 Bulimia Nervosa
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Bulimia nervosa, usually referred to as bulimia, is defined as uncontrolled episodes of overeating (binging) and usually followed by purging (self-induced vomiting), misuse of laxatives, enemas, or medications that cause increased production of urine, fasting, or excessive exercise to control weight. Binging, 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 occur at least twice a week for three months and may occur as often as several times a day.
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The cause of bulimia is not known. Factors believed to contribute to the development of bulimia include cultural ideals and social attitudes toward body appearance, self-valuation based on body weight and shape, and family problems. Thirty to 50 percent of bulimic teens will also have met the criteria for anorexia nervosa at the onset of their disorder.
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Bulimia Nervosa is common among adolescent girls in the U.S. and in industrialized nations. Many studies suggest that there has been an increase in the number of cases of bulimia over the past 50 years in the U.S. It is estimated that 1-5% of adolescents have bulimia. Adolescents who develop bulimia are more likely to come from families with a history of eating disorders, physical illness, and other mental health problems, such as mood disorders or substance abuse. Other mental health problems, such as anxiety disorders, or mood disorders, are commonly found in teens with bulimia.
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There are two subgroups of anorexic behavior aimed at reducing caloric intake, including the following.
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- purging type - regularly engages in self-induced vomiting or misuse of laxatives, diuretics, or enemas, or other cathartics (medications, through their chemical effects, that serve to increase the clearing of intestinal contents).
- non-purging type - uses other inappropriate behaviors, such as fasting or excessive exercise, rather than regularly engaging in purging behaviors to reduce caloric absorption of excessive amounts of food by the body.
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The following are the most common symptoms of bulimia. However, each child may experience signs differently. Symptoms may include:
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- usually a normal or low body weight (sees self as overweight)
- 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 binging episodes
- 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 binging 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 absence of menstruation
- anxiety
- discouraged feelings related to dissatisfaction with themselves and their 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 behaviors
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The symptoms of bulimia may resemble other medical problems or psychiatric conditions. Always consult your child's physician for a diagnosis.
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Parents, teachers, coaches, or instructors may be able to identify the child or adolescent with bulimia, although many persons with the disorder initially keep their illness very private and hidden. However, a child psychiatrist or a qualified mental health professional usually diagnoses bulimia in children and adolescents. A detailed history of the child's behavior from parents and teachers, clinical observations of the child's behavior, and, sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of bulimia in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.
The evaluation of the adolescent in whom an eating disorder is suspected includes a careful patient and family history, physical examination, laboratory tests, and mental health and nutritional assessments. The patient history includes an assessment of weight changes, self perceptions of weight and desired weight, bingeing and out of control eating and purging, and use of laxatives and diet pills. The social history includes a review of risk factors focusing on the home, education, and activities. A family history includes information about eating disorders within the family, obesity, alcoholism, depression, or other mental illness. The patient is asked questions about abdominal pain, bloating, constipation, esophagitis associated with bulimia, hair loss or texture change associated with anorexia nervosa, cold intolerance, fatigue, weakness, fainting, substance use, sexuality, depression, amount of physical exercise, and stress fractures. A general physical examination assesses blood pressure, pulse, temperature, weight and height, skin and hair changes, heart function, and the abdomen.
Bulimia, and the malnutrition that results, can adversely affect nearly every organ system in the body, increasing the importance of early diagnosis and treatment. Consult your child's physician for more information.
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Specific treatment for bulimia will be determined by your child's physician based on:
- your child's age, overall health, and medical history
- extent of your child's symptoms
- your child's tolerance for specific medications, procedures, or therapies
- expectations for the course of the condition
- your opinion or preference
Bulimia, in adolescents, is usually treated with a combination of individual therapy, family therapy, behavior modification, and nutritional rehabilitation. Treatment should always be based on a comprehensive evaluation of the adolescent and family. Individual therapy usually includes both cognitive and behavioral techniques. Medication (usually antidepressants or antianxiety medications) may be helpful if the adolescent with bulimia is also anxious or depressed. The frequent occurrence of medical complications during the course of rehabilitative treatment requires both your child's physician and a nutritionist to be active members of the management team. Parents play a vital supportive role in any treatment process.
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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.
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Researchers at Children's Hospital Boston are searching for answers to questions about eating disorders.
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- What are the best treatments to prevent osteoporosis (low bone density) in adolescent girls?
- What is the right environment for middle schools to prevent eating disorders?
- What impact did the National Eating Disorder Screening Day in 2000 have on youth and their schools?
- What is the best outpatient and inpatient protocol to help young people with eating disorders recover from their illness?
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