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BULIMIA
BULIMIA
It is an eating disorder. People with bulimia may secretly binge — eating large amounts
of food with a loss of control over the eating — and then purge, trying to get rid of the
extra calories in an unhealthy way.
To get rid of calories and prevent weight gain, people with bulimia may use different
methods. For example, you may regularly self-induce vomiting or misuse laxatives,
weight-loss supplements, diuretics or enemas after bingeing. Or you may use other
ways to rid yourself of calories and prevent weight gain, such as fasting, strict dieting or
excessive exercise.
If you have bulimia, you're probably preoccupied with your weight and body shape. You
may judge yourself severely and harshly for your self-perceived flaws. Because it's
related to self-image — and not just about food — bulimia can be hard to overcome. But
effective treatment can help you feel better about yourself, adopt healthier eating
patterns and reverse serious complications.
Symptoms
Bulimia signs and symptoms may include:
Feeling a loss of control during bingeing — like you can't stop eating or can't
control what you eat
Forcing yourself to vomit or exercising too much to keep from gaining weight after
bingeing
Using laxatives, diuretics or enemas after eating when they're not needed
If you have any bulimia symptoms, seek medical help as soon as possible. If left
untreated, bulimia can severely impact your health.
Talk to your primary care provider or a mental health professional about your bulimia
symptoms and feelings. If you're reluctant to seek treatment, confide in someone about
what you're going through, whether it's a friend or loved one, a teacher, a faith leader, or
someone else you trust. He or she can help you take the first steps to get successful
bulimia treatment.
If you think a loved one may have symptoms of bulimia, have an open and honest
discussion about your concerns. You can't force someone to seek professional care, but
you can offer encouragement and support. You can also help find a qualified doctor or
mental health professional, make an appointment, and even offer to go along.
Because most people with bulimia are usually normal weight or slightly overweight, it
may not be apparent to others that something is wrong. Red flags that family and
friends may notice include:
Repeatedly eating unusually large quantities of food in one sitting, especially foods
the person would normally avoid
Going to the bathroom right after eating, during meals or for long periods of time
Changing weight
Causes
The exact cause of bulimia is unknown. Many factors could play a role in the
development of eating disorders, including genetics, biology, emotional health, societal
expectations and other issues.
Risk factors
Girls and women are more likely to have bulimia than boys and men are. Bulimia often
begins in the late teens or early adulthood.
Dieting. People who diet are at higher risk of developing eating disorders. Many
people with bulimia severely restrict calories between binge episodes, which may
trigger an urge to again binge eat and then purge. Other triggers for bingeing can
include stress, poor body self-image, food and boredom.
Complications
Bulimia may cause numerous serious and even life-threatening complications. Possible
complications include:
Dehydration, which can lead to major medical problems, such as kidney failure
Digestive problems
Prevention:
CBT has been shown to effectively help those who may be struggling
with eating disorders or mood disorders and decrease destructive
behaviors. In relation to eating disorder, CBT may include educational
components and development of a meal plan as well as
addressing various facets.
Although there's no sure way to prevent bulimia, you can steer someone toward
healthier behavior or professional treatment before the situation worsens. Here's how
you can help:
Foster and reinforce a healthy body image in your children, no matter what their
size or shape. Help them build confidence in ways other than their appearance.
Avoid talking about weight at home. Focus instead on having a healthy lifestyle.
Talk with your primary care provider. He or she may be in a good position to
identify early indicators of an eating disorder and help prevent its development.
If you notice a relative or friend who seems to have food issues that could lead to
or indicate an eating disorder, consider supportively talking to the person about
these issues .Diagnosis & treatment
REFRENCES
1. Bulimia nervosa. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American
Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed Feb. 1, 2018.
2. Bulimia nervosa. WomensHealth.gov. https://www.womenshealth.gov/a-z-topics/bulimia-nervosa. Accessed Feb. 1,
2018.
4. Engel S, et al. Bulimia nervosa in adults: Clinical features, course of illness, assessment, and diagnosis.
https://www.uptodate.com/contents/search. Accessed Jan. 25, 2018.
7. AskMayoExpert. Bulimia nervosa. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
Accessed Feb. 1, 2018.
8. Harrington BC, et al. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. American
Family Physician. 2015;91:46.
9. Herpertz-Dahlmann B. Treatment of eating disorders in child and adolescent psychiatry. Current Opinion in
Psychiatry. 2017;30:438.
10. Forman SF. Eating disorders: Overview of epidemiology, clinical features, and diagnosis.
https://www.uptodate.com/contents/search. Accessed Jan. 25, 2018.
11. Rienecke RD. Family-based treatment of eating disorders in adolescents: Current insights. Adolescent Health,
Medicine and Therapeutics. 2017;8:69.
