Bulimia Nervosa

What is Bulimia Nervosa?

Bulimia nervosa is an eating disorder in which a person engages in uncontrollable episodes of overeating (bingeing) usually followed by intentionally vomiting (sometimes called purging), misuse of laxatives, enemas, fasting, or excessive exercise to control weight. Bingeing, in this situation, is defined as eating much larger amounts of food than would normally be consumed within a short period of time (usually less than two hours). Eating binges may occur as often as several times a day but are most common in the evening and night hours. Due to the shame, guilt and disgust a person with bulimia nervosa often feels, bingeing and purging behaviors are often done in secret and the evidence of these behaviors may be hidden for months.

What Causes Bulimia Nervosa?

Bulimia Nervosa does not have a single cause. Rather, various factors culminate in to make an individual vulnerable to develop and maintain the eating disorder. Social attitudes toward body appearance, family influences, genetics, past traumatic experiences, and neurochemical and developmental factors may contribute to the development and maintenance of bulimia nervosa. Moreover, recent research suggests that certain areas of the brain function differently with an active eating disorder. A personal or family history of substance abuse, anxiety, depression or suicide is common. It is now clear that parents do not cause eating disorders but family support is essential for recovery.

Who is Affected by Bulimia Nervosa?

Bulimia nervosa not only affects individuals who have the diagnosis, but also their family, friends and loved ones. The majority of people diagnosed with bulimia nervosa are female, adolescent, and of normal or high weight. An estimated 1 to 4 percent of adolescent and young adult females in the United States are reported to have bulimia nervosa. However, bulimia nervosa is known to affect both sexes and span all ages, socioeconomic, ethnic, and racial groups.

What Kind of Person Tends to Get Bulimia Nervosa?

The typical profile of a person with bulimia nervosa is an adolescent to young adult female who is impulsive, perfectionistic, hard-working, introverted, resistant to change and self-critical. They also tend to have low self-esteem based on body image distortion. However, regardless of the age, sex or other characteristics of the individual, eating large amounts of food and subsequently compensating as a means of avoiding weight gain initially reduces anxiety, stress and negative mood by “numbing” negative emotions and giving the person a sense of control in at least one are of her/his life. Over time, these habits cause problems of their own that may increase anxiety, stress and negative mood-especially depression, shame and guilt. Also, substance use/abuse is common among individuals with bulimia nervosa.
What are the different types of bulimia nervosa?

There are two subgroups of behavior aimed at compensating for large caloric intakes, including the following:

• Purging type: regularly engages in self-induced vomiting or misuse of laxatives, diuretics, or enemas to prevent weight gain after eating large amounts of food.
• Non-purging type: uses other behaviors, such as fasting or excessive exercise, rather than regularly engaging in purging behaviors after bingeing to stave off weight gain.

What are the Symptoms of Bulimia Nervosa?

The following are the most common symptoms of bulimia nervosa. However, each individual may experience symptoms differently. Symptoms may include:

• a low, normal or high body weight depending on the balance of caloric intake and output
• recurrent episodes of binge eating (rapid consumption of excessive amounts of food in a relatively short period of time; often secretive), coupled with fearful feelings of not being able to stop eating during the bingeing episodes
• self-induced vomiting (usually secretive)
• excessive exercise or fasting
• peculiar eating habits or rituals
• inappropriate use of laxatives, diuretics, or other cathartics
• irregular or absent menstrual periods
• anxiety
• discouraged feelings related to dissatisfaction with oneself and bodily appearance
• depression
• preoccupation with food, weight, and body shape
• scarring on the back of the fingers from the process of self-induced vomiting
• overachieving and impulsive behaviors

The symptoms of bulimia nervosa may resemble other medical problems or psychiatric conditions. Always consult your physician for a diagnosis.

How is Bulimia Nervosa Diagnosed?

Parents, family members, spouses, teachers, coaches, and instructors may be able to identify an individual with bulimia nervosa, although many persons with the disorder initially keep their illness very private and hidden. As stated, bingeing and purging behaviors are often done secretively and the evidence of these behaviors may be hidden for long periods of time. Moreover, people with bulimia nervosa often maintain a normal weight. Therefore, a detailed history of the individual's behavior from family, parents, and teachers, clinical observations of the person's behavior contribute to the diagnosis. Because a number of medical conditions can mimic some features of bulimia nervosa, a complete medical evaluation is needed. However, blood tests may be normal.

Family members who note symptoms of bulimia nervosa in a loved one can help by seeking an evaluation and treatment early. Even though an individual with bulimia nervosa may deny their behaviors and any need for concern, early treatment is essential in preventing future problems. Bulimia nervosa, and the malnutrition that results, can adversely affect nearly every organ system in the body, increasing the importance of early diagnosis and treatment. Bulimia nervosa can be fatal. Consult a physician for more information.

