Bulimia Nervosa

Bulimia (buh-LEE -me-ah) nervosa, typically called bulimia, is a type of eating disorder. The essential features of bulimia nervosa include eating binges followed by feelings of guilt, humiliation, and self-deprecation. These feelings precipitate the patient's engaging in self-induced vomiting. the use of laxatives or diuretics, or strict dieting or fasting to overcome the effects of the binges. Unless the patient devotes an excessive amount of time to binging and purging, bulimia nervosa seldom is incapacitating.

Most people with bulimia nervosa are females, ranging in age from the teens to early 20s, who are preoccupied with their weight and body image. Bulimia nervosa affects all races, but is most often diagnosed in Caucasian women.

Causes

The exact cause of bulimia is unknown, but various psychosocial factors are thought to contribute to its development. Such factors include family disturbance or conflict, sexual abuse, maladaptive learned behavior, struggle for control or self-identity, cultural overemphasis on physical appearance, and parental obesity. Bulimia nervosa is strongly associated with depression.

Signs and symptoms

• self-induced vomiting (usually secretive)
• depression
• inappropriate use of diuretics or laxatives
• overachieving behavior
• persistent preoccupation with eating and an irresistible craving for food.
• anxiety

Treatment

Treatment of bulimia nervosa may continue for several years. Interrelated physical and psychological symptoms must be treated simultaneously. Merely promoting weight gain isn't sufficient to guarantee long-term recovery. A patient whose physical status is severely compromised by inadequate or chaotic eating patterns is difficult to engage in the psychotherapeutic process.

Psychotherapy focuses on breaking the binge-purge cycle and helping the patient regain control over eating behavior. Treatment may occur in either an inpatient or outpatient setting. It includes behavior modification therapy, possibly 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 self­control strategies. Antidepressant drugs such as imipramine may be used to supplement psychotherapy.

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.

Prevention

Preventive measures to reduce the incidence of bulimia are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the process of normal growth and development, and improve the quality of life experienced by adolescents with bulimia. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.