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Bulimia
Definition
Bulimia is an illness in which a person binges on food or has regular episodes of overeating and feels a loss of control. The person then uses different methods -- such as vomiting or abusing laxatives -- to prevent weight gain.
Many (but not all) people with bulimia also have anorexia nervosa.
Alternative Names
Bulimia nervosa; Binge-purge behavior; Eating disorder - bulimia
Causes
Many more women than men have bulimia. The disorder is most common in adolescent girls and young women. The affected person is usually aware that her eating pattern is abnormal and may feel fear or guilt with the binge-purge episodes.
The exact cause of bulimia is unknown. Genetic, psychological, trauma, family, society, or cultural factors may play a role. Bulimia is likely due to more than one factor.
Symptoms
In bulimia, eating binges may occur as often as several times a day for many months.
People with bulimia often eat large amounts of high-calorie foods, usually in secret. People can feel a lack of control over their eating during these episodes.
Binges lead to self-disgust, which causes purging to prevent weight gain. Purging may include:
- Forcing yourself to vomit
- Excessive exercise
- Using laxatives, enemas, or diuretics (water pills)
Purging often brings a sense of relief.
People with bulimia are often at a normal weight, but they may see themselves as being overweight. Because the person's weight is often normal, other people may not notice this eating disorder.
Symptoms that other people can see include:
- Compulsive exercise
- Suddenly eating large amounts of food or buying large amounts of food that disappear right away
- Regularly going to the bathroom right after meals
- Throwing away packages of laxatives, diet pills, emetics (drugs that cause vomiting), or diuretics
Exams and Tests
A dental exam may show cavities or gum infections (such as gingivitis). The enamel of the teeth may be worn away or pitted because of too much exposure to the acid in vomit.
A physical exam may also show:
- Broken blood vessels in the eyes (from the strain of vomiting)
- Dry mouth
- Pouch-like look to the cheeks
- Rashes and pimples
- Small cuts and calluses across the tops of the finger joints from forcing oneself to vomit
Blood tests may show an electrolyte imbalance (such as hypokalemia) or dehydration.
Treatment
People with bulimia rarely have to go to the hospital, unless they:
- Have anorexia
- Have major depression
- Need drugs to help them stop purging
Most often, a stepped approach is used for patients with bulimia. The treatment approach depends on how severe the bulimia is, and the person's response to treatments:
- Support groups may be helpful for patients with mild conditions who do not have any health problems.
- Cognitive-behavioral therapy (CBT) and nutritional therapy are the first treatments for bulimia that does not respond to support groups.
- Antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) are often used for bulimia. A combination of CBT and SSRIs is very effective if CBT does not work alone.
Patients may drop out of programs if they have unrealistic hopes of being "cured" by therapy alone. Before a program begins, you should know that:
- You will probably need to try many different therapies to overcome this difficult disorder.
- It is common for bulimia to return (relapse), and this is no cause for despair.
- The process is painful, and you and your family will need to work hard.
Support Groups
Self-help groups like Overeaters Anonymous may help some people with bulimia. The American Anorexia/Bulimia Association is a source of information about this disorder.
See: Eating disorders - support group
Outlook (Prognosis)
Bulimia is a long-term illness. Many people will still have some symptoms, even with treatment.
People with fewer medical complications of bulimia, and those who are willing and able to take part in therapy have a better chance of recovery.
Possible Complications
Bulimia can be dangerous. It may lead to serious medical complications over time. For example, vomiting over and over again puts stomach acid in the esophagus (the tube from the mouth to the stomach), which can permanently damage this area.
Possible complications include:
- Constipation
- Dehydration
- Dental cavities
- Electrolyte imbalances
- Hemorrhoids
- Pancreatitis
- Swelling of the throat
- Tears of the esophagus from too much vomiting
When to Contact a Medical Professional
Call for an appointment with your health care provider if you (or your child) have symptoms of an eating disorder.
References
American Psychiatric Association. Treatment of patients with eating disorders, 3rd ed. American Psychiatric Association. Am J Psychiatry. 2006 Jul;163(7 Suppl):4-54.
Marcus MD, Wildes JE. Eating disorders. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 226.
Sim LA, McAlpine DE, Grothe KB, Himes SM, Cockerill RG, Clark MM. Identification and treatment of eating disorders in the primary care setting. Mayo Clin Proc. 2010;85(8):746-751.
Treasure J, Claudino AM, Zucker N. Eating disorders. Lancet. 2010;375(9714):583-593.
Hay PPJ, Bacaltchuk J, Stefano S, Kashyap P. Psychological treatments for bulimia nervosa and binging. Cochrane Database Syst Rev. 2009;(4):CD000562.
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
