Bulimia

General Illness Information

Common Name:
BULIMIA

Medical Term: Binge-Eating Syndrome

Description: Habit of consumption of large amounts of food in a discrete period of time. Binge eating is characterized by abnormal perception of body image, constant craving for food, followed by purging (self-induced vomiting, or laxative use or diuretics), rigorous dieting or excessive exercising to counteract the effects of binging.

More common in adolescents or young adults, and in females. Psychological fears of becoming fat, loss of personal control.

Causes: Unknown, thought to be largely emotional.

Prevention:

  • Confront personal problems realistically.
  • Try to correct or cope with problems with the help of counselors, therapists, family and friends.
  • Patient must develop a rational attitude about weight.

Signs & Symptoms

  • Recurrent episodes of binge eating (rapid consumption of a large amount of food in a discrete period of time).
  • Lack of control over eating behavior during eating binges.
  • Patient regularly engages in self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise to prevent weight gain.
  • A minimum average of two binge-eating episodes a week for a least three months.
  • Persistent over concern with body shape and weight.
  • Self induced vomiting cause erosion of tooth enamel and multiple dental caries.
  • Scars on the knuckles from using the fingers to induce vomiting.
  • Swollen salivary glands in the cheeks.
  • Abnormal heart rhythms- because of low potassium levels caused by self-induced vomiting.
  • Compared to anorexia nervosa, bulimic tend to be more aware of their behavior and feel remorseful or guilty about it and therefore more likely to seek help.
  • More prone to alcohol and drug abuse.

Risk Factors

  • Strict, compulsive, perfectionist family environment.
  • Anorexia nervosa.
  • Depression.
  • Stress, including life style changes, such as moving or starting a new school or job.
  • Neurotic preoccupation with being physically attractive.

Diagnosis & Treatment

Diagnosis of bulimia nervosa is suspected in a patient who is overly concerned about weight gain and has wide fluctuations in weight, especially with evidence of excessive use of laxatives. Blood tests may show low level of potassium. Examination of the patient may reveal scars on the knuckles, swollen salivary glands and erosion of teeth enamel. Diagnosis is only confirmed when the patient describes binge- purge behavior.

General Measures:

  • Therapy will consist of assessing nutritional status, establishing target goals, identifying triggers, improving relationships, overall well-being, techniques to avoid stress, etc.
  • Treatment in an eating disorder facility may be recommended.
  • Hospitalization in severe cases.
  • Psychotherapy or counseling that may include hypnosis or biofeedback training.
  • Additional information available from Anorexia Nervosa and Associated Disorders.

Medications:

Antidepressants are sometimes helpful.

Activity:

No restrictions.

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, a food diary may be maintained, feared foods will be reintroduced.

Possible Complications :

  • Fluid and electrolyte imbalance form vomiting; dental disease; stomach rupture (rare).
  • Cardiac complications.
  • Low pulse rate and low blood pressure.
  • Relapse.

Prognosis

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