Bulimia nervosa

Definition

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 to be a psychiatric illness.

Description

Bulimia nervosa is a serious health problem for over 2 million adolescent girls and young women in the United States. The bingeing and purging activity associated with this disorder can cause severe damage, even death, although the risk of death is not as high as for anorexia nervosa , an eating disorder that leads to excessive weight loss.

In rare instances, binge eating may cause the stomach to rupture. In the case of purging, heart failure can result due to loss of vital minerals such as potassium. Vomiting causes other serious problems, including acid-related scarring of the fingers (if used to induce vomiting) and damage to tooth enamel. In addition, the tube that delivers food from the mouth to the stomach (the esophagus) often becomes inflamed, and salivary glands can become swollen. Irregular menstrual periods can also result, and interest in sex may diminish.

Most bulimics find it difficult to stop their behavior without professional help. Many typically recognize that the behavior is not normal, but they feel helpless to control it. Some bulimics struggle with other compulsive, risky behaviors such as drug and alcohol abuse. Many also suffer from other psychiatric illnesses, including clinical depression, anxiety, and obsessive-compulsive disorder (OCD).

Bulimic behavior is often carried out in secrecy, accompanied by feelings of guilt or shame. Outwardly, many people with bulimia appear healthy and successful, while inside they have feelings of helplessness and low self-esteem .

Demographics

Most bulimics are females in their teens to early 20s. Males account for only 5 to 10 percent of all cases. People of all races develop the disorder, but most of those diagnosed are white.

Causes and symptoms

The cause of bulimia is as of 2004 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 in acutely ill people with bulimia nervosa. 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 in part cause bulimia in them. In addition, girls with eating disorders tend to have fathers and brothers who criticize their weight. Bulimia tends to run in families.

According to the American Anorexia/Bulimia Association Inc., warning signs of bulimia include the following:

• 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

When to call the doctor

A healthcare professional should be consulted at the first sign of behaviors associated with bulimia.

Diagnosis

Bulimia is treated most successfully when diagnosed early. However, because the bulimic may deny there is a problem, getting medical help is often delayed. A complete physical examination in order to rule out other illnesses is the first step to diagnosis.

According to the American Psychiatric Association, a diagnosis of bulimia requires that a person have all of the following symptoms:

• recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months)
• a feeling of lack of control over eating during the binges
• regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
• persistent over-concern with body shape and weight

Treatment

Early treatment is important; otherwise, bulimia may become chronic, with serious health consequences. A comprehensive treatment plan is 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 teaches people 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 emotional support may 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.

Prognosis

Bulimia may become chronic and lead to serious health problems, including seizures, irregular heartbeat, and thin bones. In rare cases, it may be fatal. Timely therapy and medication can effectively manage the disorder and help the bulimic live a normal, productive, and fulfilling life.

Prevention

There is as of 2004 no known method for preventing bulimia. However, parents can promote healthy eating habits in their children and encourage them to embrace realistic, rather than overly thin, body images.

Nutritional concerns

Abnormal food intake and purging may result in abnormal nutrition. Purging may lead to a loss of potassium and other essential metabolic ions. These can become life threatening.

Parental concerns

Parental remarks about body size and shape often trigger bulimia. Parents of bulimics must be supportive and participate in treatment if the condition is to be successfully treated.

KEY TERMS

Binge —A pattern of eating marked by episodes of rapid consumption of large amounts of food; usually food that is high in calories.

Diuretics —A group of drugs that helps remove excess water from the body by increasing the amount lost by urination.

Neurotransmitters —Chemicals in the brain that transmit nerve impulses.

Obsessive-compulsive disorder —An anxiety disorder marked by the recurrence of intrusive or disturbing thoughts, impulses, images, or ideas (obsessions) accompanied by repeated attempts to supress these thoughts through the performance of certain irrational and ritualistic behaviors or mental acts (compulsions).

Purge —To rid the body of food and calories, commonly by vomiting or using laxatives.

See also Binge eating disorder.

Resources

BOOKS

Bendich, Adrianne, and David J. Goldstein. Management of Eating Disorders and Obesity, 2nd ed. Totawa, NJ: Humana Press, 2004.

Litt, Iris F. "Anorexia Nervosa and Bulimia." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman, et al. Philadelphia: Saunders, 2003, pp. 652–3.

Smith, Grainne. Anorexia and Bulimia in the Family: One Parent's Practical Guide to Recovery. New York: Wiley & Sons, 2004.

Walsh, B. Timothy. "Eating Disorders." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald, et al. New York: McGraw Hill, 2001, pp. 486–90.

West, Delia Smith. "The Eating Disorders." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman, et al. Philadelphia: Saunders, 2003, pp. 1326–35.

PERIODICALS

Burns, M., and N. Gavey. "Healthy weight at what cost? Bulimia and a discourse of weight control." Journal of Health Psychology 9, no. 4 (2004): 249–65.

Crow, S. J., et al. "Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa." International Journal of Eating Disorders 36, no. 2 (2004): 220–3.

Hinney A., et al. "Genetic risk factors in eating disorders." American Journal of Pharmacogenomics 4, no. 4 (2004): 209–23.

Morad, M., I. Kandel, and J. Merrick. "Anorexia and bulimia in the family." International Journal of Adolescent Medicine and Health 16, no. 2 (2004): 89–90.

ORGANIZATIONS

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211–2672. Web site: <www.aafp.org/>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098. Web site: <www.aap.org/default.htm>.

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. Web site: <www.psych.org/>.

American Psychological Association. 750 First Street NW, Washington, DC, 20002–4242. Web site: <www.apa.org/>.

National Eating Disorders Organization (NEDO). 6655 South Yale Ave, Tulsa, OK 74136. Web site: <www.NationalEatingDisorders.org>.

