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Bulimia nervosa, usually referred to as bulimia, is defined as uncontrolled episodes of overeating (bingeing) and usually followed by purging (self-induced vomiting), misuse of laxatives, enemas, or medications that cause increased production of urine, fasting, or excessive exercise to control weight. Bingeing, in this situation, is defined as eating much larger amounts of food than would normally be consumed within a short period of time (usually less than two hours). Eating binges occur at least twice a week for three months and may occur as often as several times a day.
The cause of bulimia is not known. Factors believed to contribute to the development of bulimia include cultural ideals and social attitudes toward body appearance, self-valuation based on body weight and shape, and family problems.
The majority of bulimics are female, adolescent, and from a high socioeconomic group. All westernized industrial countries have reported incidence of bulimia. An estimated 1.1 to 4.2 percent of females in the United States are reported to have bulimia. Adolescents who develop bulimia are more likely to come from families with a history of eating disorders, physical illness, and other mental health problems, such as mood disorders or substance abuse. Other mental health problems, such as anxiety disorders, or mood disorders, are commonly found in persons with bulimia.
Family, friends, and physicians may have difficulty detecting bulimia in someone they know because they binge and purge in secret. Often, they are able to maintain normal or above normal body weight, but hide their problem from others for years. Many individuals with bulimia do not seek help until they reach the ages 30 or 50 - when their eating behavior is deeply ingrained and more difficult to change.
Most people with eating disorders share certain personality traits and use abnormal eating rituals as a means of handling stress and anxiety. These personality traits often include, but are not limited to, the following:
People with bulimia (and binge eating disorder) typically consume huge amounts of food - often junk food - to reduce stress and relieve anxiety.
There are two subgroups of anorexic behavior aimed at reducing caloric intake, including the following:
The following are the most common symptoms of bulimia. However, each individual may experience signs differently. Symptoms may include:
The symptoms of bulimia may resemble other medical problems or psychiatric conditions. Always consult your physician for a diagnosis.
Parents, family members, spouses, teachers, coaches, and instructors may be able to identify an individual with bulimia, although many persons with the disorder initially keep their illness very private and hidden. A detailed history of the individual's behavior from family, parents, and teachers, clinical observations of the person's behavior, and, sometimes, psychological testing contribute to the diagnosis. Family members who note symptoms of bulimia in a loved one can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems. Bulimia, and the malnutrition that results, can adversely affect nearly every organ system in the body, increasing the importance of early diagnosis and treatment. Bulimia can be fatal. Consult your physician for more information.
Specific treatment for bulimia will be determined by your physician based on:
Bulimia is usually treated with a combination of individual therapy, family therapy, behavior modification, and nutritional rehabilitation. Treatment should always be based on a comprehensive evaluation of the individual and family. Individual therapy usually includes both cognitive and behavioral techniques. Medication (usually antidepressants or antianxiety medications) may be helpful if the person with bulimia is also anxious or depressed. The frequent occurrence of medical complications during the course of rehabilitative treatment requires both your physician and a nutritionist to be active members of the management team. Families play a vital supportive role in any treatment process.
Medical complications that may result from bulimia include, but are not limited to, the following:
To understand eating disorders, researchers have studied the neuroendocrine system, which is made up of a combination of the central nervous and hormonal systems.
The neuroendocrine system regulates multiple functions of the mind and body. It has been found that many of the following regulatory mechanisms may be, to some degree, disturbed in persons with eating disorders:
Many people with eating disorders also appear to suffer from depression, and is believed that there may be a link between these two disorders. For example:
Because eating disorders tend to run in families, and female relatives are the most often affected, genetic factors are believed to play a role in the disorders.
But, other influences, both behavioral and environmental, may also play a role. Consider these facts from the National Institute of Mental Health:
Preventive measures to reduce the incidence of bulimia are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the process of normal growth and development, and improve the quality of life experienced by adolescents with bulimia. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.