Bulimia nervosa

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Bulimia nervosa
Classification and external
resources
ICD!" F50.2
ICD# 307.51
DiseasesDB 1770
e$edicine emerg!10
me"255
Bulimia nervosa is an eating "isor"er characterise" #y recurrent #inge eating, follo$e"
#y compensatory #ehaviors, referre" to as %purging%.
&1'
(he most common form)
practice" more than 75* of people $ith #ulimia nervosa)is self+in"uce" vomiting,
fasting, the use of la-atives, enemas, "iuretics, an" overe-ercising are also common.
&2'
(he $or" bulimia "erives from the .atin /blmia0 from the 1ree2 !" /#oul3mia,
ravenous hunger0, a compoun" of # /#ous0, o- 4 # /l3mos0, hunger.
&3'
Contents
&hi"e'
1 5iagnosis
2 Prevalence
3 6ffects
7 8auses
5 9elate" "isor"ers
: ;ee also
7 9eferences
%edit& Dia'nosis
(he criteria for "iagnosing a patient $ith #ulimia are:
9ecurrent episo"es of #inge eating. <n episo"e of #inge eating is characteri=e" #y
#oth of the follo$ing:
o 6ating, in a fi-e" perio" of time, an amount of foo" that is "efinitely larger
than most people $oul" eat un"er similar circumstances.
o < lac2 of control over eating "uring the episo"e: a feeling that one cannot
stop eating or control $hat or ho$ much one is eating.
9ecurrent inappropriate compensatory #ehavior to prevent $eight gain, such as:
self+in"uce" vomiting, misuse of la-atives, "iuretics, or other me"ications,
fasting, e-cessive e-ercise.
;elf+evaluation is un"uly influence" #y #o"y shape an" $eight.
(he "istur#ance "oes not occur e-clusively "uring episo"es of anore-ia nervosa.
&7'
(here are t$o su#+types of #ulimia nervosa: purging an" non+purging.
(ur'in' )ulimia is the more common of the t$o an" involves self+in"uce"
vomiting /$hich may inclu"e use of emetics such as syrup of ipecac0 an" self+
in"uce" purging /$hich may inclu"e use of la-atives, "iuretics, an" enemas0 to
rapi"ly remove foo" from the #o"y #efore it can #e "igeste".
*onpur'in' )ulimia, $hich occurs in only appro-imately :*+!* of cases,
$hich involves e-cessive e-ercise or fasting after a #inge to offset the caloric
inta2e after eating. Purging+type #ulimics may also e-ercise or fast, #ut as a
secon"ary form of $eight control.
&7'

(he onset of #ulimia nervosa is most li2ely "uring a"olescence /#et$een 13 an" 20 years
of age0, $ith many sufferers relapsing in a"ulthoo" into episo"ic #inging an" purging
even after initially successful treatment an" remission.
&5'
>ulimia nervosa can #e "ifficult to "etect, compare" to anore-ia, #ecause #ulimics ten"
to loo2 healthier an" have fe$er imme"iately+visi#le health complications. ?any
#ulimics may also engage in significantly "isor"ere" eating an" e-ercising patterns
$ithout meeting the full "iagnostic criteria for #ulimia nervosa.
&:'
%edit& (revalence
(here is little "ata on the inci"ence of #ulimia nervosa in+the+large, on general
populations. ?ost stu"ies con"ucte" thus far have #een on convenience samples from
hospital patients, high school or university stu"ents. (hese have yiel"e" a $i"e range of
results: #et$een 0* an" 2.1* of males, an" #et$een 0.3* an" 7.3* of females.
&7'
Country +ear ,ample si-e and type Incidence
@;< 1AA: 1152 college stu"ents 0.2* male 1.3* female
&!'
@;< 1AA2 7AA college stu"ents 0.7* male 5.1* female
&A'
Bor$ay 1AA5 1A0:7 psychiatric patients 0.7* male 7.3* female
&10'
<ustralia 1AA! 7200 high school stu"ents 0.3* com#ine"
&11'
8ana"a 1AA5 !11: /ran"om sample0 0.1* male 1.1* female
&12'
Japan 1AA5 25A7 high school stu"ents 0.7* male 1.A* female
&13'
<lthough #ulimia is over$helmingly a "isease of young $omen, it can affect others.
