Bulimia Nervosa Information
(from the National Association of Anorexia and Associated Disorders and National Alliance for the Mentally Ill)

Bulimia nervosa is characterized by recurring periods of binge eating, during which large amounts of food are consumed in a short period of time -- sometimes as many as 20,000 calories during the course of a single binge.

The bulimic is aware that his or her eating is out of control. He or she is fearful of not being able to stop eating, and is afraid of being fat. The bulimic usually feels depressed and guilty after a binge.

Frequently, the binges are followed by purging, through self-induced vomiting, abuse of laxatives and/or diuretics, or periods of fasting. The bulimic's weight is usually in a normal or somewhat above normal range; it may fluctuate more than 10 pounds due to alternating binges and fasts.

Bulimia Warning Signs

• Preoccupation with food
• Binge eating, usually in secret
• Vomiting after bingeing
• Abuse of laxatives, diuretics, diet pills
• Denial of hunger or drugs to induce vomiting
• Compulsive exercise
  
• Swollen salivary glands
• Broken blood vessels in the eyes
• heartburn
• bloating
• irregular periods
• dental problems
• constipation
• indigestion
• sore throat
• vomiting blood
• weakness, exhaustion

Medical Consequences

Persons with bulimia--even those of normal weight--can severely damage their bodies by frequent binging and purging. Electrolyte imbalance and dehydration can occur and may cause cardiac complications and, occasionally, sudden death.

In rare instances, binging can cause the stomach to rupture, and purging can result in heart failure due to the loss of vital minerals like potassium.

Do we know what causes bulimia?

The current obsession with thinness in our culture certainly has a large influence. There is some evidence that obesity in adolescence or obese parents predisposes an individual to the development of the disorder.

Parents' anxiety over a chubby child can perhaps also be a contributor. Some bulimics report feeling a "kind of high" when they vomit. People with bulimia are often compulsive and may also abuse alcohol and drugs.

Eating disorders like anorexia and bulimia tend to run in families, and girls are most susceptible. Recently, scientists have found certain neurotransmitters (serotonin and norepinephrine) to be decreased in some persons with bulimia.

Most likely, it is a combination of environmental and biological factors that leads to the development of this disorder.

During the early 1970s almost all persons with an eating disorder believed they had invented the behaviors and that no one else had such a problem.

As in anorexia nervosa, the behaviors associated with bulimia provide temporary relief from tension and allow ill persons to focus less on problems perceived as unresolvable and to instead focus on body weight and food.

Is treatment available for persons with bulimia?

Most people with bulimia can be treated as outpatients because they aren't in danger of starving themselves as persons with anorexia are. However, if the bulimia is out of control, a stay in an eating disorders treatment program may help them let go of their behaviors so they can concentrate on treatment.

Group therapy is especially effective for college-aged and young adult women because of the understanding of the group members. In group therapy they can talk with peers who have similar experiences. Group therapy seems to be most effective for college-aged patients.

Support groups, on the other hand, can be attended for as long as necessary, have flexible schedules, and generally have no charge. Sometimes a person with an eating disorder is unable to benefit from group therapy or support groups without the encouragement of a personal therapist.

Cognitive-behavioral therapy has been shown to benefit many persons with bulimia. It focuses on self-monitoring of eating and purging behaviors as well as changing the distorted thinking patterns associated with the disorder. Cognitive-behavioral therapy is often combined with nutritional counseling and/or antidepressant medications such as fluoxetine (Prozac).

Treatment plans should be adjusted to meet the needs of the individual concerned, but usually a comprehensive treatment plan involving a variety of experts and approaches is best.

It is important to take an approach that involves developing support for the person with an eating disorder from the family environment or within the patient's community environment (support groups or other socially supportive environments).

Further Resources

For more information about eating disorders contact the National Association of Anorexia Nervosa and Associated Disorders, Box 7, Highland Park, Illinois 60035 or at (847) 831-3438.

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