WEB SITES

"Bulimia." National Alliance for the Mentally Ill. Available online at <www.nami.org/Template.cfm?Section=By_Illness&amp;template=/ContentManagement/ContentDisplay.cfm&amp;ContentID=7638> (accessed November 2, 2004).

"Bulimia." National Library of Medicine. Available online at <www.nlm.nih.gov/medlineplus/ency/article/000341.htm> (accessed November 2, 2004).

"Bulimia and Related Disorders." Northern Arizona University. Available online at <http://dana.ucc.nau.edu/~kdk2/bulimia.html> (accessed November 2, 2004).

"Bulimia Nervosa." Internet Mental Health. Available online at <www.mentalhealth.com/dis/p20-et02.html> (accessed November 2, 2004).

L. Fleming Fallon, Jr., MD, DrPH

Bulimia nervosa

Definition

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) through fasting , excessive exercise, vomiting , or use of laxatives. Bulimics often feel that the behavior 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.

Description

Bulimia nervosa is a serious health problem for more than two million adolescent girls and young women in the United States. The bingeing and purging activity associated with this disorder can cause severe damage, even death, although the risk of death is not as high as for anorexia nervosa , an eating disorder that leads to excessive weight loss.

Binge eating may in rare instances cause the stomach to rupture. In the case of purging, heart failure can result due to loss of vital minerals such as potassium . Vomiting causes other serious problems, including acid-related scarring of the fingers (if used to induce vomiting) and damage to tooth enamel. In addition, the tube that brings food from the mouth to the stomach (the esophagus) often becomes inflamed and salivary glands can become swollen. Irregular menstrual periods can also result, and interest in sex may diminish.

Most bulimics find it difficult to stop their behavior without professional help. Many typically recognize that the behavior is not normal, but feel out of control. Some bulimics struggle with other compulsive, risky behaviors such as drug and alcohol abuse. Many also suffer from other psychiatric illnesses, including clinical depression, anxiety, and obsessive-compulsive disorder (OCD).

Most bulimics are females in their teens or early 20s. Males account for only 5-10% of all cases. People of all races develop the disorder, but most of those diagnosed are white.

Bulimic behavior is often carried out in secrecy, accompanied by feelings of guilt or shame. Outwardly, many people with bulimia appear healthy and successful, while inside they have feelings of helplessness and low self-esteem.

Causes & symptoms

Causes

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 in acutely 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.

Symptoms

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

Diagnosis

Bulimia is treated most successfully when diagnosed early. But because the bulimic may deny there is a problem, getting medical help is often delayed. A complete physical examination in order to rule out other illnesses is the first step toward diagnosis.

According to the American Psychiatric Association, a diagnosis of bulimia requires that a person have all of the following symptoms: >

• recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months)
• a feeling of lack of control over eating during the binges
• regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
• persistent over-concern with body shape and weight

Treatment

Alternative therapies may be used as complementary to conventional treatment program for bulimic patients. They include diet, nutritional therapy, herbal therapy, homeopathy, hydrotherapy, biofeedback training, hypnotherapy, massage therapy and light therapy .

Diet

The following dietary changes may be helpful for bulimic patients:

• Eat small but nutritious meals at regularly scheduled hours.
• Avoid sweet, baked goods or any other foods that may cause craving.
• Avoid allergenic foods.
• Limit intake of alcohol, caffeine , monosodium glutamate (MSG), and salty foods.

Nutritional therapy

The following supplements may help improve bulimic symptoms and prevent deficiency of essential vitamins and minerals:

• Multivitamin and mineral supplement to prevent deficiency of essential nutrients.
• Vitamin B complex with C.
• Zinc supplement. Bulimic patients may have zinc deficiency, and zinc is an important mineral needed by the body for normal hormonal activity and enzymatic function.

Homeopathy

A homeopathic physician may prescribe patient-specific remedies for the treatment of bulimia.

Light therapy

Light therapy. Exposure to artificial light, available through full spectrum light bulbs or specially designed "light boxes," may be useful in reducing bulimic episodes, especially during the dark winter months.

Hypnotherapy

Hypnotherapy may help resolve unconscious issues that contribute to bulimic behavior.

Exercise

Yoga, qigong, t'ai chi or dance not only make patients physically healthier but also make them feel better about themselves.

Other treatments.

Other potentially beneficial treatments for bulimia include Chinese herbal therapy, hydrotherapy or biofeedback training.

Allopathic treatment

Early treatment of bulimia with a combination of drug and behavioral therapies is necessary to prevent serious health consequences. A comprehensive treatment plan is called for in order to address the complex interaction of physical and psychological problems of bulimia.

Behavioral approaches include individual psychotherapy , group therapy, and family therapy. Cognitive behavioral therapy , which teaches patients 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.

Expected results

Bulimia may become chronic and lead to serious health problems, including seizures, irregular heartbeat, and thin bones. In rare cases, it can be fatal.

Timely therapy and medication can effectively manage the disorder and help the bulimic look forward to a normal, productive, and fulfilling life.

Prevention

There is no known method to prevent bulimia.

Resources

BOOKS

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Fife, WA: Future Medicine Publishing, 1995.

Cassell, Dana K. The Encyclopedia of Obesity and Eating Disorders. New York, NY: Facts on File, Inc., 1994.

Jablow, Martha M. A Parent's Guide to Eating Disorders and Obesity. New York, NY: Dell Publishing, 1992.

Kubersky, Rachel. Everything You Need to Know about Eating Disorders. New York, NY: The Rosen Publishing Group, Inc., 1992.

The Medical Advisor: The Complete Guide to Alternative & Conventional Treatments. Richmond, VA: TimeLife Education, 1997.

PERIODICALS

Berg, Frances M. "Eating Disorders Affect Both the Mind and Body." Healthy Weight Journal. 9/2 (1995): 27-31.