12. Castillo M, et al. Bulimia nervosa/purging disorder. Current Problems in Pediatric and Adolescent Health Care.
2017;47:85.
13. Using dietary supplements wisely. National Center for Complementary and Integrative Health.
https://nccih.nih.gov/health/supplements/wiseuse.htm. Accessed Jan. 31, 2018.
14. Bipolar II disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American
Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed Feb. 15, 2018.
15. Sim LA (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 21, 2018.
16. Campbell K, et al. Eating disorders in children and adolescents: State of the art review. Pediatrics. 2014;134:582.
17. Gerwitz O'Brien JR (expert opinion). Mayo Clinic, Rochester, Minn. March 6, 2018.
Is there a difference?
Anorexia and bulimia are both eating disorders. They can have similar symptoms,
such as distorted body image. However, they’re characterized by different food-
related behaviors.
For example, people who have anorexia severely reduce their food intake to lose
weight. People who have bulimia eat an excessive amount of food in a short period of
time, then purge or use other methods to prevent weight gain.
Keep reading to learn more about how these conditions present, how they’re
diagnosed, available treatment options, and more.
Anorexia
Anorexia often stems from a distorted body image, which may result from emotional
trauma, depression, or anxiety. Some people may view extreme dieting or weight loss
as a way to regain control in their lives.
There are many different emotional, behavioral, and physical symptoms that can
signal anorexia.
Someone with anorexia may exhibit certain behavioral changes before physical
symptoms are noticeable. This includes:
skipping meals
lying about how much food they’ve eaten
eating only certain “safe” — usually low-calorie — foods
adopting unusual eating habits, like sorting food on the plate or cutting food
into tiny pieces
talking badly about their body
trying to hide their body with baggy clothes
avoiding situations that could involve eating in front of other people, which can
result in social withdrawal
avoiding situations where their body would be revealed, like the beach
extreme exercising, which may take the form of exercising for too long or too
intensely, like an hour-long jog after eating a salad
Bulimia
Someone with bulimia may develop an unhealthy relationship to food over time. They
may get caught up in damaging cycles of binge eating and then panic about the
calories they’ve consumed. This may lead to extreme behaviors to prevent weight
gain.
There are two different types of bulimia. The attempts to purge are used to
differentiate them. The new edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) now refers to attempts to purge as “inappropriate compensatory
behaviors”:
Purging bulimia. Someone with this type will regularly induce vomiting after
binge eating. They may also misuse diuretics, laxatives, or enemas.
Non-purging bulimia. Instead of purging, someone with this type may fast or
engage in extreme exercise to prevent weight gain after a binge.
Many people with bulimia will experience anxiety because their eating behavior is out
of control.
As with anorexia, there are many different emotional, behavioral, and physical
symptoms that can signal bulimia.
Someone with bulimia may exhibit certain behavioral changes before physical
symptoms are noticeable. This includes:
These include:
The first step will be a physical exam. Your doctor will weigh you to determine your
body mass index (BMI). They’ll likely look at your past history to see how your
weight has fluctuated over time. Your doctor will likely ask about your eating and
exercise habits. They may also ask you to complete a mental health questionnaire.
At this stage, your doctor will likely order lab tests. This can help rule out other
causes of weight loss. It can also monitor your overall health to make sure that no
complications have occurred as a result of a possible eating disorder.
If the tests reveal no other medical causes for your symptoms, your doctor may refer
you to a therapist for outpatient treatment. They may also refer you to a nutritionist to
help you get your diet back on track.
If severe complications have occurred, your doctor may recommend that you get
inpatient treatment instead. This will allow your doctor or another medical
professional to monitor your progress. They can also watch for signs of further
complications.
In either case, your therapist may be the one to actually diagnose a specific eating
disorder after talking about your relationship with food and weight.
Diagnostic criteria
There are different criteria that the DSM-5 uses to diagnose anorexia or bulimia.
restricting food intake to maintain a weight below the average weight for your
age, height, and overall build
an intense fear of gaining weight or becoming fat
connecting your weight with your worth or other distorted perceptions about
body image
If you’re concerned about your eating behavior and don’t already have a mental
healthcare provider, you can view doctors in your area through the Healthline
FindCare tool.
Medication
According to a 2005 studyTrusted Source, medication has shown little efficacy for the
treatment of anorexia.
They include:
SSRIs like fluoxetine (Prozac) can help treat underlying depression, anxiety, or
OCD, and reduce bingeing-purging cycles.
Therapy
Family therapy may be recommended for adolescents and children. It aims to improve
communication between you and your parents, as well as teach your parents how to
best support you in your recovery.
Your therapist or doctor may also recommend support groups. In these groups, you
can talk with others who have experienced eating disorders. This can provide you with
a community of people who understand your experience and can offer helpful insight.
