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Bulimia
OVERVIEW: Bulimia nervosa is defined as body dissatisfaction. Persons with bulimia nervosa engage in repeated binge eating, with or without purging by self-induced vomiting, laxatives, or diuretics. An alternative pattern is bingeing followed by sharply restricted diet and/or vigorous exercise.
SIGNS AND SYMPTOMS: • Person may switch back and forth between bingeing and purging.
• Onset may be related to stress.
• Affected person may be average weight or even somewhat obese; most are slightly below average weight but have frequent fluctuations in weight.
• Denial of problem
• Eating high-calorie foods during binge
• Claim to feel fat even when thin
• Preoccupation with weight control
• Food collection and hoarding
• Drug and/or alcohol abuse
• Diet pill, diuretic, laxative, ipecac, and thyroid medication abuse
• Calories used up through vigorous exercise, especially running, aerobics
• Diabetic patients often withhold insulin.
• Depressed mood and self-depreciation following binges
• Relief and increased ability to concentrate following binges
• Vomiting (may be effortless)
• Abdominal pain
• Salivary gland swelling
• Eroded teeth
• Scarred hands
CAUSES: Unknown; thought to be largely emotional
SCOPE: About 2% of females suffer from bulimia nervosa. True incidence is unknown because it is
a secretive disease. It is more common among university women.
MOST OFTEN AFFECTED: Bulimia nervosa is most common among adolescents and young adults, more often seen in females than males.
RISK FACTORS: • Depression
• Impulsiveness
• Low self-esteem
• Pressure to achieve; high self-expectations
• Acceptance of the culturally condoned ideal of slimness
• Ambivalence about dependence/independence
• Stress due to multiple responsibilities, tight schedules, competition
• Unstable body image, perceptual distortions
• High risk: ballet dancers, models, cheerleaders, athletes
DIAGNOSIS PHYSICAL EXAMINATION: • The Physician will take a history and perform a thorough physical examination.
• Other medical problems should be identified, such as gastrointestinal disorders.
• Any mental health issues should be identified and addressed.
TESTS AND PROCEDURES: • A number of blood tests may be done to assist in diagnosis.
• The function of the gastrointestinal system may be evaluated.
• An electrocardiogram (EKG) may be done to assess heart activity.
• Psychological testing may be performed.
TREATMENT GENERAL MEASURES: • Most patients can be treated as outpatients.
• A person may require hospitalization if she or he is suicidal; if there is evidence of marked electrolyte imbalance or marked dehydration; or if there has been no response to outpatient therapy.
ACTIVITY: • Monitor excess activity.
• Playful, pleasurable activities are important.
DIET: • Goal is a balanced diet with adequate calories and a normal eating pattern. Affected person needs support in eliminating preoccupation with calories, weight, purging.
• Feared foods should be gradually introduced.
MEDICATIONS COMMONLY PRESCRIBED DRUGS: • Medication is indicated for patients who are severely depressed or who have not responded to an adequate trial of therapy.
• Tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOs), serotonin reuptake inhibitors (SRIs).
CONTRAINDICATIONS: Read drug product information.
PRECAUTIONS: Read drug product information.
DRUG INTERACTIONS: Read drug product information.
Other Drugs: • If there is an underlying bipolar disorder, patients may benefit from lithium (Eskalith).
• Opiate antagonist such as naltrexone (Trexan) to suppress consumption of sweet and high fat foods.
• Metoclopramide (Reglan) or cisapride before each meal and at bedtime for after-meal abdominal discomfort.
FOLLOW UP PATIENT MONITORING: The person with bulimia nervosa should see the doctor as often as necessary to monitor health status and disease activity.
PREVENTION/AVOIDANCE: • Maintain rational attitude about weight.
• Moderate overly high self-expectations.
• Enhance self-esteem.
• Diminish stress.
COMPLICATIONS: • Medication is indicated for patients who are severely depressed or who have not responded to an adequate trial of therapy.
• Tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOs), serotonin reuptake inhibitors (SRIs).
WHAT TO EXPECT: • The outcome of treatment is highly variable; bulimia nervosa tends to wax and wane.
• The illness may spontaneously remit.
• People who stay in therapy tend to improve.
MISCELLANEOUS OTHER FACTORS: N/A
PEDIATRIC: N/A
GERIATRIC: N/A
OTHERS: Infrequently diagnosed in men or in older women
PREGNANCY: • Poor nutritional status may affect fetus.
• Bingeing and purging may increase or decrease during pregnancy.
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