Cismoski, Janet, et al. "Teen Nutrition." Whose Kids?..Our Kids! 6 (1995).

Levine, Michael P. "10 Things Men Can Do and Be to Help Prevent Eating Disorders." Healthy Weight Journal. 9/1 (1995): 15.

ORGANIZATIONS

American Anorexia/Bulimia Association, Inc. 293 Central Park West, Suite IR, New York, NY 10024. (212) 501-8351.

Anorexia Nervosa and Related Eating Disorders, Inc. PO Box 5102, Eugene, OR 97405. (541) 344-1144.

Center for the Study of Anorexia and Bulimia, 1 W. 91st St., New York, NY 10024. (212) 595-3449.

Eating Disorder Awareness & Prevention, Inc. 603 Stewart St., Suite 803, Seattle, WA 98101. (206) 382-3587.

National Association of Anorexia Nervosa and Associated Disorders. Box 7, Highland Park, IL 60035. (708) 831-3438.

National Eating Disorders Organization. 6655 South Yale Ave, Tulsa, OK 74136. (918) 481-4044.

Mai Tran

Bulimia Nervosa

Definition

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.

Description

Bulimia nervosa is a serious health problem for over two million adolescent girls and young women in the United States. The bingeing and purging activity associated with this disorder can cause severe damage, even death, although the risk of death is not as high as for anorexia nervosa, an eating disorder that leads to excessive weight loss.

Binge eating may in rare instances cause the stomach to rupture. In the case of purging, heart failure can result due to loss of vital minerals such as potassium. Vomiting causes other serious problems, including acid-related scarring of the fingers (if used to induce vomiting) and damage to tooth enamel. In addition, the tube that brings food from the mouth to the stomach (the esophagus) often becomes inflamed and salivary glands can become swollen. Irregular menstrual periods can also result, and interest in sex may diminish.

KEY TERMS

Binge— To consume large amounts of food uncontrollably within a short time period.

Diuretic— A drug that promotes the formation and excretion of urine.

Neurotransmitters— Certain brain chemicals that may function abnormally in acutely ill bulimic patients.

Obsessive-compulsive disorder (OCD)— A disorder that may accompany bulimia, characterized by the tendency to perform repetitive acts or rituals in order to relieve anxiety.

Purge— To rid the body of food and calories, commonly by vomiting or using laxatives.

Most bulimics find it difficult to stop their behavior without professional help. Many typically recognize that the behavior is not normal, but feel out of control. Some bulimics struggle with other compulsive, risky behaviors such as drug and alcohol abuse. Many also suffer from other psychiatric illnesses, including clinical depression, anxiety, and obsessive-compulsive disorder (OCD).

Most bulimics are females in their teens or early 20s. Males account for only 5-10% of all cases. People of all races develop the disorder, but most of those diagnosed are white.

Bulimic behavior is often carried out in secrecy, accompanied by feelings of guilt or shame. Outwardly, many people with bulimia appear healthy and successful, while inside they have feelings of helplessness and low self-esteem.

Causes and symptoms

Causes

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 in acutely 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.

Symptoms

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

Diagnosis

Bulimia is treated most successfully when diagnosed early. But because the bulimic may deny there is a problem, getting medical help is often delayed. A complete physical examination in order to rule out other illnesses is the first step to diagnosis.

According to the American Psychiatric Association, a diagnosis of bulimia requires that a person have all of the following symptoms:

• recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months)
• a feeling of lack of control over eating during the binges
• regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
• persistent over-concern with body shape and weight

Treatment

Early treatment is important otherwise bulimia may become chronic, with serious health consequences. A comprehensive treatment plan is 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 teaches patients 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.

Alternative treatment

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.

Prognosis

Bulimia may become chronic and lead to serious health problems, including seizures, irregular heartbeat, and thin bones. In rare cases, it may be fatal.

Timely therapy and medication can effectively manage the disorder and help the bulimic look forward to a normal, productive, and fulfilling life.

Prevention

There is no known method to prevent bulimia.

Resources

ORGANIZATIONS

American Anorexia/Bulimia Association, Inc. 293 Central Park West, Suite IR, New York, NY 10024. (212) 501-8351.

Anorexia Nervosa and Related Eating Disorders, Inc. P.O. Box 5102, Eugene, OR 97405. (541) 344-1144.

Center for the Study of Anorexia and Bulimia. 1 W. 91st St., New York, NY 10024. (212) 595-3449.

Eating Disorder Awareness. & Prevention, Inc., 603 Stewart St., Suite 803, Seattle, WA 98101. (206) 382-3587.

National Association of Anorexia Nervosa and Associated Disorders. Box 7, Highland Park, IL 60035. (708) 831-3438.

National Eating Disorders Organization (NEDO). 6655 South Yale Ave, Tulsa, OK 74136. (918) 481-4044.

BULIMIA

Bulimia (from the Greek boulima : hunger [limos ] of an ox [bous ]), a medical term that has entered common usage, refers to an eating disorder characterized by episodes.

A bulimic episode (a binge) is defined as a fit of frenzied overeating in which an excessive amount of food is consumed in a short time; this episode involves a sense of loss of control. It can occur several times in one day and can completely overwhelm the subject. Bulimia always entails a major and overwhelming event that is convulsive or ritualized, and violent. There is usually an awareness of the pathological nature of this behavior, combined with fear of an inability to avoid it, pleasure, shame, and self-denigration. In addition to bulimia relating to food, there is a form of bulimia that relates to various consumer items (medicines, pathological buying) and to sex.