Anorexia
anemia
electrolyte imbalance
arrhythmia
bone loss
kidney failure
heart failure
In severe cases, death may occur. This is possible even if you aren’t yet underweight.
It can result from arrhythmia or an imbalance of electrolytes.
Bulimia
tooth decay
inflamed or damaged esophagus
inflamed glands near the cheeks
ulcers
pancreatitis
arrhythmia
kidney failure
heart failure
In severe cases, death may occur. This is possible even if you aren’t underweight. It
can result from arrhythmia or organ failure
If you notice that someone you love is exhibiting signs of an eating disorder, however,
speak up. Sometimes people with eating disorders are afraid or unable to ask for help,
so you’ll need to extend the olive branch.
Pick a private location where you can both talk openly without distractions.
Share that you love them and want to help however they may need.
Go into the conversation knowing some solutions, but don’t suggest them off
the bat. Only share resources if they’re open to taking next steps.
Encourage them to get help. Offer to help them find a therapist or go with them
to the doctor if they’re scared. A doctor’s visit is crucial to help someone with
an eating disorder get on track and to make sure they’re getting the treatment
they need.
There are also a few things that you should avoid doing:
Don’t shame someone about their potential disorder. To avoid this, use “I”
statements like “I worry about you” instead of “you” statements like “You’re
making yourself sick for no reason.”
Don’t give medical advice you aren’t equipped to give. Saying things like,
“Your life is great, you have no reason to be depressed” or “You’re gorgeous,
you don’t need to lose weight,” do nothing to address the problem.
Don’t try to force someone into treatment. Ultimatums and added pressure
don’t work. Unless you’re the parent of a minor, you can’t make someone go
into treatment. By doing so, you’ll only strain the relationship and take away a
stem of support when they need it most.
If you’re a minor and you have a friend who you believe has an eating disorder, you
can go to their parents to express your concern. Sometimes peers can pick up on
things that parents don’t, or see behaviors that they hide from their parents. Their
parents may be able to get your friend.
Exercising excessively
Bingeing and self-induced vomiting to get rid of food, which may include the use of
laxatives, enemas, diet aids or herbal products
Preoccupation with food, which sometimes includes cooking elaborate meals for
others but not eating them
Eating only a few certain "safe" foods, usually those low in fat and calories
Adopting rigid meal or eating rituals, such as spitting food out after chewing
Fear of gaining weight that may include repeated weighing or measuring the body
Complaining about being fat or having parts of the body that are fat
Social withdrawal
Irritability
Insomnia
Unfortunately, many people with anorexia don't want treatment, at least initially. Their
desire to remain thin overrides concerns about their health. If you have a loved one
you're worried about, urge her or him to talk to a doctor.
If you're experiencing any of the problems listed above, or if you think you may have an
eating disorder, get help. If you're hiding your anorexia from loved ones, try to find a
person you trust to talk to about what's going on.
Causes
The exact cause of anorexia is unknown. As with many diseases, it's probably a
combination of biological, psychological and environmental factors.
Biological. Although it's not yet clear which genes are involved, there may be
genetic changes that make some people at higher risk of developing anorexia.
Some people may have a genetic tendency toward perfectionism, sensitivity and
perseverance — all traits associated with anorexia.
Risk factors
Anorexia is more common in girls and women. However, boys and men have
increasingly developed eating disorders, possibly related to growing social pressures.
Anorexia is also more common among teenagers. Still, people of any age can develop
this eating disorder, though it's rare in those over 40. Teens may be more at risk
because of all the changes their bodies go through during puberty. They may also face
increased peer pressure and be more sensitive to criticism or even casual comments
about weight or body shape.
Complications
Anorexia can have numerous complications. At its most severe, it can be fatal. Death
may occur suddenly — even when someone is not severely underweight. This may
result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes —
minerals such as sodium, potassium and calcium that maintain the balance of fluids in
your body.
Anemia
Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart
failure
Loss of muscle
Kidney problems
If a person with anorexia becomes severely malnourished, every organ in the body can
be damaged, including the brain, heart and kidneys. This damage may not be fully
reversible, even when the anorexia is under control.
In addition to the host of physical complications, people with anorexia also commonly
have other mental health disorders as well. They may include:
Personality disorders
Obsessive-compulsive disorders
Prevention
There's no guaranteed way to prevent anorexia nervosa. Primary care physicians
(pediatricians, family physicians and internists) may be in a good position to identify
early indicators of anorexia and prevent the development of full-blown illness. For
instance, they can ask questions about eating habits and satisfaction with appearance
during routine medical appointments.
If you notice that a family member or friend has low self-esteem, severe dieting habits
and dissatisfaction with appearance, consider talking to him or her about these issues.
Although you may not be able to prevent an eating disorder from developing, you can
talk about healthier behavior or treatment optio