Former >ritish 5eputy Prime ?inister John Prescott says he "evelope" #ulimia in his :0s
&17'
.
%edit& .ffects
(hese cycles often involve rapi" an" out+of+control eating, $hich may stop $hen the
#ulimic is interrupte" #y another person or the stomach hurts from overe-tension,
follo$e" #y self+in"uce" vomiting or other forms of purging. (his cycle may #e repeate"
several times a $ee2 or, in more serious cases, several times a "ay
&15'
, an" may "irectly
cause:
Perimolysis, or the erosion of tooth enamel #y gastric aci"s.
Cral trauma, $here ha#itual insertion #y fingers or other o#Dects cause lacerations
to the lining of the mouth an" throat.
8hronic gastric reflu- after eating.
6sophagitis, or irritation of the esophagus #y freEuent contact $ith gastric aci"s.
5ehy"ration an" hypo2alemia "ue to loss of flui"s an" potassium "epletion.
;$ollen salivary glan"s.
&1:'

6lectrolyte im#alance.
%edit& Causes
>ulimia is relate" to "eep psychological issues an" feelings of lac2 of control. ;ufferers
often use the "estructive eating pattern to feel in control over their lives.
&17'
(hey may
hi"e or hoar" foo" an" overeat $hen stresse" or upset. (hey may feel a loss of control
"uring a #inge, an" consume great Euantities of foo" /over 20,000 calories0.
&1!'
<fter a
length of time, the sufferer of #ulimia $ill fin" that they no longer have control over their
#inging an" purging. (he #inging #ecomes an a""iction that seems impossi#le to #rea2.
9ecovery is very har" an" often in the early stages of recovery the patient $ill gain
$eight as they are still #inging #ut no longer purging, causing an-iety $hich $ill in turn
cause the patient to revert #ac2 to #ulimia.
(here are higher rates of eating "isor"ers in groups involve" in activities that emphasi=e
thinness an" #o"y type, such as gymnastics, mo"elling, "ance, cheerlea"ing, running,
acting, ro$ing/light$eightsco-$ains0 an" figure s2ating.
&1A'
>ulimia is more prevalent
among 8aucasians. Fn one stu"y, "iagnosis of #ulimia $as correlate" $ith high
testosterone an" lo$ estrogen levels, an" normali=ing these levels $ith com#ine" oral
contraceptive pills re"uce" cravings for fat an" sugar.
&20'
%edit& /elated disorders
>ulimics are much more li2ely than non+#ulimics to have an affective "isor"er, such as
"epression or general an-iety "isor"er: a 1A!5 8olum#ia @niversity stu"y on female
#ulimics at Be$ Gor2 ;tate Psychiatric Fnstitute foun" 70* ha" suffere" "epression some
time in their lives /as oppose" to 25.!* for a"ult females in a control sample from the
general population0, rising to !!* for all affective "isor"ers com#ine".
&21'
<nother stu"y
#y the 9oyal 8hil"renHs Iospital in ?el#ourne on a cohort of 2000 a"olescents similarly
foun" that those meeting at least t$o of the 5;?+FJ criteria for #ulimia nervosa or
anore-ia nervosa ha" a si-fol" increase in ris2 of an-iety an" a "ou#ling of ris2 for
su#stance "epen"ency.
&22'
%edit& ,ee also
Bulimia *ervosa
,i'ns, ,ymptoms, Treatment, and 0elp
People $ith #ulimia are e-tremely concerne" $ith their $eight, yet they canKt fight the
compulsion to #inge. ;o they "rastically overeat, an" then they purge, fast, or e-ercise to
get ri" of the calories. (his vicious cycle of #ingeing an" purging ta2es a toll on the #o"y,
an" itKs even har"er on emotional $ell+#eing. >ut the cycle can #e #ro2en. 6ffective
#ulimia treatment an" support can help you or a love" one "evelop a healthier
relationship $ith foo" an" overcome feelings of an-iety, guilt, an" shame.