There are descriptions of bulimic episodes dating from antiquity. Medical dictionaries, particularly in the English language, refer to this disorder from the beginning of the eighteenth century (Blankaart, 1708). Historically, bulimia was predominantly a male disorder and was akin to hyperphagia and gluttony. It was long considered a manifestation of the same order as neurotic symptoms (Janet, 1903); Sigmund Freud referred to it as one of the symptoms of anxiety neurosis and also recorded it as an eating compulsion motivated by a fear of starvation.

As a manifestation of orality in the broad sense, bulimia is generally a form of pathological behavior, a passage to the act that is often impulsive and bypasses any mentalization or psychic material. It then has a defensive function in warding off psychotic disorganization or depressive affects. Karl Abraham mentioned it in his work on melancholia and, in Fear of Breakdown (1974), Donald Winnicott described it as a form of defense against the frightening nature of the void.

Bulimia is also associated with the addictions (Radó, 1926). In 1945, Otto Fenichel classified it as a "drugless addiction." Marie-Claire Célérier regards it as a symptom on the boundary between a psychosomatic loss of meaning and a hysterical signifier (1977), while Joyce McDougall describes it in terms of a symptomatic act that substitutes for the undreamt dream.

Bulimia is a widespread phenomenon in Western societies that is both on the increase and more out in the open. It has gradually become a syndrome in its own right—bulimia nervosa—with a separate status from anorexia nervosa and obesity. Wermuth and Russell first established the diagnostic criteria for the bulimic syndrome. In addition to bulimic episodes, these include various strategies for controlling weight and a psychiatric co-morbidity that can be severe (thymic disorders and addictions). These criteria reflect the notions of loss of control, chaotic functioning, inadequate mentalization and relationships of dependency (Jeammet, 1991) that are observed in these patients.

Contemporary discussions of bulimia refer to a complex, multi-faceted disorder that combines eating binges with a range of strategies for maintaining a normal weight, distortions in cognitive functioning and body-image perception, and emotional disturbances (Vindreau, 1991). In the majority of cases, the origins of the disorder are traced back to adolescence and its physiological and psychodynamic transformations. As of 2004, ninety percent of bulimics are women but the bulimia rate is rising among men. Whereas the incidence of the syndrome is three percent in the general population, it rises to seven percent in some adolescent, student, and high-school groups.

The conception of bulimia has developed from a simple compulsive substitution for a repressed sexual drive, into the widely-recognized, contemporary bulimia nervosa. Throughout this development, its definition has closely reflected both sociological and cultural changes and the psychopathological theories that prevailed over time. Above all, both the recourse of acting out through eating behavior, and the perceived need for particular bodily sensations in order to produce a psychic effect (Brusset, 1991), pose questions relating to self-esteem, difficulty in controlling behavior and emotions, narcissistic difficulties, and the quest for identity.

Christine Vindreau

See also: Anorexia nervosa; Self representation.

Bibliography

Abraham, Karl. (1924). A short study of the development of the libido, viewed in the light of mental disorders. Selected papers on Psycho-Analysis (pp. 418-501). London: Hogarth Press.

Brusset, Bernard. (1991). Psychopathologie de l 'anorexie mentale. Paris: Dunod.

Célérier, Marie-Claire. (1977). La boulimie compulsionnelle. Topique, 18, 95-116.

Fenichel, Otto. (1945). The psychoanalytic theory of neurosis. New York: W. W. Norton.

Freud, Sigmund. (1926d). Inhibitions, symptoms and anxiety. SE, 20: 75-172.

Igoin, Laurence. (1979). La boulimie et son infortune. Paris: Presses Universitaires de France.

Janet, Pierre. (1903). Les Obsessions et la psychasthénie. Paris: Alcan.

Jeammet, Phillipe. (1991). Dysrégulations narcissiques et objectales dans la boulimie. In Bernard Brusset and Catherine Couvreur (Eds.), La boulimie (pp. 89-104). Paris: Presses Universitaires de France.

McDougall, Joyce. (1974). The psyche-soma and the psychoanalytic process. International Journal of Psycho-Analysis, 1, 437-460.

Radó, Sándor. (1926). The psychic effects of intoxicants: an attempt to evolve a psycho-analytical theory of morbid cravings. International Journal of Psycho-Analysis, 7, 396-413.

Vindreau, Christine. (1991). La boulimie dans la clinique psychiatrique. In Bernard Brusset and Catherine Couvreur (Eds.), La boulimie (pp. 63-79). Paris: Presses Universitaires de France.

Winnicott, Donald W. (1974). Fear of breakdown. International Journal of Psycho-Analysis, 1, 103-107.

Bulimia

An eating disorder in which a person indulges in recurrent episodes of binge eating, followed by purging through self-induced vomiting or by the use of laxatives and/or diuretics in order to prevent weight gain.

The symptoms of bulimia, or bulimia nervosa, include eating uncontrollably (binging) and then purging by dieting, fasting, exercising, vomiting, or abusing laxatives or diuretics. A binge involves a large amount of food, for example, several boxes of cookies, a loaf of bread, a half gallon of ice cream, and a bucket of fried chicken, eaten in a short and well-defined time period. Specific behaviors associated with bulimia include: 1) eating high-calorie "junk food" (candy bars, cookies, ice cream, etc.); 2) eating surreptitiously; 3) eating until stopped by a stomach ache, drowsiness, or external interruption; 4) a tendency to go on "crash diets"; and 5) weight that varies over a 10-pound (4.5 kg) range. Although all of these behaviors are not present in all bulimics, the presence of at least three makes it likely that an individual is suffering from the disorder. In general, binging episodes occur at least twice a week, and may take place two or more times a day.

Unlike anorexics, bulimics may be close to normal weight or overweight (within 15 percent of normal standards) and do not suffer from amenorrhea or lose interest in sex. Bulimics feel out of control, realize that their eating patterns are abnormal, and experience intense feelings of guilt and shame over their binging. Their preoccupation with body weight and secretive eating behaviors may combine with depression or mood swings. Possible warning signals of bulimia may include irregular periods, dental problems, swollen cheeks, heartburn, bloating, and alcohol or drug abuse.

