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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. Thirty to 50 percent of bulimic teens will also have met the criteria for anorexia nervosa at the onset of their disorder.
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 to 4 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 teens with bulimia.
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 adolescent may experience signs differently. Symptoms may include:
The symptoms of bulimia may resemble other medical problems or psychiatric conditions. Always consult your adolescent's physician for a diagnosis.
Parents, teachers, coaches, or instructors may be able to identify the child or adolescent with bulimia, although many persons with the disorder initially keep their illness very private and hidden. However, a child psychiatrist or a qualified mental health professional usually diagnoses bulimia in children and adolescents. A detailed history of the adolescent's behavior from parents and teachers, clinical observations of the adolescent's behavior, and, sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of bulimia in their child or teen 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. Consult your adolescent's physician for more information.
Specific treatment for bulimia will be determined by your adolescent's physician based on:
Bulimia, in adolescents, is usually treated with a combination of individual therapy, family therapy, behavior modification, and nutritional rehabilitation. Among adults, cognitive behavioral therapy and antidepressant medications have both been shown to be effective. Treatment should always be based on a comprehensive evaluation of the adolescent and family. Individual therapy usually includes both cognitive and behavioral techniques. Medication (usually antidepressants or antianxiety medications) may be helpful if the adolescent with bulimia is also anxious or depressed. The frequent occurrence of medical complications during the course of rehabilitative treatment requires both your adolescent's physician and a nutritionist to be active members of the management team. Parents play a vital supportive role in any treatment process.
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.