Bulimia nervosa is an eating disorder that involves repetitive binge eating: eating large quantities of food at one sitting, regardless of hunger. During the binge, the person feels out of control of the eating and cannot stop. The condition also involves behavior that is aimed at controlling weight, such as purging (self-induced vomiting). Individuals may also abuse laxatives, suppositories, enemas or diuretics, or they may go on an extended fast or exercise furiously.

Many individuals have symptoms that overlap with anorexia nervosa . In both bulimia and anorexia, the person may be preoccupied with weight and be very self-conscious about size and shape.

Women make up 85% to 90% of people with bulimia nervosa. In men, the nonpurging form of bulimia is more common than the purging form.

Often bulimia appears between the ages of 15 and 20, but it can develop earlier or later. The incidence in younger children is not well researched. The condition affects up to 4% of women over the course of a lifetime. Although people with bulimia are afraid of becoming fat, most are of normal weight or only slightly overweight.

People with bulimia eat huge quantities of food — sometimes up to 20,000 calories at a time. The foods on which they binge tend to be "comfort foods" — sweet foods; foods high in calories; or smooth, soft foods such as ice cream, cake and pastries. People with bulimia may binge a few times a week or as frequently as several times a day.

Like anorexia, bulimia wreaks havoc on the body. It can lead to dehydration from purging, chronic bowel problems from laxative use, tooth decay from excessive vomiting and gastrointestinal difficulties. At its most destructive, bulimic behavior can lead to an irregular heartbeat, permanent heart damage and even death.

People with bulimia usually feel ashamed of their binging and purging behaviors. They are often impulsive and may have other addictive behaviors. Many people with bulimia also have a history of anorexia or obesity. They also may have undiagnosed major depression, , anxiety disorder, , social phobia or panic disorder.

There is almost certainly a genetic predisposition to bulimia. The disorder runs in families. The biological cause is not specifically known, but most experts believe that brain pathways that control appetite are involved in the disorder.

Symptoms include:

• Extreme concern over body weight or body shape
• Eating large quantities of food over a short period (binge eating), usually in secret
• Following binge eating with purging — self-induced vomiting or the use of laxatives, diuretics, enemas or suppositories — or with fasting, restrictive dieting or excessive exercise

Bulimia can lead to:

• Apathy, poor concentration
• Tooth erosion and decay
• Constant sore throat
• Muscle weakness
• Bone pain with exercise
• Low blood pressure
• Irregular heartbeat
• Swollen salivary glands
• Constipation or other bowel problems
• Gastrointestinal problems, such as bloating, heartburn or acid reflux
• Fertility problems

A diagnosis of bulimia is made when you are obsessed with weight and body image and have severe eating binges at least twice a week for three months, along with compensating behavior such as purging, exercise or excessive dieting.

To help in the diagnosis, your doctor will ask you about your a medical history and examine you to look for the physical signs of bulimia. Blood tests can tell the doctor whether vomiting or using diuretics or laxatives has caused you to be dehydrated or depleted of electrolytes and other significant nutrients.

Your doctor will also explore whether you have any other mental disorders, such as obsessive compulsive disorder or an anxiety or mood disorder.

Bulimia can last for a short time or can continue for many years. About a quarter of individuals with bulimia get better without treatment. With treatment, more than half improve.

But even after successful treatment, bulimia can return. Many women continue to have some symptoms of an eating disorder. Estimates of frequency and severity vary widely.

There is no known way to prevent bulimia. Treatment can be easier if the problem is detected early.

An eating disorder is a complex mix of physical and emotional problems. Healthcare providers try to organize a treatment that will address these problems comprehensively.

The goals of treatment are to

• reduce or eliminate binge eating and purging
• treat any physical complications
• provide education and motivate the individual to restore healthy eating
• help the individual understand and change harmful thought patterns related to the disorder
• identify and treat any associated mental disorders (for example, depression or anxiety)
• encourage and develop family support
• prevent relapse

Treatment includes nutritional counseling; psychological counseling; and medication, such as antidepressants. A combination of approaches — when they are available — is often the most helpful approach.

Nutritional counseling usually involves developing a structured meal plan and learning to recognize body cues and urges to binge and purge.

Psychotherapy helps people with bulimia create a healthy body image, understand and deal with their emotions, change their obsessive-compulsive behaviors related to food, and gain healthy eating behaviors. Cognitive behavior therapy (CBT) is the best studied approach, and it is known to be effective for many. Family and group psychotherapy can be helpful. In practice, many therapists combine elements of CBT, interpersonal therapy and psychodynamic therapy during the treatment. Self-help, sometimes with the guidance of a professional, can help, as can self-help groups.

With or without psychotherapy, medication often helps to decrease the urge to binge and purge. Fluoxetine (Prozac) has been most frequently studied and is effective, as is sertraline (Zoloft). Sometimes people need higher doses than the doses used to treat depression. Because mood and anxiety disorders are often part of the eating problem, medications for these conditions also may help.

Contact a health care professional (physician, counselor, psychiatrist) if you think you have, or are at risk of, bulimia. If you do not feel comfortable doing this, talk to a trusted friend or family member about your concerns and ask them to contact someone for you.

If someone you know shows signs of bulimia, encourage him or her to contact a physician or mental health professional. Confronting someone with bulimia can be difficult. He or she may deny the problem or become defensive. For more information on how to talk to someone you suspect is bulimic, see the Additional Information section below.

Many people with eating disorders recover, especially if their condition is recognized early. Estimates vary, but between one-third and two-thirds of individuals continue to have symptoms. Treatment improves the chances of reducing problems and improving functioning. When the illness begins in adolescence, the prognosis is probably better. Prognosis is worse if the person has other psychiatric problems, such as obsessive-compulsive disorder, a mood problem or a personality disorder.

National Association of Anorexia Nervosa and Associated Disorders
P.O. Box 7
Highland Park, IL 60035
Phone: 847-831-3438
Fax: 847-433-4632
Email: anad20@aol.com
http://www.anad.org/

American Psychiatric Association
1000 Wilson Blvd.
Suite 1825
Arlington, VA 22209-3901
Phone: 703-907-7300
Toll-Free: 1-888-357-7924
Email: apa@psych.org
Web site: http://www.psych.org/Public information site: http://www.healthyminds.org/

American Psychological Association
750 First St., NE
Washington, DC 20002-4242
Phone: 202-336-5510
Toll-Free: 1-800-374-2721
TTY: 202-336-6123
http://www.apa.org/