Definition

Bulimia is an illness in which a person binges on food or has regular episodes of significant overeating and feels a loss of control. The affected person then uses various methods -- such as vomiting or laxative abuse -- to prevent weight gain.

Many (but not all) people with bulimia also have anorexia nervosa.

Alternative Names

Causes

Many more women than men have bulimia, and the disorder is most common in adolescent girls. The affected person is usually aware that her eating pattern is abnormal and may experience fear or guilt with the binge-purge episodes.

The exact cause of bulimia is unknown. Genetic, psychological, trauma, family, society, or cultural factors may play a role. Bulimia is likely due to more than one factor.

Symptoms

In bulimia, eating binges may occur as often as several times a day for many months. These binges cause a sense of self-disgust, which leads to self-induced vomiting or excessive exercise.

Body weight is usually normal, although the person may perceive themselves as being overweight. In a person who also has anorexia, body weight may be extremely low.

• Abuse of laxatives, diuretics, or enemas to prevent weight gain
• Binge eating
• Frequent weighing
• Self-induced vomiting
• Overachieving behavior

Exams and Tests

A dental exam may show dental cavities or gum infections (such as gingivitis). The enamel of the teeth may be eroded or pitted because of excessive exposure to the acid in vomit.

A chem-20 test may show an electrolyte imbalance (such as hypokalemia) or dehydration.

Treatment

Some doctors recommend a stepped approach for patients with bulimia. This treatment approach follows specific stages, depending on the severity of the bulimia, and the person's response to treatments:

• Support groups. This is the least expensive approach. It may be helpful for patients with mild conditions who do not have any health problems.
• Cognitive-behavioral therapy (CBT) and nutritional therapy is the preferred first treatment for bulimia that does not respond to support groups.
• Drugs. The drugs used for bulimia are typically antidepressants known as selective serotonin-reuptake inhibitors (SSRIs). A combination of CBT and SSRIs is very effective if CBT is not effective alone.

Patients may drop out of programs if they have unrealistic expectations of being "cured" from therapy alone. Before a program begins, the following should be made clear:

• The process is painful and requires hard work on the part of patients and their families.
• A number of therapies are likely to be tried until the patient succeeds in overcoming this difficult disorder.
• It is common for bulimia to return (relapse), and this is no cause for despair.

Support Groups

Self-help groups like Overeaters Anonymous may help some people with bulimia. The American Anorexia/Bulimia Association is a source of information about this disorder.

See: Eating disorders - support group

Outlook (Prognosis)

Bulimia is a chronic illness and many people continue to have some symptoms despite treatment. People with fewer medical complications of bulimia, and who are willing and able to engage in therapy, tend to have a better chance of recovery.

Possible Complications

Bulimia can be dangerous and may lead to serious medical complications over time. For example, frequent vomiting puts stomach acid in the esophagus (the tube from the mouth to the stomach), which can permanently damage this area.

Possible complications include:

• Constipation
• Dehydration
• Dental cavities
• Electrolyte abnormalities
• Hemorrhoids
• Inflammation of the throat
• Pancreatitis
• Tears of the esophagus

When to Contact a Medical Professional

Call for an appointment with your health care provider if you (or your child) have symptoms of an eating disorder.

Prevention

Less social and cultural emphasis on physical perfection may eventually help reduce the frequency of this disorder.

References

American Psychiatric Association. Treatment of patients with eating disorders, 3rd ed. American Psychiatric Association. Am J Psychiatry. 2006 Jul;163(7 Suppl):4-54.

Berkman ND, Lohr KN, Bulik CM. Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord. 2007 May;40(4):293-309.

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