Bulimia Nervosa

WHAT YOU SHOULD KNOW:

• Bulimia (bu-LEE-mee-ah) nervosa is a condition where a person eats a large amount of food over a short period of time. This is usually done while the person is alone, and the person may feel unable to control what or how much they eat. This is called binge eating. After binge eating, the person will do activities that would burn off the calories in the food that had just been eaten. This may include making themselves vomit (throw up) or taking medicine (laxatives) to help them go to the bathroom. This may also include exercising too much, or going for a very long time without eating at all.
  
  
• Bulimia nervosa is an eating disorder that is most common in teenage girls, but anyone can have it. Caregivers may have trouble discovering that someone has bulimia because the problem is often kept a "secret". You may always be on a diet, and worrying about your body shape and weight. You may not realize that you have a serious problem. Bulimia nervosa can be treated with talk therapy, other therapy, and special medicines.

AFTER YOU LEAVE:

Medicines:

• Keep a list of your medicines: Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Do not take any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers.
  
  
• Take your medicine as directed: Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver.
  
  
• Always tell caregivers if you are taking any vitamins, herbs, or other supplements to make sure they are the best ones for you. Caregivers also know if these supplements may affect how your other medicines work.
  
  
• Do not use any medicines that are not ordered for you by your caregiver. Do not drink liquids that contain alcohol while taking medicine for bulimia.
  
  
• Do not drive or use heavy equipment if you are taking medicine that makes you drowsy.

Medicine monitoring:

• You may need blood tests once you start taking medicine for bulimia. These tests are used to check how much medicine is in your blood. Caregivers use the results of these tests to decide how much medicine is right for you. You may need to have these blood tests more than once.
  
  
• Each time you meet with your caregivers, they will ask you about how you are feeling. Caregivers watch how you respond to your medicines. Tell caregivers about side effects or problems you may be having with your medicine. Sometimes caregivers have to change how much or the type of medicine you take. The goal is for you to feel better with the least amount of side effects. Your caregiver will also talk about how long you may need the medicine.

Follow-up visit information: You may need to see several different caregivers. Keep all appointments with your caregivers. Write down questions you have about bulimia and how it is being treated. This way you'll remember to ask these questions during your next visit. Also, learn what the early signs and symptoms are when your bulimia is not under control. That way you can make an extra appointment sooner if you are having problems. The sooner you get in to see your caregiver, the easier it is to control bulimia.

Types of therapy approaches:

• Assertiveness training teaches you to stand up for yourself. It teaches you how to ask for what you need, how to set limits, and how to say no.
  
  
• Behavioral modification teaches you how to change your behavior (actions). You will look at the reasons for your behavior and the results of your actions. With behavior "mod" therapy, you learn that certain behaviors have good or bad results. These results may make you feel either good or bad about yourself. Good behavior makes most people feel good about themselves. Good behaviors are often rewarded.
  
  
• Biofeedback teaches your body to respond in a different way to stress. Teaching your body to relax can help you feel more in control. Caregivers may use a biofeedback machine so that you know right away when your body is relaxed. You can learn to do this without a machine. If you learn to take your pulse, you can make it slow down by thinking hard about it. This can work with breathing, temperature, and blood pressure too.
  
  
• Cognitive therapy helps to make you aware of how you see things. You may have trouble seeing the good in things around you. Then you are more likely to feel depressed, sad or angry. Cognitive therapy teaches you to learn how you see things in a more positive way.
  
  
• Exposure/desensitization (de-sen-si-teye-ZAY-shun) therapy helps you to face your fears in a safe setting with caregivers there to support and help you. After you have practiced ways to decrease your fear and anxiety you are better able to handle your fears when alone. Desensitization is when caregivers help you practice facing a fear a little at a time. This is taught in a supportive and safe setting.
  
  
• Hypnosis teaches you to change your level of awareness. This means that caregivers teach you to focus your attention so you can move away from upsetting feelings. You make yourself open to suggestions, like feeling happy and having more energy. Hypnosis can give long-lasting relief from depression without changing your normal activities. This treatment gives you better control of your body. After practice, you can learn to do hypnosis when you are by yourself. You may feel less hopeless and helpless because you are actively doing something to get better.
  
