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Bulimia nervosa

Also listed as: Eating disorders - bulimia


Bulimia nervosa is an eating disorder characterized by periods of binge eating. In some cases, the person will compensate for this overeating by forcing vomiting; misusing laxatives, diuretics, or enemas; fasting; or excessive exercising. People with bulimia cannot control their eating and have a paralyzing fear of becoming fat. Bulimia is associated with depression and other psychiatric disorders and shares symptoms with anorexia nervosa, another major eating disorder. Because many individuals with bulimia maintain a normal or above-normal body weight, they are able to keep their condition a secret for years.


Signs and Symptoms

Bulimia is often accompanied by the following signs and symptoms:


What Causes It?

There are several different theories about what is involved in the development of bulimia. Bulimia may have a hereditary component, and some experts believe that a family environment with an overemphasis on achievement may be another contributing factor. The role of sexual abuse in the development of bulimia is controversial. Other psychological and environmental factors may be involved -- these may include mood disorders and substance abuse in families of people with bulimia. Individuals with bulimia may also experience depression, self-mutilation, substance abuse, and obsessive-compulsive behavior. Cultural pressures to appear slender contribute to the disorder, particularly among dancers and athletes.


Who's Most At Risk?

People with the following conditions or characteristics are at higher risk for developing bulimia:


What to Expect at Your Provider's Office

Often, people with bulimia are ashamed of their condition and do not seek help for many years, by which time their behaviors are deeply ingrained and harder to change. If you are experiencing symptoms associated with bulimia, you should see a doctor as soon as possible. The doctor should check for physical signs such as eroded tooth enamel and enlargement of the salivary glands, as well as signs of depression, possibly including marks from self-mutilation. Laboratory tests can reveal chemical changes caused by bingeing and purging, and psychological tests may point to obsessive-compulsive or antisocial behaviors.


Treatment

Treatment Plan

The most successful treatment is a combination of interpersonal therapy, family therapy, patient education, and medication.

Drug Therapies

The most common antidepressants prescribed for bulimia are selective serotonin reuptake inhibitors (SSRIs). They include:

Prozac is considered the drug of choice, although some studies suggest that other SSRIs, such as Luvox, may be even more effective.

Important note : Recent studies indicate that the use of Prozac and other antidepressants may cause children and teenagers to have suicidal thoughts. Children who are taking these drugs must be monitored very carefully for signs of potential suicidal behavior.

Your health care provider may prescribe potassium supplements.

Complementary and Alternative Therapies

Psychotherapy is a cornerstone of bulimia treatment. Using biofeedback may also help you to better manage stress. Other mind-body and stress-reduction techniques, such as yoga, tai chi, and meditation, may help you become more aware of your body and form a more positive body image. A 6-week clinical trial showed that guided imagery helped people with bulimia reduce bingeing and vomiting, feel more able to comfort themselves, and improve their feelings about their bodies and eating. More studies are needed to verify these findings and to determine if guided imagery has long-term benefits. Always tell your health care provider about the herbs and supplements you are using or considering using.

Nutrition and Supplements

Bulimic individuals with low body weight, low body mass index (BMI), and low serum albumin (the main protein in blood) levels are at increased risk for vitamin and mineral deficiency. Vitamin abnormalities may contribute to cognitive difficulties such as poor judgment or memory loss and other psychiatric conditions. These deficiencies can often be corrected with dietary interventions.

Some natural therapies, including dietary supplements, may help the general health and well-being of a person struggling with bulimia to become more balanced.

Following these nutritional tips may help reduce symptoms:

You may address nutritional deficiencies with the following supplements:

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Homeopathy

No scientific literature supports the use of homeopathy for bulimia. However, an experienced homeopath will consider your individual case and may recommend treatments to address both your underlying condition and any current symptoms.

Acupuncture

No scientific literature supports the use of acupuncture for bulimia. However, there is a long history of successfully treating a full range of psychiatric disorders with acupuncture. A trained acupuncturist may be able to recommend acupuncture treatments to support your overall health.

Massage

Therapeutic massage can be an effective part of a bulimia treatment plan. In one study, adolescent women with bulimia were assigned at random either to receive massage therapy for 5 weeks or be in a control group (not receiving massage therapy). The 24 women receiving massage improved immediately, while the control group did not improve. Women in the massage group were less anxious and depressed right after their initial massages. They also had better scores on the Eating Disorder Inventory, which helps providers assess psychological and behavioral traits in eating disorders.


Prognosis/Possible Complications

Relapse is common in people with bulimia. Possible complications from repeated bingeing and purging include problems with the esophagus, stomach, heart, lungs, muscles, or pancreas. Suicidal individuals or those with severe symptoms may need to be hospitalized to prevent further complications. Pregnancy may be difficult emotionally for women with bulimia because of the changes in body shape that occur. Poor nutritional health of the mother may also have a negative impact on the unborn child. Women who have stopped menstruating because of bulimia will be unable to become pregnant.


Following Up

Since bulimia is usually a long-term disease, the person's weight, exercise habits, and physical and mental health need to be checked periodically by a health care provider.


Supporting Research

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