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.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

If bulimia is not treated, it could get worse. Your illness could make it hard to go to school, work, and to get along with others. You may be unable to take care of your children or others who depend on you. If you lose lots of weight, you may get sick. If you continue to throw up, this can affect your heart and other body organs. If you become severely depressed, you may harm yourself or others. You may even die from this disorder. Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Care settings:

• Inpatient unit: This is the place where you will stay while in the hospital. It has bedrooms and a living area. Sometimes the doors of this unit are locked.
  
  
• Partial care program: This is when you come to the unit every day during the day or evening. After you are treated each day, you then go home. You may need a partial care program just after you've been treated in the hospital. Caregivers may suggest this type of program to keep you from needing to go into the hospital.
  
  
• Intensive outpatient program: This is when you come to the hospital or clinic for one to three hours of treatment. This program is usually two to five times a week, for a short period of time.
  
  
• Outpatient program: This is when you meet with your therapist once a week or less. Appointments are one hour long or shorter. You could meet one-to-one with your therapist, or you may meet with your therapist in a group. You may have few or many scheduled appointments over time.

Patient rights:

• Release of information form: This is a legal paper that lets caregivers share information with those listed on this form. You have to sign this form before any information can be released to persons outside the hospital.
  
  
• Right to privacy: Information that you share with your caregivers is kept private among caregivers. They will not share information with others without your permission.

Caregivers:

• Specialist: This is a caregiver who may do tests to check for other medical problems that you may have as a result of your eating disorder.
  
  
• Psychiatrist (seye-KEYE-ah-trist): This is a medical doctor who works in the area of mental health. The psychiatrist is in charge of ordering your medicine. You may work closely with this doctor and other caregivers.
  
  
• Nutritionist: This is a caregiver that will help you to learn to follow a healthy diet and form healthy eating habits. Together you can also set goals for weight and exercise.
  
  
• Therapist: This is a caregiver that works closely with you during treatment. This person may be a doctor, psychologist (seye-KOL-oh-jist), nurse, mental health counselor, or social worker.

Tests:

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Dental evaluation: Your caregiver may want you to see a dentist. Vomiting (throwing up) may cause problems with your teeth.

Medicines:

• Antianxiety medicine: This medicine may be given to decrease anxiety and help you feel calm and relaxed.
  
  
• Anticonvulsants (an-ti-kon-VUL-sants): This medicine is given to control seizures. It may also be used to decrease violent behavior, aggression, or irritability. This medicine may also help control your mood swings.
  
  
• Antidepressants: This medicine is given to decrease or prevent the symptoms of depression. Often people that have bulimia are also depressed.
  
  
• Mood stabilizers: This medicine is given to control mood changes.
  
  
• Sedative-hypnotics (SED-ah-tiv hip-NOT-iks): This medicine may be given to help you feel calmer. It is often used to help you sleep better at night, if you are having trouble.

Personal:

• Clothes: You may wear your own clothes while you are in the hospital.
  
  
• Meals: Your caregiver will help you start eating a healthy diet. Caregivers may plan your meals and snacks, or you may be able to plan them yourself.
  
  
• Personal belongings: Caregivers search your belongings when you are admitted to the unit. Any belongings brought to you during your stay are also searched. This search is done to keep you and the staff safe.

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 another 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.

Safety:

• 72-hour hold: This is when you are put in the hospital by police or a caregiver for 72 hours without your permission. This may only be done if others are concerned that you may hurt yourself or others. Caregivers or police may not think you can safely care for yourself because you are so out of control.
  
  
• Quiet room: This is an empty room used for patients who need to have time out in a safe place. You may be put here if caregivers are worried that you may hurt yourself or others.
  
  
• Restraints: There are two types of restraints that may be used while you are in the hospital. They will only be used if caregivers feel you are in danger of hurting yourself or others. Physical restraints may be put on your wrists or ankles and tied to something else. These are usually cloth or leather bands. Other things will always be tried before using physical restraints, such as going into a quiet room or seclusion. Caregivers may also use "chemical" restraints, which is medicine used to help you gain control of your actions and help you relax. Restraints should never be used to punish you.
  
  
• Seclusion (see-KLOO-zhun): This is when you need to be locked in a safe room to regain control and calmness. The door is locked. Caregivers will closely watch you while you are in seclusion. You may come out of seclusion when caregivers feel you will not hurt yourself or others.
  
  
• Sharps: You are not allowed to keep any sharp items with you. Sharp items may include scissors, nail files, razors, or glass. Ask a caregiver if you need to use one of these items.
  
  
• Time out: This is time spent away from other people. This is usually needed when you are not able to control your behavior. You may be put in time out if your behavior is affecting others. Time out may be in your room or another room.

Copyright © 2011. Thomson Reuters. 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.

Learn more about Bulimia Nervosa (Inpatient Care)