Treatment for Bulimia Nervosa

Specific treatment for bulimia nervosa will be determined by a physician based on:

• age, overall health, and medical history
• extent of the symptoms
• tolerance for specific meal plans, therapies or medications
• individual and family opinions and preferences

Bulimia nervosa is usually treated with a combination of medical care focused on nutrition rehabilitation, individual therapy, family therapy, behavior modification related to eating and exercise habits. This may occur in an inpatient hospital program, a day treatment center or a series of outpatient appointments with therapists, physicians and nutritionists. Treatment should always be based on a comprehensive evaluation of the individual and family. Individual therapy usually includes cognitive and behavioral therapy (CBT). This therapy is centered on helping individuals with bulimia nervosa to adopt healthier ways of thinking and acting. Medication may also be helpful when used in conjunction with individual therapy. Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g. Prozac, Zoloft or Celexa) are now considered a standard of treatment, even if the patient is not feeling depressed or anxious. The frequent occurrence of medical complications during the course of rehabilitative treatment requires both a physician and a nutritionist are active members of the management team. Although families are not the cause of bulimia nervosa, they play a vital supportive role throughout the treatment process.

Possible Complications of Bulimia Nervosa

Medical complications are common in bulimia nervosa. Almost all complications are reversible with change in dysfunctional weight control habits. Without treatment, complications persist and can worsen, and can be associated with death. The complications include, but are not limited to, the following:

• stomach rupture
• purging may result in heart failure due to loss of vital minerals, such as potassium
• vomiting causes other less deadly, but serious, problems, including:
  the acid in vomit erodes the dental enamel on teeth
• scarring on the backs of hands when fingers are pushed down the throat to induce vomiting
• esophagus becomes inflamed
• glands near the cheeks become swollen
• irregular menstrual periods
• increased risk for suicidal behavior, substance abuse, clinical depression, anxiety, obsessive-compulsive disorder, and other psychiatric illnesses

Prevention of Bulimia Nervosa

Preventive measures to reduce the incidence of bulimia nervosa 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 people with bulimia nervosa. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful. Moreover, having healthy adult role models who do not talk about body shape or size, dieting, fat, or losing weight is helpful. Also, encouraging healthy eating habits and realistic attitudes toward weight and diet may be an effective preventative measure.

Biochemistry and Eating Disorders

To understand eating disorders, researchers have studied the neuroendocrine system, which is made up of a combination of the central nervous and hormonal systems.

The neuroendocrine system regulates multiple functions of the mind and body. It has been found that many of the following regulatory mechanisms may be, to some degree, disturbed in persons with eating disorders:

• physical growth and development
• appetite and digestion
• sleep
• heart rate
• kidney function
• emotions
• thinking
• memory
• temperature regulation

Eating Disorders, Anxiety and Depression

Many people with eating disorders also appear to suffer from anxiety and depression, and is believed that there may be a link between these two disorders. For example:
In the central nervous system, chemical messengers known as neurotransmitters control hormone production. The neurotransmitters serotonin and norepinephrine, which function abnormally in people who have depression, have been discovered to also have decreased levels in both people with bulimia nervosa and anorexia nervosa.

• Research has shown that some patients with bulimia nervosa may respond well to antidepressant medication that affects serotonin function in the body when used in conjunction with individual therapy.
• Biochemical similarities have been discovered between people with bulimia nervosa, anorexia nervosa and obsessive-compulsive disorder (OCD). The hormone vasopressin is another brain chemical found to be abnormal in people with eating disorders and OCD. Levels of this hormone are elevated in patients with OCD, anorexia nervosa, and bulimia nervosa.

Genetic/Environmental Factors Related to Eating Disorders

Because eating disorders tend to run in families, and female relatives are most often affected, genetic factors are believed to play a role in the disorders. However, parents are not to blame and are not the cause of eating disorders.
But, other influences, both behavioral and environmental, may also play a role. Consider these facts from the National Institute of Mental Health:

• Genetic factors are known to contribute to the anxiety, depression, addiction and obsessive-compulsive traits often occurring in eating disorders. This does not mean that parents who are anxious, depressed or have obsessive-compulsive traits cause eating disorders, but that there is an increased vulnerability to develop it (pre-disposing causes).
• “Innocent” teasing, especially by male family members may contribute to the onset of an eating disorder.
• People pursuing activities or professions that focus on the body and emphasize thinness - such as modeling, ballet, gymnastics, wrestling, and long-distance running - are more susceptible to develop these disorders.