The American Anorexia/Bulimia Association estimates that up to 5 percent of college-age women are bulimic and more than 90 percent of all bulimics are women. The onset of the disorder commonly occurs in the late teens or early twenties and can begin after a period of dieting or weight loss. Risk factors for the disorder involve a pattern of excessive dieting in an attempt to weigh less, a history of depression or alcoholism, low self-esteem , obese parents or siblings, and a history of anorexia nervosa. It has also been suggested that bulimia may have physiological causes, including a defective satiety mechanism.

In order to reduce the risks of developing an eating disorder, cultural attitudes associating thinness and beauty with personal worth and happiness must change to reflect a greater emphasis on developing healthier attitudes and eating behaviors in early childhood . Individuals must learn to value themselves and others for intrinsic rather than extrinsic qualities such as appearance.

Although bulimia is seldom life-threatening, it is a serious illness with severe medical consequences, including abdominal pain , vomiting blood, electrolyte imbalance possibly leading to weakness or cardiac arrest, muscle weakness, and intestinal damage. Bulimics and anorexics rarely cure themselves and the longer the behavior continues, the more difficult it is to help the individual change. The most effective treatment involves a team approach consisting of medical evaluation, individual and/or group psychotherapy , nutritional counseling, anti-depressant medication, and possible hospitalization. Psychotherapy generally consists of investigating the patient's unconscious motivations for binging in combination with behavior modification techniques to help cope with the disease. Commonly recommended medications include diphenylhydantoin (Dilantin), an anticonvulsant, and tricyclic antidepressants . Even with treatment, only about one-third of bulimics appear to recover while another third show some improvement in their eating behavior. The remaining third do not respond to treatment and 10 to 20 percent of these people eventually die of the disease.

See also Anorexia; Body image

Further Information

American Anorexia/Bulimia Association (AABA). 418 E. 76th St., New York, New York 10021, (212) 734–1114.

American Dietetic Association (ADA) NCND-Eating Disorders. 216 W. Jackson Blvd., Chicago, Illinois 60606,(800) 366–1655.

National Anorexic Aid Society. 445 E. Dublin-Granville Rd., Worthington, Ohio 43229, (614) 436–1112.

National Association of Anorexia Nervosa and Associated Disorders (ANAD). Box 7, Highland Park, Illinois 60035,(708) 831–3438.

Bulimia Nervosa

Bulimia nervosa is an eating disorder characterized by frequent episodes of binge eating, which are followed by purging to prevent weight gain. During these incidents, unusually large portions of food are consumed in secret, followed by compensatory behaviors such as self-induced vomiting or diuretic and laxative abuse. Although the types of food chosen may vary, sweets and high-calorie foods are commonly favored. Bulimic episodes are typically accompanied by a sense of a loss of self-control and feelings of shame.

A clinical diagnosis of bulimia nervosa requires that the behavior occur at least two times a week for a minimum of three months.

see also Addiction, Food; Anorexia Nervosa; Binge Eating; Body Image; Eating Disorders; Eating Disturbances.

Karen Ansel

Bibliography

American Dietetic Association (1998). Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder Not Otherwise Specified (EDNOS). Chicago: Author.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: Author.

Escott-Stump, Sylvia, and Mahan, L. Kathleen (1996). Krause's Food, Nutrition, & Diet Therapy, 9th edition. Philadelphia: W. B. Saunders.

BULIMIA NERVOSA

DEFINITION

Bulimia (pronounced bu-LIM-ee-uh) nervosa is a serious and sometimes life-threatening eating disorder that affects primarily young women. Bulimics (people who have bulimia) go through cycles of binging and purging. Binging is the consumption of abnormally large amounts of food in a very short period of time, and purging is the elimination of food by some unusual activity. Bulimics use fasting (not eating), excessive exercise, vomiting, or laxatives to purge themselves of food. Bulimia is partly caused by excessive concern about weight control and self-image. It is considered to be a psychiatric (mental) disorder.

DESCRIPTION

Bulimia nervosa is a serious health problem for over two million adolescent girls and young women in the United States. In the most extreme cases, bulimia can cause severe bodily damage or even death. For example, in rare cases, binging can cause the stomach to break open. Purging can be dangerous because the body loses nutrients it needs to function properly. The loss of potassium, for example, can cause heart failure.

Vomiting is a common source of problems. When a person vomits, he or she brings up partially digested food and stomach acid. The acid is very strong and can burn the digestive tract, the mouth, and the lips. It can also damage the teeth. Binging and purging also disrupts the menstrual cycle.

Most bulimics know that their eating patterns are not normal, but they feel unable to change their behavior. Their binging and purging is done in secrecy so that family and friends often do not even know about their disorder. Some bulimics may turn to other ways of solving their problems, such as drugs and alcohol. Many develop other mental disorders, such as depression (see depressive disorders) and anxiety. In many cases, a physician or mental health professional must be consulted.

Most bulimics are females in their teens or early twenties; males of the same age range make up about 5 to 10 percent of bulimics. People of all races develop the disorder. The majority of bulimics who receive treatment, however, are white.

CAUSES

The cause of bulimia nervosa is unknown. Both genetic and social factors are probably responsible. Bulimia does appear to run in families, so a child is at risk for bulimia if another family member already has the disorder.

An important factor contributing to bulimia is the social pressure for women to be thin. Advertisements, television programs, and motion pictures are full of images depicting beautiful, successful women who are very thin. Young women often feel that they, too, need to be slender in order to be attractive and ultimately accepted in society. For young women with these feelings, bulimia may be the only way to achieve such standards.

Bulimia Nervosa: Words to Know

Binge:

To consume large amounts of food without control in a short period of time.

