Bulimia Nervosa

What is bulimia nervosa?

• 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.

Who is at risk for bulimia nervosa?

Bulimia nervosa often happens because of emotional changes that usually happens during teenage years. These may include changes in your body, in relationships with other people, and in your life. Adults can also have bulimia nervosa. You may be at higher risk for bulimia if:

• You are female.
  
  
• You are very sad most of the time.
  
  
• You do not really like yourself or how your body looks.
  
  
• Someone else in your family has an eating disorder.
  
  
• Someone else in your family has had an eating disorder in the past.
  
  
• You have had a loss in your life like a death or a divorce.
  
  
• You feel a lot of stress, like having to move to a new town, house, or school.
  
  
• You feel there is lot of pressure on you to be thin.

What are the signs and symptoms of bulimia?

Bulimia can start slowly or quickly. You may not want to admit that you do the behaviors, or have the signs of bulimia nervosa. You may have one or more of the following behaviors and signs:

• "Bingeing" is the most common symptom. It is often done by quickly eating large amounts of high calorie food. You may or may not try to "purge" (get rid of) food after binge eating. Vomiting (throwing up) is the most common way to purge your food. You also may use laxatives or diuretics (water pills).
  
  
• You may complain that you are fat, even if you are of average weight, or thin. Changes in weight are common with bulimia. Because of weight changes, your monthly periods may not be normal.
  
  
• You may exercise too much, such as running or doing aerobics much more than other people.
  
  
• Your teeth may show signs of decay (rotting), and your salivary glands may be swollen. Swollen salivary glands may cause your face to look more round. These signs are caused by vomiting.
  
  
• You may not be able to have bowel movements unless you use a laxative.
  
  
• You may start hiding food. You may also feel that you cannot stop eating. You may have mixed feelings about what you are doing.
  
  
• You may abuse illegal (street) drugs, prescribed drugs, and alcohol (use them too much or too often).

What may be done to treat bulimia?

• Treating bulimia may be difficult because you may not think anything is wrong. If bulimia is found early, you can probably be treated in a clinic or in your caregiver's office. You may need to visit your caregiver several times a month. You and family members may have meetings with your caregiver. These meetings can help you and family members understand bulimia. Caregivers will help you talk about your feelings and teach you the best way to care for yourself.
  
  
• Medicine may be used to treat your illness. You may need to go to the hospital for tests and treatment if your weight gets too low or for other health reasons. If you need to go into the hospital for more intense treatment, the following medicines may be used:
  
  
  • 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.

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.

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.

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 near you. 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/
  

Risks:

If your 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.

Call your caregiver if:

• You have questions or concerns about bulimia nervosa 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 your bulimia.

Seek care immediately if:

• You have very bad side effects, such as rash, swelling, or trouble breathing after taking medicine.
  
  
• Your bulimia is so out of control that you cannot do your regular daily activities.
  
  
• You think about committing suicide (killing yourself).

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.

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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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