Bulimia Nervosa

What is bulimia nervosa?

Bulimia is an eating disorder. You binge eat and then vomit, use laxatives, starve yourself, or exercise for hours to prevent weight gain. This behavior happens often, usually at least 2 times a week for several months.

What increases my risk for bulimia nervosa?

Bulimia is most common among women, but men can also have bulimia. It usually begins between the ages of 13 and 28. The following may increase your risk for bulimia:

  • You are overweight or think you are too heavy. You have tried many diets.

  • You do not feel good about yourself or your body. You set high goals or try to be perfect at all times.

  • You participate in a sport or activity that values thinness, such as gymnastics, cheerleading, wrestling, or modeling.

  • You have a history of anxiety, depression, or obsessive-compulsive thoughts.

  • You have a family member with an eating disorder, obesity, or problems with substance abuse.

  • You do not have good relationships with family members, or you have had lots of stress or trauma in your life.

What are the signs and symptoms of bulimia nervosa?

  • Binge and purge cycles: You binge eat and then vomit, use laxatives, starve yourself, or exercise. You may feel lonely, anxious, sad, or angry before a binge. During a binge, you feel like you cannot stop eating and eat large amounts of food. You might do this in secret. After a binge, you feel guilty, depressed, and terrified of weight gain. You then vomit, take laxatives or diuretics, starve yourself, or exercise for hours to avoid weight gain. This gives you a sense of relief and control for a short time. Before long, you start to feel bad about yourself again, and the cycle repeats.

  • Physical problems: Your weight may go up and down a lot. You may have a sore throat and tooth decay caused by vomiting. You may have calluses or cuts on your knuckles if you use your hand to make yourself vomit. Your monthly periods may be irregular or stop completely. You may often be bloated and have constipation or diarrhea. You may often feel tired and weak.

  • Emotional problems: You feel moody and depressed, or believe that your self-worth is determined by your weight. You may abuse drugs or alcohol to cope with mood swings and thoughts that frighten you. You think about food and your weight all the time.

How is bulimia nervosa diagnosed?

Your caregiver will examine you and check your height and weight. He will ask how you feel about yourself and how you control your weight. He may ask you to fill out several forms about your feelings and eating habits. He may ask a parent or friend about your behavior and eating habits. This is because patients with bulimia often find it very hard to discuss their symptoms or ask for help. You may need the following tests:

  • Blood test: This will show if you are getting enough iron, calcium, glucose, and other nutrients.

  • Urine test: Your caregiver may test your urine for signs of dehydration or pregnancy.

  • Telemetry is continuous monitoring of your heart rhythm. Sticky pads placed on your skin connect to an EKG machine that records your heart rhythm.

How is bulimia nervosa treated?

It is important to understand that bulimia is a life-threatening medical condition. Treatment may need to take place in a hospital or clinic. One goal of treatment is to develop healthy thoughts about your body and food. Another goal is to treat or prevent serious health problems that can occur because of bulimia. Treatment will be more effective if you understand the seriousness of your condition and truly want to get better. You may have relapses, but with treatment, you can recover from bulimia.

  • Therapy or counseling:

    • Cognitive behavioral therapy (CBT): A therapist will help you change your thoughts about food, weight gain, and self-worth. You will learn how to identify negative thoughts and beliefs and replace them with positive thoughts and beliefs. CBT also teaches you new ways to cope with events that trigger bulimia.

    • Group therapy, family therapy, or a support group: Group therapy is a meeting with other people who also have bulimia. Family therapy is a meeting with a therapist and your family members. Overeaters Anonymous, Eating Disorders Anonymous, or another support group may help prevent a relapse in the future.

    • Nutrition therapy: You will meet with a dietitian to talk about nutrition and develop a healthy meal plan. It is important to eat 3 to 5 structured meals a day to reduce the urge to binge. You might need to learn how to prepare healthy food. You might also need to relearn what it feels like when you are hungry and full. You may be asked to keep a food diary and bring it to future visits.

  • Medicine:

    • Antidepressants: Antidepressants called SSRIs are usually used to treat bulimia. You may need this medicine even if you are not depressed. An SSRI gives your brain more of a chemical called serotonin. Serotonin may help you focus on other things and think less about weight and food.

    • Anticonvulsants: This medicine may help control your mood swings and decrease aggression or irritability.

    • Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.

    • Laxatives: Treat constipation with a laxative that contains polyethylene glycol 3350, or use glycerin suppositories. Do not use stimulant laxatives, because they can damage your bowels.

    • Vitamins: You may need vitamin and mineral supplements if your nutrient levels are low because of bulimia.

What are the risks of bulimia nervosa?

  • Without treatment, bulimia is likely to be a long-term condition. Many of the risks of bulimia can be life-threatening. You can develop congestive heart failure if you use ipecac to make yourself vomit. Vomiting can cause your electrolytes (calcium, sodium, potassium) to be too high or too low, and this could cause your heart to stop. If you have type 1 diabetes and skip insulin to lose weight, you could slip into a coma or even die.

  • The acid in vomit may erode the enamel on your teeth and cause cavities and gum disease. Repeated vomiting can also cause heartburn, acid reflux, and damage to your esophagus. If you abuse laxatives, your bowels could stop working and you could need rectal surgery or a colostomy bag. Your bones could fail to develop fully, and you could have weak bones or bone fractures. You may have a hard time getting pregnant during episodes of severe bulimia, and your risk for miscarriage is higher. Your baby may be born prematurely, at a low birth weight, and with a small head circumference.

Where can I find support and more information?

  • 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/
  • The National Women's Health Information Center
    8270 Willow Oaks Corporate Drive
    Fairfax , VA 22031
    Phone: 1- 800 - 994-9662
    Web Address: http://www.womenshealth.gov

When should I contact my caregiver?

Contact your caregiver if:

  • You are constipated.

  • You have tingling in your hands or feet.

  • You have pain in your teeth, mouth, or gums.

  • You have new pain in your abdomen.

  • Your monthly period is very light or has stopped completely.

  • You are planning to get pregnant, in order to develop a safe eating plan.

  • You have questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • You want to harm or kill yourself.

  • Your muscles feel weak, and you have pain and stiffness.

  • You cannot stop vomiting.

  • You have pain when you swallow, or very bad pain in your chest or abdomen.

  • You vomit blood or see blood in your bowel movements.

  • Your heart is beating very fast or fluttering, or you feel dizzy or faint.

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. 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.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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