In This 1rticle2
Lhat is #ulimiaM
(he #inge an" purge cycle
;igns an" symptoms
6ffects
8auses an" ris2 factors for #ulimia
(reatment an" recovery
Ielping a person $ith #ulimia
9elate" lin2s
Print <uthors
(e-t ;i=e
What is )ulimia3
1my4s ,tory
Cnce again, <my is on a liEui" "iet. NFKm going to stic2 $ith it,O she tells herself. NF
$onKt give in to the cravings this time.O >ut as the "ay goes on, <myKs $illpo$er
$ea2ens. <ll she can thin2 a#out is foo". Finally, she "eci"es to give in to the urge to
#inge. ;he canKt control herself any longer, an" at this point, she "oesnKt $ant to. ;o she
gra#s a pint of ice cream out of the free=er, inhaling it $ithin a matter of minutes. (hen
itKs on to $hatever she can fin" in the 2itchen: a #o- of granola #ars, micro$ave popcorn,
cereal an" mil2, leftovers from the fri"ge. <fter 75 minutes of #ingeing, <my is so
stuffe" that her stomach feels li2e itKs going to #urst. ;heKs "isguste" $ith herself an"
terrifie" #y the thousan"s of calories sheKs consume". ;he runs to the #athroom to thro$
up. <fter$ar"s, she steps on the scale to ma2e sure she hasnKt gaine" any $eight. ;he
vo$s to start her "iet again tomorro$. (omorro$, it $ill #e "ifferent.
>ulimia nervosa is characteri=e" #y freEuent episo"es of #inge eating, from t$ice a $ee2
to multiple times a "ay, follo$e" #y frantic efforts to avoi" gaining $eight.
5uring an average #inge, a #ulimic consumes 3,000 to 5,000 calories in one short hour.
<fter it en"s, the person turns to "rastic measures to Nun"oO the #inge, such as ta2ing e-+
la-, in"ucing vomiting, or going for a ten+mile run.
(he 2ey features of #ulimia nervosa are:
9egular episo"es of out+of+control #inge eating
Fnappropriate #ehavior to prevent $eight gain
;elf+$orth is e-cessively influence" #y $eight an" physical appearance
(here are t$o types of #ulimia, "istinguishe" #y the metho"s the #ulimic uses to
compensate for the #inge eating. Fn the pur'in' type of #ulimia, people physically purge
the foo" from the #o"y #y thro$ing up or using la-atives, enemas, or "iuretics. Fn the
nonpur'in' type of #ulimia)$hich is much less common)#ulimics ma2e up for their
lac2 of restraint #y fasting, e-ercising to e-cess, or going on crash "iets.
Lomen are much more li2ely than men to "evelop #ulimia, appro-imately A0* of those
$ith the "isor"er are female. Gounger $omen are particularly at ris2. >ulimia typically
#egins "uring the late teens or early t$enties, often follo$ing a strict perio" of "ieting or
a stressful life event.
5C F I<J6 >@.F?F<M
<s2 yourself the follo$ing Euestions. (he more NyesO ans$ers, the more li2ely youKre
suffering from #ulimia or another eating "isor"er.
<re you o#sesse" $ith your #o"y an" your $eightM
5oes foo" an" "ieting "ominate your lifeM
<re you afrai" that $hen you start eating, you $onKt #e a#le to stopM
5o you ever eat until you feel sic2M
5o you feel guilty, ashame", or "epresse" after you eatM
5o you vomit or ta2e la-atives to control your $eightM
The )in'e and pur'e cycle
>ulimiaKs "estructive cycle of #ingeing an" purging is triggere" #y "ieting. 5riven #y a
"esire to #e thin, people $ith #ulimia go on strict "iets. >ut the more rigi" an" restrictive
the "iet plan, the more preoccupie" they #ecome $ith foo". (hey o#sess over $hat,
$hen, an" ho$ much to eat, $hat they shoul"nKt eat, an" ho$ to avoi" eating. <t the
same time, their calorie restriction triggers physical cravings)the #o"yKs $ay of as2ing
for the nutrition it nee"s.
