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Bulimia Nervosa

Alternative names:- Binge-purge behavior; Eating disorder - bulimia

The essential features of bulimia nervosa include eating binges followed by feelings of guilt, humiliation, and self deprecation. These feelings cause the patient to engage in self-induced vomiting, use laxatives or diuretics, follow a strict diet, or fast to overcome the effects of the binges.

Unless the patient spends an excessive amount of time bingeing and purging, bulimia nervosa seldom is incapacitating. However, electrolyte imbalances (metabolic alkalosis, hypochloremia, and hypokalemia) and dehydration can occur, increasing the risk of physical complications.

Bulimia nervosa usually begins in adolescence or early adulthood and can occur simultaneously with anorexia nervosa. It affects nine women for every man affected. Nearly 2% of adult women meet the diagnostic criteria for bulimia nervosa; 5% to 15% have some symptoms of the disorder.

Causes

Bulimia nervosa has no known cause, but psychosocial factors may contribute to its development, including family disturbance or conflict, sexual abuse, maladaptive learned behavior, struggle for control or self-identity, cultural overemphasis on physical appearance, and parental obesity.

Signs and symptoms

• self-induced vomiting
• Swollen glands in neck and face
• overachieving behavior
• Depression or anxiety
• Sores in the throat and mouth
• Using the bathroom frequently after meals.
• Sores, scars or calluses on the knuckles or hands
• Irregular heartbeat
• Weakness, exhaustion bloodshot eyes

Diagnosis

Additional diagnostic tools include the Beck Depression Inventory, which may identify coexisting depression, and laboratory tests to help determine the presence and severity of complications. Serum electrolyte studies may show elevated bicarbonate, decreased potassium, and decreased sodium levels.

A baseline electrocardiogram may be done if tricyclic antidepressants will be prescribed for the patient.

Treatment

Psychotherapy concentrates on interrupting the binge-purge cycle and helping the patient regain control over her eating behavior. Treatment may be provided in either an inpatient or an outpatient setting and includes behavior modification therapy, which may take place in highly structured psychoeducational group meetings.

Individual psychotherapy and family therapy, which address the eating disorder as a symptom of unresolved conflict, may help the patient understand the basis of her behavior and teach her self-control strategies. Antidepressant drugs may also be used in cases that involve depression.

The patient also may benefit from participation in self-help groups, such as Overeaters Anonymous, or in a drug rehabilitation program if she has a concurrent substance abuse problem.

With proper treatment, most people with bulimia recover. For some, though, the condition becomes a lifelong battle. Periods of bingeing and purging may come and go through the years, depending on life circumstances.

Prevention

In young children and adolescents, pediatricians may be in a good position to identify early indicators of an eating disorder and prevent the development of full-blown illness. They can ask children questions about their eating habits and satisfaction with their appearance during routine medical appointments, for instance.

Less social and cultural emphasis on physical perfection may eventually help reduce the frequency of this disorder.