Bulimia nervosa

Binge-Eating Syndrome

Basic Information

What is Bulimia nervosa?

A psychological eating disorder characterized by abnormal perception of body image, constant craving for food and binge eating, followed by self-induced vomiting or laxative use.

Frequent signs and symptoms

Recurrent episodes of binge eating (rapid consumption of a large amount of food in a short time, usually less than 2 hours), plus at least 3 of the following:

  • Preference for high-calorie, convenience foods during a binge.
  • Secretive eating during a binge. Patients are aware that the eating pattern is abnormal, and they fear being unable to stop eating.
  • Termination of an eating binge with purging measures, such as laxative use or self-induced vomiting.
  • Depression and guilt following an eating binge.
  • Repeated attempts to lose weight with severely restrictive diets, self-induced vomiting and use of laxatives or diuretics.
  • Frequent weight fluctuations greater than 10 pounds from alternately fasting and gorging.
  • No underlying physical disorder.

Causes

Unknown; thought to be largely emotional.

Risk increases with

  • Strict, compulsive, perfectionistic family environment.
  • Anorexia nervosa.
  • Depression.
  • Stress, including lifestyle changes, such as moving or starting a new school or job.
  • Personality disorders.
  • Neurotic preoccupation with being physically attractive.
  • Being a ballet dancer, model, cheerleader or athlete (especially a gymnast).

Preventive measures

  • Encourage a rational attitude about weight.
  • Enhance self-esteem.
  • Avoid stress and overly high self-expectations..

Expected outcomes

Outcome is variable; patients can learn to control the behavior with counseling, psychotherapy, biofeedback training and individual or group psychotherapy.

Possible complications

  • Fluid and electrolyte imbalance from vomiting; dental disease from vomiting gastric acid; stomach rupture (rare); malnutrition.
  • Without treatment, complications can be fatal.
  • Relapse.

Bulimia nervosa treatment

General measures

  • The goal of treatment is to establish healthy eating patterns to regain normal weight. This can be accomplished with behavior modification training supervised by a qualified professional.
  • Those who stay in therapy have the best chance to improve.
  • Additional information available from Anorexia Nervosa and Associated Disorders, Helpline : (630) 577-1330 (9 AM-5 PM Central Time, Monday through Friday.)

Medications

Antidepressants are sometimes helpful.

Information Brand Generic Label Rating
Sertraline uses Zoloft Sertraline Off-Label
Effexor capsules Effexor Venlafaxine Off-Label
Prozac Fluoxetine On-Label
Tofranil Imipramine Off-Label
Revia Naltrexone Off-Label
Topamax Topiramate Off-Label

Activity

No restrictions. Don't overexercise to lose weight.

Diet

  • If hospitalization is necessary, intravenous fluids may be prescribed. During recovery, vitamin and mineral supplements will be necessary until signs of deficiency disappear and normal eating patterns are established.
  • For outpatient therapy, supervision and regulation of eating habits, maintenance of a food diary and reintroduction of feared foods.

Notify your physician if

  • You have symptoms of bulimia or you suspect your child has bulimia.
  • The following occur during treatment:
    • Rapid, irregular heartbeat or chest pain.
    • Loss of consciousness.
    • Cessation of menstrual periods.
    • Repeated vomiting or diarrhea.
    • Continued weight loss, despite treatment.

Last updated 20 December 2011


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