Section 7. Mental Health Disorders

Chapter 103. Eating Disorders

Topics: Introduction | Anorexia Nervosa | Bulimia Nervosa | Binge Eating Disorder

Bulimia Nervosa

Bulimia nervosa is characterized by the repeated rapid consumption of large quantities of food (bingeing), followed by attempts to rid the body of the excess food consumed (purging).

As in anorexia nervosa, bulimia nervosa is influenced by hereditary and social factors. Also as in anorexia nervosa, most people who have bulimia nervosa are young women, are deeply concerned about body shape and weight, and belong to the middle or upper socioeconomic classes. About 2% of college women, the population believed to be at highest risk, are bulimics.

Symptoms

People with bulimia nervosa engage in repeated episodes of bingeing, which involves consuming large amounts of food within a relatively short period of time, often within 2 hours. Emotional stress often triggers the binge-purge cycle, which usually is done in secret. Bingeing, which is accompanied by a feeling of a loss of control, typically includes eating when not hungry and eating to the point of pain. In an attempt to counteract the effects of the binge, people with bulimia nervosa engage in purging through such means as vomiting or taking laxatives; rigorously dieting; overexercising; or any combination of these. Many also take diuretics to treat perceived bloating. Unlike in anorexia nervosa, however, the body weight of people with bulimia nervosa tends to fluctuate around normal.

Self-induced vomiting can erode tooth enamel, enlarge the salivary glands in the cheeks (parotid glands), and inflame the esophagus. Vomiting and purging can lower potassium levels in the blood, causing abnormal heart rhythms. Sudden death from repeatedly taking large quantities of ipecac to induce vomiting can occur, the result of an abnormal heart rhythm. Rarely, people who have this disorder eat so much during a binge that their stomach ruptures or their esophagus tears, leading to life-threatening complications.

Compared with people who have anorexia nervosa, those who have bulimia nervosa tend to be more aware of their behavior and to feel remorseful or guilty about it. They are more likely to admit their concerns to a doctor or other confidant. Generally, people with bulimia nervosa are more outgoing. They also are more prone to impulsive behavior, drug or alcohol abuse, and depression.

Diagnosis and Treatment

A doctor suspects bulimia nervosa if a person, particularly a young woman, is overly concerned about weight gain and has wide fluctuations in weight, especially with evidence of excessive laxative use. Other clues include swollen salivary glands in the cheeks, scars on the knuckles from using the fingers to induce vomiting, erosion of tooth enamel from stomach acid, and a low level of potassium detected by a blood test. The diagnosis is not confirmed until the person describes binge-purge behavior and reports having two or more binge-eating episodes a week for at least 3 months.

The two most effective approaches to treatment are cognitive-behavior therapy and drug therapy.

In cognitive-behavior therapy, dysfunctional thoughts are identified and examined, and the person is helped to give them up. The person meets with the therapist once or twice a week over a period of 4 to 5 months, for a total of about 20 sessions. Cognitive-behavior therapy has been shown to reduce the frequency of bingeing in about two thirds of people with bulimia and to stop bingeing altogether in about one third. People who have undergone this type of therapy continue to reduce or refrain from bingeing for at least 1 year.

Drug therapy with selective serotonin reuptake inhibitors, a type of antidepressant, has been shown to work at least as well as cognitive-behavior therapy in the treatment of bulimia nervosa. However, when the drugs are stopped, bingeing recurs.