<s the tension, hunger, an" feelings of "eprivation #uil",
the compulsion to eat #ecomes too po$erful to resist: a Nfor#i""enO foo" is eaten, a
"ietary rule is #ro2en. Fn the all+or+nothing min"set of #ulimics, any slip+up is a total
failure. (heyKve alrea"y #lo$n it, so they might as $ell let go an" enDoy an all+out #inge.
>ut the enDoyment of a #ingeing is soon replace" $ith feelings of guilt, revulsion, an"
self+loathing.
Fn an effort to regain control an" ma2e up for the e-cess calories eaten, most #ulimics
purge to ma2e up for their #ingeing. Lhile purging is inten"e" to counteract #inge eating,
it en"s up reinforcing it. FtKs har"er to say no to temptation $hen you thin2 you can avoi"
the conseEuences. N(his is the last time,O people $ith #ulimia tell themselves as they
launch into a ne$ "iet. Fn the #ac2 of their min"s, ho$ever, they 2no$ that they can
al$ays thro$ up, pop a $ater pill, or use la-atives if they lose control again. Lhat they
"onKt reali=e is that purging "oesnKt come close to $iping the slate clean after a #inge.
(ur'in' does *5T prevent 6ei'ht 'ain
8ontrary to popular #elief, purging isnKt very effective at getting ri" of calories, $hich is
$hy most #ulimics en" up gaining $eight over time. Jomiting imme"iately after eating
$ill only eliminate 50* of the calories consume" at #est)an" usually much less. (his is
#ecause calorie a#sorption #egins the moment you put foo" in the mouth. .a-atives an"
"iuretics are even less effective. .a-atives get ri" of only 10* of the calories eaten, an"
"iuretics "o nothing at all. Gou may $eigh less after ta2ing them, #ut that lo$er num#er
on the scale is "ue to $ater loss, not true $eight loss.
,i'ns and symptoms of )ulimia
People $ho have #ulimia usually try to hi"e their #ingeing an" purging. (heyKre ashame"
over their ina#ility to control themselves, so they #inge $hen others arenKt aroun". Ff they
clean out the fri"ge, theyKll replace the foo" so others in the house $onKt notice ho$
much theyKve eaten. Ff theyKre #uying foo" for a #inge, theyKll go to four separate
mar2ets so the chec2er $onKt suspect $hat theyKre up to. (heyKll gorge late at night or
#ehin" loc2e" "oors)anything to conceal their eating ha#its. >ut "espite the secrecy,
there are $arning signs an" symptoms of #ulimia that can alert you to the pro#lem.
5espite the fear #ulimics have of #ecoming fat, #eing un"er$eight is not a characteristic
$arning sign of #ulimia. Fn fact, people $ith #ulimia are usually of normal $eight or are
even over$eight. Ff a person #inges an" purges #ut is "ramatically un"er$eight, he or she
most li2ely suffers from the purging type of anore-ia, rather than #ulimia.
Bin'e eatin' si'ns and symptoms
7ack of control over eatin'. Fna#ility to stop eating. 6ating until the point of
physical "iscomfort an" pain.
,ecrecy surroundin' eatin'. 1oing to the 2itchen after everyone else has gone to
#e". 1oing out alone on une-pecte" foo" runs. Lanting to eat in privacy.
.atin' unusually lar'e amounts of food $ith no o#vious change in $eight.
Disappearance of food, numerous empty $rappers or foo" containers in the
gar#age, or hi""en stashes of Dun2 foo".
1lternatin' )et6een overeatin' and fastin'. 9arely eats normal meals. FtKs all+
or+nothing $hen it comes to eating.
(ur'in' si'ns and symptoms
8oin' to the )athroom after meals P FreEuently "isappears after meals or ta2es
a trip to the #athroom to thro$ up. ?ay run the $ater to "isguise soun"s of
vomiting.
9sin' la:atives, diuretics, or enemas after eating. ?ay also ta2e "iet pills to
cur# appetite or use the sauna to Ns$eat outO $ater $eight.
