Bulimia Nervosa

People who have bulimia nervosa have episodes where they feel they are unable to control their eating, which are typically followed by periods of self-disgust and efforts to compensate for overeating. Normal weight and secretive bingeing and purging can make it difficult for others to recognize what is occurring; however, vomiting and using medications to lose weight or encourage bowel movements can create other symptoms.

Common primary symptoms of bulimia nervosa include:

• Awareness of abnormal eating patterns

• Eating large quantities of food at one sitting

• Excessive exercising

• Feelings of lack of control over eating binges

• Normal weight

• Preoccupation with weight, fear of weight gain

• Secretive behavior

• Self-disgust and guilt over eating binges

• Unhappiness over size and body shape

• Use of emetics to induce vomiting, laxatives or enemas to stimulate bowel movements, or diuretics or diet pills to lose weight

• Vomiting after eating

Purging by vomiting or using medications to lose weight or encourage bowel movements can cause additional symptoms including:

• Broken blood vessels in the eyes

• Cuts, calluses and scars on the knuckles and backs of the hands

• Dry mouth

• Heartburn

• Intestinal problems and indigestion

• Perioral dermatitis (perleche)

• Sensitive teeth

• Sore throat

• Swollen salivary glands

• Teeth discoloration

• Thirst

• Tooth erosion and decay

In some cases, bulimia nervosa can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

• Being a danger to oneself or others, including threatening, irrational or suicidal behavior

• Bluish coloration of the lips or fingernails

• Change in level of consciousness or alertness, such as passing out or unresponsiveness

• Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

• Chest pain, chest tightness, chest pressure, palpitations

• Cold, clammy, pale skin

• Not producing any urine

• Rapid heart rate (tachycardia) or abnormal heart rhythm (arrhythmia)

• Respiratory or breathing problems, such as shortness of breath, difficulty breathing, not breathing

• Seizure

• Severe abdominal pain

• Vomiting blood, rectal bleeding, or bloody stool

The cause of bulimia nervosa is not known, but it is probably related to an interaction of factors, such as genetics, environment, culture, trauma, and psychological and family issues. Bulimia nervosa occurs more commonly in adolescent and young adult women than in men or other age groups.

A number of factors increase the risk of developing bulimia nervosa. Not all people with risk factors will get bulimia nervosa. Risk factors for bulimia nervosa include:

• Adolescence and early adulthood
• External pressure to maintain or lose weight
• Family history of bulimia or other eating disorders
• Female gender
• History of sexual, emotional or physical abuse

Mild bulimia nervosa may respond well to support groups; otherwise, bulimia is typically treated with a combination of psychotherapy and nutrition therapy. Severe or complicated bulimia may require initial hospitalization. If your bulimia does not improve sufficiently with psychotherapy and nutrition therapy, antidepressants may be added and may prove to have significant benefit.

Any coexisting psychiatric conditions or medical complications also need to be treated.

Treatment of bulimia nervosa may involve psychotherapy, nutrition therapy, antidepressants, hospitalization, and treatment of coexisting psychiatric conditions or medical complications. Common treatments include:

• Antidepressants to complement psychotherapy and potentially reduce the risk of relapse

• Cognitive behavioral therapy to work on thought patterns and behavior

• Family therapy, which is is extremely helpful for adolescent patients

• Hospitalization for medical complications, coexisting anorexia, major depression, or to treat purging withdrawal

• Nutrition therapy

• Support groups, such as Overeaters Anonymous and others

• Surgery for severe complications, such as stomach obstruction or rupture or esophageal tears

• Treatment of coexisting psychiatric disorders or medical conditions

Complications of untreated or poorly controlled bulimia nervosa can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of bulimia nervosa include:

• Anemia (low red blood cell count)

• Dehydration (loss of body fluids and electrolytes, which can be life threatening when severe and untreated)

• Dilation, obstruction or rupture of the stomach

• Electrolyte imbalances

• Esophageal tears

• Gastroesophageal reflux disease (GERD)

• Heart failure

• Kidney failure

• Menstrual irregularities

• Poor teeth