  
• Insight oriented therapy makes you think about things that have happened in the past. It helps you to understand your feelings and behavior now as it relates to past events.
  
  
• Relaxation is a way to focus your attention on something other than your feelings. For instance, good smells may change your mood and help you relax. Good smells may also help your brain make special chemicals called endorphins (en-DOR-fins). Endorphins are a natural body chemical that can decrease bad feelings and pain. you may want to try listening to music or taking a bath with special oils. Candles, massage oils, and scented bubble baths are ways that smells can be used for relaxation.

Types of therapeutic sessions:

• Couples therapy: You and your significant other meet with a caregiver to talk about how to cope with your illness. Your significant other may by your spouse (husband or wife) or a boyfriend or girlfriend.
  
  
• Family meetings: Your caregivers will meet with you and your family. You will talk about how to cope with your illness
  
  
• Group therapy: A series of meetings that you attend with other patients and staff. During these meetings, patients and staff talk together about ways to cope with illness.
  
  
• Individual therapy: A time for you to meet alone with your therapist. During this time you and your therapist may talk about how to cope with your illness.

Wellness hints:

• Continue to eat regular, healthy meals. You may need to have regular meetings with a dietician or nutritionist. These are special caregivers that can help you learn how to regularly eat a healthy diet, and stay at a healthy weight.
  
  
• Do not drink liquids that contain alcohol while taking medicine for bulimia. Alcohol can make you feel worried and upset. It can also upset your sleep cycle so you feel more tired. You should also not take any street or illegal drugs. Both alcohol and illegal drugs can affect the way your medicine works, and can make bulimia worse.
  
  
• Talk to your caregiver before exercising. Together you can plan the best exercise program for you. Exercising makes the heart stronger, lowers blood pressure, and keeps you healthy. With bulimia, you may want to exercise too much. If you have bulimia, exercise can make the condition worse. Listen to your caregiver.
  
  
• Stop smoking. Smoking cigarettes or anything else harms the heart, lungs, and the blood. You are more likely to have a heart attack, lung disease, and cancer if you smoke. You will help yourself and those around you by not smoking. Ask your caregiver for more information about how to stop smoking if you are having trouble quitting.
  
  
• Learn healthy ways to manage stress. Learn new ways to relax (deep breathing, relaxing muscles, meditation, or biofeedback). Talk to your caregiver about things that upset you.
  
  
• Get enough sleep. Regular sleep is very important. Try to get six to eight hours of sleep each night. Tell your caregiver if you are not able to sleep, or if you are sleeping too much.

Where can I go for support? Accepting that you have bulimia is hard. You and those close to you may feel angry, sad, or frightened. These are normal feelings. Talk to your caregivers, family, and friends about your feelings. You may also want to join a support group. This is a group of people who also have eating disorders. Ask your caregiver for the names and numbers of support groups in your town. Ask your health care provider if they know about books that you can read. Reading about your illness might help you better understand it. You can also contact the following for more information:

• American Anorexia Bulimia Association, Inc.
  165 West 46th Street, Suite 1108
  New York, NY 10036
  Phone: 1-212-575-6200
  Web Address: http://www.aabainc.org
  

• National Institute of Mental Health (NIMH), Public Information & Communication Branch
  6001 Executive Boulevard, Room 8184, MSC 9663
  Bethesda, MD 20892-9663
  Phone: 1-301-443-4513
  Phone: 1-866-615-6464
  Web Address: http://www.nimh.nih.gov/
  

CONTACT A CAREGIVER IF:

• You have questions or concerns about bulimia or your medicine.
  
  
• You are unable to follow the treatment plan given to you.
  
  
• You are not able to sleep well or are sleeping more than usual.
  
  
• You cannot eat, or are eating more than usual.
  
  
• You cannot make it to your next meeting with your caregiver.
  
  
• You feel that your symptoms of bulimia are returning. The sooner you see your caregiver, the easier it is to control bulimia.

SEEK CARE IMMEDIATELY IF:

• You have very bad side effects, such as rash, swelling, or trouble breathing after taking medicine.
  
  
• You think about committing suicide (killing yourself).

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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