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.
The lifetime prevalence of BED has been assessed in large population samples in the US and Europe. In six European countries it was 1.9 % for women and 0.3 % for men. In the US higher lifetime prevalences were found among adults (women 3.5 %; men 2.0 %) and among 13–18 year old adolescents (girls 2.3 %; boys 0.8 %).The US researchers used a duration criterium of only three months instead of the six months DSM-IV research criteria require, which might partly explain the higher percentages. Hudson and colleagues examined data from a non-clinical sample to estimate how much the prevalence of BED will increase under the proposed DSM-5-criteria that relax the requiremens for the frequency (from two per week to one per week) and duration of binges (from six to three months). They extrapolated their findings to the results of the aforementioned study of the US household population and estimated that the lifetime prevalence of BED would increase with an additional 0.1 % to 3.6 % in women and 2.1 % in men. In a study of a large sample of adult Swedish female twins, a relatively low lifetime prevalence of 0.17 % for BED was found, which rose to 0.35 % when DSM-5 criteria were applied.