Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Bulimia Nervosa

(Bulimia)
by Debra Wood, RN
Definition

Bulimia nervosa is an eating disorder. People who have it eat very large amounts of food (binging) and many also use inappropriate means to rid their bodies of the food (purging). Purging may be caused by vomiting, laxatives, or water pills. Individuals use this cycle to prevent gaining weight. These behaviors last for more than three months for at least two times a week. Individuals are overly concerned with weight and body image. In some, excessive exercise or fasting may replace or supplement purging.

Causes

The cause of bulimia is unknown. Several factors may contribute to this condition:

  • Physical changes in the digestive system, including:
    • A stomach that empties slowly
    • An enlarged stomach
    • Decreased production of a digestive hormone
  • Changes in the level of brain chemicals
  • Cultural bias toward thinness
  • Dieting or restricted eating
  • Emotional stress
Risk Factors

Factors that increases your chance of developing bulimia include:

  • History of obesity
  • Age: 11-20 years old
  • Anxiety
  • Career in which physical appearance is important
  • Compulsive dieting
  • Family members who have been obese
  • Family members who have had a mood disorder
  • Low self-esteem
  • Mood disorder
  • Sex: female
  • Unhappiness with weight and size
Symptoms

Behavioral symptoms include:

  • Alcohol or drug abuse
  • Depression
  • Eating unusually large amounts of food at one time
  • Excessive exercising
  • Feeling like eating is out of control
  • Making yourself throw up
  • Mood swings
  • Taking laxatives, enemas, water pills, or diet pills
  • Trouble controlling impulses

Physical symptoms include:

  • Abdominal pain
  • Bloating
  • Cuts or scars on back of hands, from scraping skin on teeth during forced vomiting
  • Menstrual problems
  • Sore throat
  • Stained or chipped teeth, due to contact with stomach acid
  • Swollen cheeks and jaw
  • Swollen salivary glands

Bulimia may lead to other problems, including:

  • Changes in body chemistry and fluids due to vomiting and abuse of laxatives or water pills
  • Dental and throat problems from stomach acid that rises during vomiting

Symptoms of these complications include:

  • Constipation
  • Dizziness
  • Feeling faint
  • Heart problems, including sudden death
  • Irregular heartbeat
  • Muscle cramps
  • Thirst
  • Weakness

People with bulimia have a high incidence of personality disorder and of treatable psychiatric conditions, including:

  • Anxiety and panic disorder
  • Depression, often with rapid and wide swings in mood
  • Drug and alcohol abuse or dependence
Diagnosis

The doctor will ask about:

  • The amount of food you eat
  • The ways you to try to rid your body of food
  • Your medical and psychological history

The doctor will also perform a physical exam. They will check your teeth for signs of erosion.

Tests may include:

  • Blood tests—to look for chemical imbalances
  • Drug screening—to check for drug use
  • Electrocardiogram (ECG or EKG)—to look for heart problems due to purging

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

Treatment

The goals of treatment are:

  • To focus self-esteem away from body weight and shape
  • To stop binging and purging

Treatments include:

Nutritional Consult

You may be referred to a registered dietitian. A dietitian can help you learn more about the components of a healthy diet, reasonable weight and calorie goals.

Psychotherapy

Cognitive behavioral therapy can be very effective. It may be particularly effective when combined with drug treatment.

Other therapies may be less effective, but can help patients:

  • Develop a more appropriate idea of thinness
  • Develop healthier attitudes about eating
  • Develop new coping skills
  • Gain insight into the problem
  • Learn and practice stress-management techniques
  • Learn to eat regularly to reduce the urge to binge
  • Recognize what triggers binging and purging
  • Talk about feelings
Medications

Antidepressant drugs, particularly selective serotonin reuptake inhibitors (SSRIs), have proven effective in helping reduce these behaviors.

Prevention

Healthy attitudes about food and your body help prevent bulimia nervosa. Suggestions include:

  • Talk to your doctor or a mental health professional if:
    • You think you may be developing an eating disorder
    • You think your quest for thinness may be getting out of control
  • Accept a realistic body image.
  • If you have a friend who may have bulimia, encourage your friend to get help.
  • Maintain a rational approach to dieting and food.
  • Set realistic goals.
  • Take pride in what you do well.

Last reviewed: September 2011 by �Dianne Scheinberg MS, RD, LDN.

RESOURCES:
CANADIAN RESOURCES:
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