Eating Disorders - 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.

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.

Terms:

Eating disorders