Using laxatives, diuretics or enemas after eating when they're not needed
  • Fasting, restricting calories or avoiding certain foods between binges
  • Using dietary supplements or herbal products excessively for Weight loss

The severity of bulimia is determined by the number of times a week that you purge, usually at least once a week for at least three months.

When to see a doctor

If you have any bulimia symptoms, seek medical help as soon as possible. If left untreated, bulimia can severely impact your health.

Talk to your primary care provider or a mental health professional about your bulimia symptoms and feelings. If you're reluctant to seek treatment, confide in someone about what you're going through, whether it's a friend or loved one, a teacher, a faith leader, or someone else you trust. He or she can help you take the first steps to get successful bulimia treatment.

Helping a loved one with bulimia symptoms

If you think a loved one may have symptoms of bulimia, have an open and honest discussion about your concerns. You can't force someone to seek professional care, but you can offer encouragement and support. You can also help find a qualified doctor or mental health professional, make an appointment, and even offer to go along.

Because most people with bulimia are usually normal weight or slightly overweight, it may not be apparent to others that something is wrong. Red flags that family and friends may notice include:

  • Constantly worrying or complaining about being fat
  • Having a distorted, excessively negative body image
  • Repeatedly eating unusually large quantities of food in one sitting, especially foods the person would normally avoid
  • Strict dieting or fasting after binge eating
  • Not wanting to eat in public or in front of others
  • Going to the bathroom right after eating, during meals or for long periods of time
  • Exercising too much
  • Having sores, scars or calluses on the knuckles or hands
  • Having damaged teeth and gums
  • Changing weight
  • Swelling in the hands and feet
  • Facial and cheek swelling from enlarged glands



What are the causes for bulimia nervosa?

The exact cause of bulimia is unknown. Many factors could play a role in the development of eating disorders, including genetics, biology, emotional health, societal expectations and other issues.



What are the treatments for bulimia nervosa?

Studies on treatment effectiveness for bulimia seem to show that psychotherapy treatment for bulimia is superior to medication or behavior therapy. Cognitive behavior therapy is thought to be somewhat superior to other forms of psychotherapy in treating this eating disorder. This form of psychotherapy helps to alleviate bulimia and reduce the likelihood that it will come back by helping the eating disorder sufferer change his or her way of thinking about certain issues. In CBT, the therapist uses three techniques to accomplish these goals:

  • Didactic component: This phase helps to set up positive expectations for therapy and promote the person's cooperation with the treatment process.
  • Cognitive component: This helps to identify the thoughts and assumptions that influence the bulimic individual's behaviors, particularly those that may predispose the sufferer to disordered eating.
  • Behavioral component: This employs behavior-modification techniques to teach the person more effective strategies for dealing with problems.

Family therapy is also often used to treat bulimia, particularly for adolescent sufferers. It usually takes place in three phases:

  • Initially, the family works with the therapist to help the adolescent maintain appropriate food intake and limit negative ways the eating-disordered person uses to control their weight.
  • After the bulimic individual has begun to control their negative eating behaviors, he or she is encouraged to take responsibility for maintaining appropriate eating and refraining from purging behaviors.
  • In the final phase of treatment, more general life issues of the adolescent are addressed and the effects of bulimia on normal activities and normal development are examined.

Nutritional counseling involves teaching the bulimic individual how to diet in a healthy way. It has been found to help decrease the sufferer's tendency to engage in purging behaviors.

Regarding medication treatment of bulimia, fluoxetine (Prozac) has been approved by the U.S. Food and Drug Administration for treatment of this condition. Fluoxetine is a member of the serotonergic antidepressants (SSRIs). Other SSRIs, as well as serotonin/norepinephrine-reuptake inhibitors like venlafaxine (Effexor) and duloxetine (Cymbalta), and tricyclic antidepressants like imipramine (Tofranil) and amitryptiline (Elavil), have also been shown to decrease the binge eating and purging symptoms of bulimia.

SSRIs tend to have fewer side effects than the tricyclic antidepressants (TCAs). Also, SSRIs do not cause orthostatic hypotension (sudden drop in blood pressure when sitting up or standing) and heart-rhythm disturbances like the TCAs do. Therefore, SSRIs are often the first-line treatment for bulimia. Examples of other SSRIs include paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro).

SSRIs are generally well tolerated, and side effects are usually mild. The most common side effects are nausea, diarrhea, agitation, insomnia, and headache. However, these side effects generally go away within the first month of SSRI use. Some patients experience sexual side effects, such as decreased sexual desire (decreased libido), delayed orgasm, or an inability to have an orgasm. Some patients experience tremors with SSRIs. The so-called serotonergic (meaning caused by serotonin) syndrome is a rare but serious neurologic condition associated with the use of SSRIs. It is characterized by high fevers, seizures, and heart-rhythm disturbances. This condition tends to occur only in very ill psychiatric patients taking multiple psychiatric medications.

The antiepileptic medication topiramate (Topamax) has also been shown to significantly decrease binge eating and is sometimes used to treat people who do not respond to or have intolerable side effects from the other medications.



What are the risk factors for bulimia nervosa?

Girls and women are more likely to have bulimia than boys and men are. Bulimia often begins in the late teens or early adulthood.

Factors that increase your risk of bulimia may include:

  • Biology. People with first-degree relatives (siblings, parents or children) with an eating disorder may be more likely to develop an eating disorder, suggesting a possible genetic link. Being overweight as a child or teen may increase the risk.
  • Psychological and emotional issues. Psychological and emotional problems, such as depression, anxiety disorders or substance use disorders are closely linked with eating disorders. People with bulimia may feel negatively about themselves. In some cases, traumatic events and environmental stress may be contributing factors.
  • Dieting. People who diet are at higher risk of developing eating disorders. Many people with bulimia severely restrict calories between binge episodes, which may trigger an urge to again binge eat and then purge. Other triggers for bingeing can include stress, poor body self-image, food and boredom.



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