Purge:

To rid the body of food by vomiting, the use of laxatives, or some other method.

For some young women, the social pressure to maintain thinness may come from family, friends, or the social activities in which they participate. For instance, modeling, dancing, and gymnastics tend to emphasize an importance on body size and shape.

SYMPTOMS

The following are typical symptoms of bulimia nervosa:

• Eating large amounts of food uncontrollably (binging)
• Vomiting, using laxatives, or using other methods to eliminate food (purging)
• Excessive concern about body weight
• Depression or changes in mood
• Irregular menstrual periods
• Unusual dental problems, swollen cheeks or glands, heartburn, or bloating (swelling of the stomach)

IS IT BARBIE'S FAULT?

The causes of bulimia are many and complex. Could the Barbie doll be one of those causes? Some researchers think so. They point out that Barbie dolls have been one of the most popular toys ever developed and that an untold number of young girls have grown up playing with Barbie. So, in some ways, Barbie may have become a role model for young girls.

But how realistic is Barbie? For years critics have complained that Barbie's measurements are exaggerated. They argue that Barbie's waist was so small and breasts so large that a woman with the same measurements would not be able to stand. The fear is that young girls may begin to think that they should look like Barbie. And if their idea of beauty is being molded by a doll who was incredibly thin and unnaturally shaped, the message may lead to dangerous behavior such as anorexia or bulimia.

Scientists are also wondering if toys can affect the way boys view their bodies. For example, GI Joe has long been a very popular action figure among young boys. Unlike Barbie, GI Joe had a relatively realistic design. For example, the size of the doll's biceps (upper arm) was equivalent to 11 and one-half inch biceps on an adult male. This size falls within normal range for the average adult male.

In 1997, however, a new version of GI Joe was introduced called GI Joe Extreme. The new toy's dimensions increased so that the adult equivalent of his biceps would now measure 26 inches around, which is unnaturally exaggerated. It is interesting to note that also in 1997, Mattel, the toy company that produces both Barbie and GI Joe, announced that it was changing the shape of Barbie. In efforts to create a more realistic Barbie, the new and improved doll has smaller breasts and a wider waist.

DIAGNOSIS

Bulimia is often difficult to diagnose because patients often try to hide their condition and may deny they have a problem. Early diagnosis, however, is important. The sooner the condition is diagnosed, the better the chance it can be treated. One step in diagnosis is a physical examination. Because the symptoms of bulimia are similar to those of other diseases, a doctor needs to make sure that a patient is not suffering from some other physical problem.

According to the American Psychiatric Association, there are four signs that indicate bulimia. They are:

• Repeated episodes of binge eating
• Repeated use of purging devices, such as vomiting
• A feeling of lack of control over binge eating
• An ongoing concern over body shape and weight

TREATMENT

Bulimia nervosa is usually treated with a combination of drugs and counseling. Drugs are used to help the patient deal with his or her mental concerns. For example, anti-depressants may be used to help a person feel better about himself or herself.

Many types of counseling may be needed in the treatment of bulimia. Individual and group therapy can help patients understand the cause of their disorder, which may help patients learn to deal with their problems in ways other than binging and purging. Family counseling is also valuable.

Alternative Treatment

Light therapy may prove helpful in treating bulimia. Some people become depressed when there is an absence of light. The winter months can be especially difficult. Light therapy involves the use of artificial light to improve a patient's mood. Massage and hydrotherapy (water therapy) are also recommended for the treatment of bulimia. These techniques may help a person feel better about the shape and appearance of his or her own body.

PROGNOSIS

Bulimia may become chronic. That is, it can turn into an ongoing problem that lasts for many years. In such cases, it can cause a number of health problems, including seizures, irregular heartbeat, and thin bones. On rare occasions, bulimia can be fatal. Early treatment is the key to a promising prognosis. People who learn to deal with their problems of self-image can often be cured of the condition and can go on to lead normal, productive lives.

PREVENTION

Because bulimia is a psychiatric disorder with many possible causes, it is difficult to identify methods of prevention. Many suggest that the reason for eating disorders comes from society at large and that until the images of women in the media are changed to become more realistic, eating disorders such as bulimia, will continue to exist.

FOR MORE INFORMATION

Books

Cassell, Dana K. The Encyclopedia of Obesity and Eating Disorders. New York: Facts on File, 1994.

Jablow, Martha M. A Parent's Guide to Eating Disorders and Obesity. New York: Dell Publishing, 1992.

Kubersky, Rachel. Everything You Need to Know about Eating Disorders. New York: The Rosen Publishing Group, 1992.

Organizations

American Anorexia/Bulimia Association. 165 West 46th Street, Suite 1108 New York, NY 10036. (212) 575–6200.

Anorexia Nervosa and Related Eating Disorders. PO Box 5102, Eugene, OR 97405. (541) 344–1144.

Center for the Study of Anorexia and Bulimia. 1 W. 91st Street, New York, NY 10024. (212) 595–3449.

Eating Disorder Awareness & Prevention. 603 Steward St., Suite 803, Seattle, WA 98101. (206) 382–3587.

National Association of Anorexia Nervosa and Associated Disorders. Box 7, Highland Park, IL 60035. (708) 831–3438.

National Eating Disorders Organization. 6655 South Yale Avenue, Tulsa, OK 74136. (918) 481–4044.

Web sites

Anorexia Nervosa and Related Eating Disorders, Inc. [Online] http://www.anred.com (accessed on June 15, 1999).

"A Teen Guide to Eating Disorders." [Online] http://kidshealth.org. (accessed on October 5, 1999).

