BULIMIA NERVOSA

General Information

DEFINITION--A psychological eating disorder characterized by abnormal perception of body image, constant craving for food and binge eating, followed by self-induced vomiting or laxative use.

BODY PARTS INVOLVED--Brain and central nervous system; kidneys; liver; endocrine system; gastrointestinal tract.

SEX OR AGE MOST AFFECTED-- Adolescents or young adults, usually female.

SIGNS & SYMPTOMS--

Recurrent episodes of binge eating (rapid consumption of a large amount of food in a short time, usually less than 2 hours), plus at least 3 of the following:

• Preference for high-calorie, convenience foods during a binge.
• Secretive eating during a binge. Patients are aware that the eating pattern is abnormal, and they fear being unable to stop eating.
• Termination of an eating binge with purging measures, such as laxative use or self-induced vomiting.
• Depression and guilt following an eating binge.
• Repeated attempts to lose weight with severely restrictive diets, self-induced vomiting and use of laxatives or diuretics.
• Frequent weight fluctuations greater than 10 pounds from alternately fasting and gorging.
• No underlying physical disorder.

CAUSES--Unknown. Thought to be largely emotional.

RISK INCREASES WITH

• Strict, compulsive, perfectionistic family environment.
• Anorexia nervosa.
• Depression.
• Stress, including lifestyle changes, such as moving or starting a new school or job.
• Neurotic preoccupation with being physically attractive.
• Ballet dancers, gymnasts, models, cheerleaders and athletes.

HOW TO PREVENT

• Encourage rational attitude about weight.
• Enhance self-esteem.
• Avoid overly high self-expectations.
• Avoid stress.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms. Many patients are secretive, and parents may be unaware of this condition.
• Medical history and physical exam by a doctor.
• Laboratory blood studies, including measurement of electrolyte levels.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Psychotherapy or counseling that may include hypnosis or biofeedback training.
• Treatment in an eating disorder facility (sometimes).
• Hospitalization (severe cases).

POSSIBLE COMPLICATIONS

• Fluid and electrolyte imbalance from vomiting; dental disease; stomach rupture (rare).
• Without treatment, complications can be fatal.
• Relapse.

PROBABLE OUTCOME--Outcome is variable; patients can learn to control the behavior with counseling, psychotherapy, biofeedback training and individual or group psychotherapy.

How To Treat

GENERAL MEASURES--

• Those who stay in therapy have the best chance to improve.
• See Resources for Additional Information.

MEDICATION--Medication is usually not necessary for this disorder. However, antidepressants are sometimes helpful.

ACTIVITY--No restrictions.

DIET--

• If hospitalization is necessary: Intravenous fluids may be prescribed. During recovery, vitamin and mineral supplements will be necessary until signs of deficiency disappear and normal eating patterns are established.
• For outpatient therapy: Supervision and regulation of eating habits. A food diary may be maintained. Feared foods will be reintroduced.

Call Your Doctor If

• You have symptoms of bulimia or you suspect your child has bulimia.
• The following occurs during treatment: Rapid, irregular heartbeat or chest pain. Loss of consciousness. Cessation of menstrual periods. Repeated vomiting or diarrhea. Continued weight loss, despite treatment.