,mell of vomit. (he #athroom or the person may smell li2e vomit. (hey may try
to cover up the smell $ith mouth$ash, perfume, air freshener, gum, or mints.
.:cessive e:ercisin' P Lor2s out strenuously, especially after eating. (ypical
activities inclu"e high+intensity calorie #urners such as running or aero#ics.
(hysical si'ns and symptoms of )ulimia
Calluses or scars on the knuckles or hands from stic2ing fingers "o$n the
throat to in"uce vomiting.
(uffy ;chipmunk< cheeks cause" #y repeate" vomiting.
Discolored teeth from e-posure to stomach aci" $hen thro$ing up. ?ay loo2
yello$, ragge", or clear.
Frequent fluctuations in 6ei'ht + Leight may fluctuate #y 10 poun"s or more
"ue to alternating episo"es of #ingeing an" purging.
.ffects of )ulimia
8hronic #ingeing an" purging lea"s to many health pro#lems)some of them life+
threatening. (he most "angerous si"e effect of #ulimia is "ehy"ration "ue to purging.
Jomiting, la-atives, an" "iuretics can cause electrolyte im#alances in the #o"y, most
commonly in the form of lo$ potassium levels. .o$ potassium levels trigger a $i"e
range of symptoms ranging from lethargy an" clou"y thin2ing to irregular heart#eat an"
"eath. 8hronically+lo$ levels of potassium can also result in 2i"ney failure.
Cther common me"ical complications an" a"verse effects of #ulimia inclu"e:
Leight gain
<#"ominal pain, #loating
;$elling of the han"s an" feet
8hronic sore throat, hoarseness
>ro2en #loo" vessels in the eyes
;$ollen chee2s an" salivary glan"s
Lea2ness an" "i==iness
(ooth "ecay an" mouth sores
<ci" reflu- or ulcers
9upture" stomach or esophagus
.oss of menstrual perio"s
8hronic constipation from la-ative
a#use
The dan'ers of ipecac syrup
9egular use of ipecac syrup, a me"icine use" to in"uce vomiting, can #e "ea"ly. Fpecac is
particularly "angerous #ecause it #uil"s up in the #o"y over time. 6ventually, it can
"amage the heart an" lea" to su""en car"iac arrest, as in the case of singer Qaren
8arpenter, $hose early "eath $as attri#ute" to ipecac a#use.
$ource% &ational 'omen(s )ealt* +nformation Center
Bulimia causes and risk factors
(here is no single cause of #ulimia. Lhile lo$ self+esteem an" concerns a#out $eight
an" #o"y image play maDor roles, there are many other contri#uting causes, inclu"ing
social, psychological, an" #iological factors.
?aDor causes an" ris2 factors for #ulimia inclu"e:
(oor )ody ima'e P Cur cultureKs emphasis on thinness an" #eauty can lea" to
#o"y "issatisfaction, particularly in young $omen #om#ar"e" $ith me"ia images
of an unrealistic physical i"eal.
7o6 selfesteem P People $ho thin2 of themselves as useless, $orthless, an"
unattractive are at ris2 for #ulimia. (hings that can contri#ute to lo$ self+esteem
inclu"e "epression, perfectionism, chil"hoo" a#use, an" a critical home
environment.
Dietin' P People $ho "iet are much more li2ely to "evelop an eating "isor"er
than those $ho "onKt. (he "eprivation of "rastic "ieting can trigger #inge eating,
lea"ing to #ulimiaKs #inge+an"+purge cycle.
1ppearanceoriented professions or activities P People $ho face tremen"ous
pressure to loo2 a certain $ay or stay thin are vulnera#le to "eveloping an eating
"isor"er. (hose at ris2 inclu"e #allet "ancers, mo"els, gymnasts, $restlers,
runners, an" actors.
$a=or life chan'es P >ulimia is often triggere" #y stressful changes or
transitions, such as the physical changes of pu#erty, going a$ay to college, or the
#rea2up of a relationship. >ingeing an" purging may #e a misgui"e" attempt to
cope $ith the stress.
Biolo'ical factors P 6ating "isor"ers run in families, in"icating a genetic
component. 9esearch also sho$s that lo$ levels of serotonin play a role in
#ulimia.
