Bulimia nervosa Binge-Eating Syndrome

Basic Information

What is Bulimia nervosa?

A psychological eating disorder characterized by abnormal perception of body image, constant craving for food and binge eating, followed by self-induced vomiting or laxative use.

Frequent signs and symptoms

Recurrent episodes of binge eating (rapid consumption of a large amount of food in a short time, usually less than 2 hours), plus at least 3 of the following:

• Preference for high-calorie, convenience foods during a binge.
• Secretive eating during a binge. Patients are aware that the eating pattern is abnormal, and they fear being unable to stop eating.
• Termination of an eating binge with purging measures, such as laxative use or self-induced vomiting.
• Depression and guilt following an eating binge.
• Repeated attempts to lose weight with severely restrictive diets, self-induced vomiting and use of laxatives or diuretics.
• Frequent weight fluctuations greater than 10 pounds from alternately fasting and gorging.
• No underlying physical disorder.

Causes

Unknown; thought to be largely emotional.

Risk increases with

• Strict, compulsive, perfectionistic family environment.
• Anorexia nervosa.
• Depression.
• Stress, including lifestyle changes, such as moving or starting a new school or job.
• Personality disorders.
• Neurotic preoccupation with being physically attractive.
• Being a ballet dancer, model, cheerleader or athlete (especially a gymnast).

Preventive measures

• Encourage a rational attitude about weight.
• Enhance self-esteem.
• Avoid stress and overly high self-expectations..

Expected outcomes

Outcome is variable; patients can learn to control the behavior with counseling, psychotherapy, biofeedback training and individual or group psychotherapy.

Possible complications

• Fluid and electrolyte imbalance from vomiting; dental disease from vomiting gastric acid; stomach rupture (rare); malnutrition.
• Without treatment, complications can be fatal.
• Relapse.

Bulimia nervosa treatment

General measures

• The goal of treatment is to establish healthy eating patterns to regain normal weight. This can be accomplished with behavior modification training supervised by a qualified professional.
• Those who stay in therapy have the best chance to improve.
• Additional information available from Anorexia Nervosa and Associated Disorders, Helpline : (630) 577-1330 (9 AM-5 PM Central Time, Monday through Friday.)

Medications

Antidepressants are sometimes helpful.

Information	Brand	Generic	Label	Rating
	Zoloft	Sertraline
	Effexor	Venlafaxine
	Prozac	Fluoxetine
	Tofranil	Imipramine
	Revia	Naltrexone
	Topamax	Topiramate

Activity

No restrictions. Don't overexercise to lose weight.

Diet

• If hospitalization is necessary, intravenous fluids may be prescribed. During recovery, vitamin and mineral supplements will be necessary until signs of deficiency disappear and normal eating patterns are established.
• For outpatient therapy, supervision and regulation of eating habits, maintenance of a food diary and reintroduction of feared foods.

Last updated 20 December 2015