Bulimia Nervosa

Eating Disorder Overview

Introduction

People eat for many reasons that have little or nothing to do with being hungry. Having lots of food around can trigger munching, as can being with family and friends. Holidays, festivals, parties, and other cultural practices may require eating. Attempts to change one's body image can lead to a change in eating habits.

Dieting to an unhealthy body weight is promoted by current fashion trends. This fuels sales campaigns for special foods, diet plans, books, and fitness activities. Participating in these fads may be harmless, but sometimes a simple diet can lead to something more serious. Eating disorders involve severe disturbances in eating behavior, such as extreme reduction of food intake or even severe overeating, as well as feelings of distress or excessive concern about body weight and appearance.

Eating disorders frequently occur along with other psychiatric disorders such as mood disorders, substance abuse, and anxiety disorders. In addition, people with eating disorders may experience many physical health problems. Recognition of eating disorders as real and treatable diseases, therefore, is critically important.

Prevalence

An estimated 1 to 4 percent of females will have bulimia nervosa sometime in their lifetime. Like anorexia nervosa, bulimia is ten times more common in females than males. This is thought to reflect greater societal emphasis on looks and thinness in females. Nevertheless, males may suffer from bulimia or a related condition known as muscle dysmorphia that also involves dissatisfaction with appearance.

Symptoms of Bulimia

Symptoms of bulimia nervosa include binge eating — eating a substantially greater amount of food in a period of time (less than 2 hours) than most people would eat under similar circumstances. This bingeing may be planned in advance or may begin spontaneously. During a binge, the individual usually eats rapidly, until uncomfortably full. They often feel a lack of control over their eating, which can be dissociative. The bingeing is often triggered by unhappy moods, and may be temporarily comforting.

Bingeing is then followed by an inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medications, fasting, or excessive exercise. Vomiting is the most common form of purging (90% of bulimics), as it brings immediate physical relief and reduces fears of weight gain. Men with bulimia are less likely to vomit and more likely to exercise excessively (click here for a true story). For a diagnosis of bulimia, the binge eating and inappropriate compensatory behaviors both must occur at least twice a week for three months. The bulimic's self-evaluation is unduly influenced by body shape and weight.

People with bulimia are on average within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel extremely dissatisfied with their bodies. People with bulimia often binge and purge in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.

Treatment of Bulimia

The primary goal of treatment for bulimia is to reduce or stop binge eating and purging behavior. Nutritional education, psychotherapy, family intervention, and medication are often used. The goals of treatment usually include the establishment of regular, non-binge meals, improvement in attitudes related to the eating disorder, encouragement of healthy but not excessive exercise, and resolution of co-occurring conditions such as depression or anxiety disorders. Individual psychotherapy (especially cognitive-behavioral or interpersonal psychotherapy), group psychotherapy that uses a cognitive-behavioral approach, and family or marital therapy have been reported to be effective. Psychiatric medications, primarily antidepressants such as the selective serotonin reuptake inhibitors (SSRIs), have been found helpful for people with bulimia, particularly in patients with depression or anxiety, or those who have not responded adequately to psychotherapy alone. These medications also may help prevent relapse.

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Disclaimer: This information should not be considered medical advice and should not substitute the judgment of a competent psychiatrist.

Credits: Article edited by M. Williams, Ph.D. (more about author). Source: "Eating Disorders: Facts About Eating Disorders and the Search for Solutions," NIH Publication No. 01-4901, Printed 2001