Bulimia Nervosa
What is it?
Bulimia nervosa is a serious eating disorder in which
people develop a secret pattern of binge eating (eating
large amounts of food at one time), followed by purging.
Purging is the process of getting rid of the food and
calories by self-induced vomiting or taking laxatives
and/or diuretics. The person may also fast or exercise
vigorously, only to binge again. Bulimia nervosa is
considered a mental illness, and is usually accompanied by
symptoms of depression and obsessive-compulsive disorder.
Who gets it?
Most people with bulimia nervosa are females, ranging
in age from the teens to early 20s, who are preoccupied
with their weight and body image. Bulimia nervosa affects
all races, but is most often diagnosed in Caucasian women.
What causes it?
The exact cause of bulimia is unknown. However, because
this disorder tends to run in families, there may be a
genetic link. Many young women cite pressures to conform
to society’s or their family’s image of the perfect woman.
Others find that the bingeing and purging is one factor in
their lives that they can control. The bulimic person uses
the bingeing and purging process to relieve stress and
anxiety. For some bulimics, the binge/purge pattern is a
component of obsessive-compulsive disorder, an anxiety
disorder in which a person has repeated unwanted thoughts,
ideas, images, or impulses, called obsessions, over which
they feel they have no control. The patient uses food to
make these thoughts or images go away and to relieve the
anxiety they cause. Studies have also found that people
with bulimia may have malfunctioning brain chemicals,
called neurotransmitters.
What are the symptoms?
People with bulimia nervosa cannot control the urge to
eat large amounts of food at one time because it makes
them feel better. Afterward, however, feelings of guilt
and remorse lead them to purge the food. The purging
process progresses until they may purge after any meal, no
matter what size. Vomiting not only gets rid of the food,
but also some important minerals that the body needs to
remain healthy. Loss of minerals such as potassium can
lead to heart failure. The acids in vomit can wear away
tooth enamel, called erosion; enlarge the salivary glands
in the cheeks; irritate the fingers, which are often used
to trigger vomiting; and inflame the esophagus, the tube
leading from the mouth to the stomach. Excessive dieting
and exercise can lead to irregular menstrual periods. In
rare cases, a bulimic person may eat so much food at once
that the stomach ruptures. Because bulimia is linked to
obsessive-compulsive disorder and depression, people who
are bulimic are more likely to abuse substances such as
drugs or alcohol, and perform other obsessive-compulsive
rituals. Those close to the bulimic person may notice that
he or she is unnaturally concerned with body weight and
appearance, and finds a reason to use the bathroom right
after a meal. Severe bulimia can lead to malnutrition and
death.
How is it diagnosed?
Early diagnosis and treatment of bulimia is extremely
important. A person with bulimia is aware that his or her
behavior is not normal and, under the right circumstances,
may discuss it with a doctor, family member, or friend.
However, most often, these patients deny that anything is
wrong. To diagnose bulimia, the doctor will perform a
thorough physical examination and take a complete medical
history. He or she may order tests to rule out other
possible causes of the patient’s symptoms. A doctor will
suspect bulimia nervosa if an examination reveals swollen
salivary glands, tooth enamel erosion, and signs of
irritation to the fingers, especially around the knuckles.
He or she will order a blood test to check for low
potassium levels. It is important for the patient to admit
to his or her behavior and describe a pattern of bingeing
and purging at least twice per week, for at least three
months.
What is the treatment?
It is important to begin treatment as soon as possible
before permanent physical damage is done. The most common
and effective treatment is a combination of psychotherapy
and drugs. The goal of psychotherapy is to address the
anxieties that are at the root of the bulimic behavior.
Individual and family therapy are beneficial because the
bulimic person needs a strong support system to break the
binge/purge pattern and to reinforce a positive body and
food image. Many patients also find group therapy very
helpful because they can learn from the experiences of
others. Antidepressants are the most effective drug
treatment. A nutritionist can help the patient develop a
diet plan that is healthy and realistic.
Self-care tips
Although there is no known medical treatment to prevent
bulimia, recognizing the signs and symptoms of this
disorder are important to early diagnosis and treatment,
which prevents long-term physical damage. Parents and
caregivers can help develop a positive body image in their
female children, especially, by encouraging healthy eating
and exercise, promoting a realistic model of healthy body
shapes and sizes, and providing a positive role model in
terms of moderation in eating. It is important not to
place too much emphasis on appearance and weight as a
child is growing and developing.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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