Bulimia Nervosa

Bulimia Nervosa is an eating disorder. People who have bulimia eat very large amounts of food (called binging) and then use inappropriate means (vomiting, laxatives, water pills) to rid their bodies of the food (called purging). They eat compulsively and feel unable to stop, then purge to prevent gaining weight. They are overly concerned with weight and body image.

Causes

The cause of Bulimia Nervosa is unknown. Several factors may contribute to this condition:
  • Cultural bias toward thinness
  • Dieting or restricted eating
  • Changes in the level of brain chemicals
  • Emotional stress
  • Physical changes in the digestive system, including:
  • An enlarged stomach
  • A stomach that empties slowly
  • Decreased production of a digestive hormone

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Sex: Female
  • Age: 11-20 years old
  • History of obesity
  • Anxiety
  • Mood disorder
  • Family members who have been obese
  • Family members who have had a mood disorder
  • Compulsive dieting
  • Low self-esteem
  • Unhappiness with weight and size
  • Career in which physical appearance is important

Symptoms

Behavioral symptoms include:
  • Eating huge amounts of food at one time
  • Feeling like eating is out of control
  • Making yourself throw up
  • Taking laxatives, enemas, water pills, or diet pills
  • Excessive exercising
  • Spending a lot of time alone
  • Mood swings
  • Depression
  • Trouble controlling impulses
  • Alcohol or drug abuse
Physical symptoms include:
  • Abdominal pain
  • Menstrual problems
  • Swelling cheeks and jaw
  • Sore throat
  • Swollen salivary glands
  • Bloating
  • Stained or chipped teeth, due to contact with stomach acid
  • Cuts or scars on back of hands, from scraping skin on teeth during forced vomiting
Bulimia may lead to other problems, including:
  • Dental and throat problems from stomach acid that rises during vomiting
  • Changes in body chemistry and fluids due to vomiting and abuse of laxatives or water pills
Symptoms of these complications include:
  • Dizziness
  • Feeling faint
  • Thirst
  • Muscle cramps
  • Weakness
  • Constipation
  • Irregular heartbeat
  • Heart problems
Note: People with bulimia have a high incidence of psychiatric disorders, including:
  • Depression
  • Dysthymia
  • Anxiety
  • Personality disorders
  • Drug abuse
  • Alcohol abuse

Diagnosis

The doctor will ask about:
  • Your medical history
  • The amount of food you eat
  • The ways you to try to rid your body of food
The doctor will also perform a physical exam and check your teeth for signs of erosion.

Tests may include:

Blood Tests – to look for chemical imbalances

Electrocardiogram (ECG or EKG) – to look for heart problems due to purging

Drug Screening - to check for drug use

A mental-health professional may also perform a psychiatric exam and/or psychological tests.

Treatment

The goals of treatment are:
  • To stop binging and purging
  • To focus self-esteem away from body weight and shape
Treatments include: Psychotherapy - individual or group therapy designed to help patients:
  • Gain insight into the problem
  • Recognize what triggers binging and purging
  • Develop new coping skills
  • Learn and practice stress-management techniques
  • Talk about feelings
  • Develop a more appropriate idea of thinness
  • Develop healthier attitudes about eating
  • Learn to eat regularly to reduce the urge to binge
Medications - antidepressant drugs

Prevention

Healthy attitudes about food and your body help prevent Bulimia Nervosa. Suggestions include:
  • Maintain a rational approach to dieting and food.
  • Accept a realistic body image.
  • Take pride in what you do well.
  • Set realistic goals.
  • Talk to your doctor or a mental health professional if:
  • You think your quest for thinness may be getting out of control
  • You think you may be developing an eating disorder