"Understanding Eating Disorders." [Online] http://www.ndmda.org. (accessed on June 15, 1999).

bu·lim·i·a / boŏˈlimēə; ˈlē-/ • n. insatiable overeating as a medical condition, in particular: ∎  (also bu·lim·i·a ner·vo·sa / nərˈvōsə/ ) an emotional disorder involving distortion of body image and an obsessive desire to lose weight, in which bouts of extreme overeating are followed by depression and self-induced vomiting, purging, or fasting. Also called binge-purge syndrome. DERIVATIVES: bu·lim·ic / -ˈlimik; ˈlē-/ adj. & n.

Bulimia

Marlene’s Perfect Figure

What Is Bulimia?

What Causes Bulimia?

What Are the Signs and Symptoms of Bulimia?

How Is Bulimia Diagnosed?

How Is Bulimia Treated?

Resources

Bulimia (bull-EE-me-a), sometimes referred to as the “binge-purge” disorder, involves repeated episodes of excessive eating (bingeing) followed by attempting to rid the body of the food by vomiting, using laxatives or enemas (purging), or exercising excessively.

KEYWORDS

for searching the Internet and other reference sources

Anorexia

Binge eating disorder

Binge and purge

Compulsive overeating

Eating disorders

Marlene’s Perfect Figure

To her friends and family, Marlene had a perfectly fine figure, and she seemed confident and self-assured. But privately, Marlene suffered from bulimia and could not seem to stop bingeing and purging. Several times a week, she would eat whole batches of cookies, packages of candies, and as much bread and muffins as she could find. Her guilt and fear of overweight always led her to make herself vomit. Marlene stayed at a healthy weight for her size, but she was obsessed with her weight and body shape.

What Is Bulimia?

Eating disorders are habits or patterns of eating that are out of balance and may involve major health and emotional problems. Bulimia is a type of eating disorder in which a person binges, or consumes large quantities of food, and then purges, or attempts to rid the body of the food. When bingeing, people with bulimia often feel like they have little control over their behavior. After a binge, they feel guilty and fearful of becoming fat, so they try to rid the body of the food by vomiting or using laxatives or enemas. They may use diet pills or take drugs to reduce the volume of fluids in the body. Some people with bulimia also exercise excessively in order to burn up some of the calories eaten during binges. People with bulimia have a distorted body image*; even though many people with bulimia stay at a fairly healthy weight, they are fixated on body shape and weight and feel like they are fat.

* body image

is a person’s impressions, thoughts, feelings, and opinions about his or her body.

Most people who develop bulimia are girls and young women of European ancestry, although males and people of all ethnic groups can have it. Bulimia affects at least 1 to 3 percent of middle and high school girls and up to 5 percent of college-age women in the United States.

What Causes Bulimia?

Bulimia often starts out with dieting after a binge, but once the purging begins, the situation worsens. A person eats too much, feels guilty about it, and purges. The purging provides some immediate relief but is followed by shame and guilt. People with bulimia begin to believe that the only way to control their weight is to purge. They often feel intense social and cultural pressure to be thin. Family problems and conflict are also often present in the lives of people with bulimia. Poor self-esteem can also play a role. People with bulimia overemphasize the importance of body shape and size in their overall self-image.

What Are the Signs and Symptoms of Bulimia?

A person with bulimia can often hide it very well. A girl with bulimia is usually near a healthy weight but is preoccupied with eating and dieting. Bulimia and other eating disorders share many symptoms, such as fatigue, low blood pressure, dehydration, preoccupation with food, and secretiveness about eating. However, because of the purging, bulimia can be associated with additional, serious symptoms that include:

• tooth and other dental problems caused by stomach acids damaging tooth enamel
• rips or tears in the esophagus (the tube that runs from the throat to the stomach) from frequent vomiting
• other gastrointestinal problems
• imbalances in electrolytes (essential body chemicals and minerals) that can lead to heart and other health problems
• feelings of loss of control, shame, depression, irritability, withdrawal, and secretiveness

How Is Bulimia Diagnosed?

Like Marlene, people often keep their bulimia hidden from family, friends, and health care professionals. The shame and embarrassment about purging can be profound. Sometimes a dentist will notice damage to the tooth enamel. A health care professional might ask about a person’s weight, diet, nutrition, and body image, and the responses may reveal an eating disorder. If concerned, a physician might order lab tests to study nutritional and medical status. A mental health professional may uncover bulimia when a person is treated for a different symptom, such as anxiety* or depression*.

* anxiety

can be experienced as a troubled feeling, a sense of dread, fear of the future, or distress over a possible threat to a person’s physical or mental well-being.

* depression

(de-PRESH-un) is a mental state characterized by feelings of sadness, despair, and discouragement.

How Is Bulimia Treated?

Bulimia, like other eating disorders, is treated most effectively with a combination of therapies. The main treatment for bulimia is psychotherapy*. The focus of treatment is on changing eating behaviors and thinking patterns. To help a person overcome bulimia, a therapist will also address the person’s distorted body image and fear of fat. Sometimes a physician will prescribe an antidepressant medication to relieve anxiety or depressive symptoms. Nutritional counseling, support groups, and family counseling can also be helpful.

* psychotherapy

(sy-ko-THER-apee), or mental health counseling, involves talking about feelings with a trained professional. The counselor can help the person change thoughts, actions, or relationships that play a part in the illness.