Bulimia treatment and recovery
If you need help for )ulimia...
Ff you or a love" one has anore-ia, call the *ational .atin' Disorders 1ssociation4s
tollfree hotline at !>""#?!@@?A or clic2 here for free referrals, information, an"
a"vice.
9egar"less of ho$ long youKve ha" #ulimia, you can get #etter. Lith treatment an"
support, many #ulimics e-perience a full an" successful recovery. (o stop the cycle of
#ingeing an" purging, itKs important to see2 professional help early, follo$ through $ith
treatment, an" resolve the un"erlying emotional issues that cause" the #ulimia in the first
place. Lhile recovering from an eating "isor"er isnKt easy, regaining your health an"
happiness is $orth the effort.
Therapy for )ulimia
>ecause poor #o"y image an" lo$ self+esteem un"erlie #ulimia, psychotherapy is an
important aspect of treatment. ?any people $ith #ulimia feel isolate" an" shame" #y
their #ingeing an" purging, an" therapists can help $ith these feelings.
(he treatment of choice for #ulimia is cognitive+#ehavioral therapy. 8ognitive+#ehavioral
therapy targets the unhealthy eating #ehaviors of #ulimia an" the unrealistic, negative
thoughts that fuel them. 8ognitive+#ehavioral therapy for #ulimia involves t$o phases:
Breakin' the )in'eandpur'e cycle P (he first phase of #ulimia treatment
focuses on stopping the vicious cycle of #ingeing an" purging an" restoring
normal eating patterns. Patients learn to monitor their eating ha#its, avoi"
situations that trigger a "esire to #inge, cope $ith stress in $ays that "onKt involve
foo", eat regularly to re"uce foo" cravings, an" fight the urge to purge.
Chan'in' unhealthy thou'hts and patterns P (he secon" phase of #ulimia
treatment focuses on i"entifying an" changing "ysfunctional #eliefs a#out $eight,
"ieting, an" #o"y shape. Patients challenge their Nall+or+nothingO attitu"es a#out
eating, e-plore the connection #et$een emotions an" eating, an" rethin2 the i"ea
that self+$orth is #ase" on $eight.
The importance of decidin' not to diet
(reatment for #ulimia is much more li2ely to succee" $hen people stop "ieting. Lhen
#ulimics stop trying to restrict calories an" follo$ strict "ietary rules, they are no longer
over$helme" $ith cravings an" thoughts of foo"s. >y eating normally, they can #rea2
the #inge+an"+purge cycle an" still reach a healthy, attractive $eight.
Fn a""ition to cognitive+#ehavioral therapy, there are several other #ulimia treatments that
are effective. +nterpersonal ps,c*ot*erap, helps people $ith #ulimia solve relationship
issues an" interpersonal pro#lems that are contri#uting to their eating "isor"er.
Fnterpersonal psychotherapy also treats the "epression an" lo$ self+esteem that goes
along $ith #ulimia. -roup t*erap, is also helpful in #ulimia treatment. 1roup therapy for
#ulimia involves e"ucation a#out the eating "isor"er an" strategies for overcoming it. Ft
can also help #ulimics feel less alone in their suffering.
1ntidepressant medications for )ulimia
<nti"epressants are often use" in the treatment of #ulimia. Lhen com#ine" $ith therapy,
anti"epressant me"ications can help re"uce #inge eating. (hey can also improve
preoccupation $ith $eight an" #o"y image, as $ell as the "epression that often
accompanies #ulimia.
(o learn more a#out the #enefits, ris2s, an" si"e effects of anti"epressants, see
<nti"epressants: ?e"ication for 5epression.
0elpin' a person 6ith )ulimia
Ff you suspect that your frien" or family mem#er has #ulimia, tal2 to the person a#out
your concerns. Gour love" one may "eny #ingeing an" purging, #ut thereKs a chance that
he or she $ill $elcome the opportunity to open up a#out the struggle. 6ither $ay, #ulimia
shoul" never #e ignore". (he personKs physical an" emotional health is at sta2e.