Bulimia nervosa is a serious and sometimes life-threatening eating disorder affecting mainly young women. People with bulimia, known as bulimics, consume large amounts of food (binge) and then try to rid themselves of the food and calories (purge) by fasting, excessive exercise, vomiting, or using laxatives. The behavior often serves to reduce stress and relieve anxiety. Because bulimia results from an excessive concern with weight control and self-image, and is often accompanied by depression, it is also considered a psychiatric illness.
The cause of bulimia is unknown. Researchers believe that it may be caused by a combination of genetic and environmental factors. Bulimia tends to run in families. Research shows that certain brain chemicals, known as neurotransmitters, may function abnormally inacutely ill bulimia patients. Scientists also believe there may be a link between bulimia and other psychiatric problems, such as depression and OCD. Environmental influences include participation in work or sports that emphasize thinness, such as modeling, dancing, or gymnastics. Family pressures also may play a role. One study found that mothers who are extremely concerned about their daughters' physical attractiveness and weight may help to cause bulimia. In addition, girls with eating disorders tend to have fathers and brothers who criticize their weight.
According to the American Anorexia/Bulimia Association, Inc., warning signs of bulimia include, eating large amounts of food uncontrollably (bingeing), vomiting, abusing laxatives or diuretics, or engaging in fasting, dieting, or vigorous exercise (purging), preoccupation with body weight, using the bathroom frequently after meals, depression or mood swings, irregular menstrual periods, onset of dental problems, swollen cheeks or glands, heartburn or bloating.
Early treatment is important otherwise bulimia may become chronic, with serious health consequences. A comprehensive treatment planis called for in order to address the complex interaction of physical and psychological problems in bulimia. A combination of drug and behavioral therapies is commonly used. Behavioral approaches include individual psychotherapy, group therapy, and family therapy. Cognitive-behavioral therapy, which teachespatients how to change abnormal thoughts and behavior, is also used. Nutrition counseling and self-help groups are often helpful. Antidepressants commonly used to treat bulimia include desipramine (Norpramin), imipramine (Tofranil), and fluoxetine (Prozac). These medications also may treat any co-existing depression. In addition to professional treatment, family support plays an important role in helping the bulimic person. Encouragement and caring can provide the support needed to convince the sick person to get help, stay with treatment, or try again after a failure. Family members can help locate resources, such as eating disorder clinics in local hospitals or treatment programs in colleges designed for students.
Light therapy—exposure to bright, artificial light—may be useful in reducing bulimic episodes, especially during the dark winter months. Some feel that massage may prove helpful, putting people in touch with the reality of their own bodies and correcting misconceptions of body image. Hypnotherapy may help resolve unconscious issues that contribute to bulimic behavior.
Eleven patients exhibited growth retardation during the course of their illness, as evident in a decrease in their height standard deviation score (SDS). The mean height SDS at the time of admission (−0.81 ± 0.93) was significantly lower than the premorbid SDS (−0.21 ± 0.91). Weight restoration resulted in accelerated linear growth (up to 2 cm/mo) in all patients. Positive weight gain (weight gain rate >1 kg/y) was associated with a mean height gain of 6.97 ± 6.48 cm/y, whereas weight loss or failure to gain weight (weight gain rate ≤1 kg/y) was associated with a mean of 2.7 ± 3.9 cm/y. This between-group difference was highly significant. Complete catch-up growth was not achieved in 9 of 12 patients. There was a trend for the mean adult final height SDS (−0.52 ± 0.84) to be higher than the admission height SDS but lower than both the premorbid height SDS and the midparental target height SDS (−0.21 ± 0.79).