See also

Anorexia

Binge Eating Disorder

Body Dysmorphic Disorder

Body Image

Eating Disorders

Peer Pressure

Self-Esteem

Resources

Organizations

American Anorexia Bulimia Association, Inc., 165 West 46th Street, Suite 1108, New York, NY 10036. Telephone 212-575-6200 http://aabainc.org

Eating Disorders Awareness and Prevention, Inc. (EDAP), 603 Stewart Street, Suite 803, Seattle, WA 98101. Telephone: (800) 931-2237 for toll-free information and referral hotline http://www.edap.org

National Association of Anorexia Nervosa and Associated Disorders (ANAD), P.O. Box 7, Highland Park, IL 60035. Telephone 807-831-3438 http://anad.org

U.S. Food and Drug Administration (FDA) posts the fact sheet On the Teen Scene: Eating Disorders Require Medical Attention at its website. http://www.fda.gov/opacom/catalog/eatdis.html

BULIMIA NERVOSA

Since 1980, bulimia nervosa has been recognized by the American Psychiatric Association as an autonomous eating disorder. The term bulimia means "an extreme hunger," but the word is most commonly understood to refer to Bulimia Nervosa. It is characterized by recurrent episodes of binge eating followed by such regular activities as self-induced vomiting, excessive use of laxatives and/or diuretics, fasting or dieting, and vigorous exercise—all of which are directed at weight control. A characteristic feature in the bulimic patient is a persistent concern with weight and body shape. Other psychiatric disorders can accompany bulimia, particularly major depression. The full syndrome affects 1 to 3 percent of the adolescent and young adult female population, but many more experience subclinical variants of the disorder. Bulimia nervosa does occur in males, but such incidence is rare.

This disturbance in eating affects mostly young women—usually women of normal weight—and is often preceded by Anorexia nervosa (restricted eating). The bulimic symptoms may continue for many years with exacerbations and remissions. From the mid-1970s to the mid-1990s, the prevalence of eating disorders appeared to be increasing in industrialized countries. The etiology of bulimia is unknown, although psychological, sociocultural, and biological theories have been proposed. Many consider Western societies' increasing emphasis on thinness, especially among women, to be a contributing influence.

Parallels between bulimia nervosa and substance abuse have been drawn based on an Addic-Tion model, a self-psychology model, and a psychobiological model. According to the addiction model, food is the "substance" that is abused in bulimia nervosa. Although there are superficial similarities in phenomenology between binge eating and substance abuse, these similarities are selective and rely on a loose definition of addiction. The self-psychology perspective is that both bulimia nervosa and substance abuse arise from a common deficit in psychological functioning. Difficulties regulating affect and tension generate a need for the external distraction provided by food or psychoactive substances, respectively. This model may have some heuristic value but it has not, as of the mid-1990s, received empirical validation. The psychobiological view regards eating and drinking as consummatory behaviors with the potential for dysregulation. One possibility is a shared disturbance in the brain neurochemical functioning that regulates drives of appetite. There is some evidence that brain Serotonin function may be disrupted in both bulimia nervosa and Alcohol abuse; however, research in this area has just begun and the validity of this model is unknown as of the mid-1990s.

Among women receiving treatment for substance abuse, estimates of the prevalence of bulimia nervosa range from 8 to 17 percent, and estimates of the prevalence of some eating disorder range from 26 to 47 percent. Similarly, estimates of alcohol abuse among women seeking treatment for bulimia nervosa range from 27 to 49 percent. Thus, substance abuse and bulimia nervosa occur together in young women much more frequently than would be expected for independent disorders. One potential source of this comorbidity lies in genetic risk. Several studies have indicated an overrepresentation of alcohol abuse in the families of women with eating disorders. Another possibility is that certain psychological factors place certain women at risk for the development of either bulimia nervosa or substance abuse. There is some limited evidence for an underlying Addictive Personality in both disorders. As well, women with both disorders seem to have more difficulties, generally, with impulsive behaviors.

The treatment of bulimia nervosa depends on its severity. Many cases of the eating disturbance resolve on their own. Specific interventions that may be tried include psychodynamic (individual, family, group) therapies as well as cognitive and behaviorally oriented therapies and pharmacological treatments. Modest improvements have been reported with the use of Antidepressant medication. Studies conducted in the late 1990s have shown that ondansetron (a drug commonly used for patients with vomiting associated with chemotheraphy) could be an effective treatment for those with bulimia; this drug was not shown to treat the psychological aspects of the disorder though (Kiss, 2000).

BIBLIOGRAPHY

Fairburn, Christopher G., et al. (2000). The natural course of bulimia nervosa and binge eating disorders in young women. Archives of General Psychiatry, 57, 659.

Goldbloom, D. S. (1993). Alcohol abuse and eating disorders: Aspects of an association. Alcohol and Alcoholism.

Kiss, Alexander (2000). Treatment of chronic bulimic symptoms: new answers, more questions. The Lancet, 355, 769.

Mitchell, J. E. (1990). Bulimia nervosa. Minneapolis: University of Minnesota Press.

Peveler, R., & Fairburn, C. (1990). Eating disorders in women who abuse alcohol. British Journal of Addiction, 85, 1633-1638.

Vandereycken, W. (1990). The addiction model in eating disorders: some critical remarks and a selected bibliography. International Journal of Eating Disorders, 9, 95-101.

Wilson, G. T. (1991). The addiction model of eating disorders: a critical analysis. Advances in Behaviour Research and Therapy, 12, 27-72.

Marion Olmsted

David Goldbloom

Miroslava Romach

Karen Parker

Revised by Rebecca Marlow-Ferguson

bulimia nervosa Eating disorder that takes the form of compulsive eating, then purging by induced vomiting or the use of a laxative or diuretic. Confined mainly to girls and women, the disorder most often results from an underlying psychological problem. An obsession with body image may be reinforced by Western media stereotypes of slim as beautiful.

bulimia (bew-lim-iă) n. insatiable overeating. This symptom may be psychogenic, as in anorexia nervosa (b. nervosa or the binge–purge syndrome); or it may be due to neurological causes, such as a lesion of the hypothalamus.

bulimia nervosa An eating disorder, characterized by powerful and intractable urges to overeat, followed by self‐induced vomiting and the excessive use of purgatives; mainly a problem of young women. See also anorexia nervosa.

bulimia see eating disorders .

Bulimia Nervosa

SeeEating Disorders

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