Definition

Bulimia Nervosa is one of the major Eating Disorders classified in the DSM-IV. The central features of the disorder are binge eating and excessive efforts to compensate for any weight gain. These compensatory behaviors can include self-induced vomiting, misuse of laxatives, diuretics, or other such medications, enemas, fasting, and frequent exercise. Binge eating may also be generally defined as a seemingly uncontrolled consumption of a considerable amount of food in a relatively short period of time (within a 2hr. period). Further, for a diagnosis to be at least partially warranted, an individual must have engaged in binge eating and compensatory behaviors at least twice a week for three months, and his/her self-evaluation must rest largely on body shape and weight.

Individuals with Bulimia Nervosa are typically in the normal weight range, or they may be slightly over or under weight. They are often ashamed of their eating problems and, consequently, take great strides to conceal their symptoms and behavior. For these and, perhaps, other reasons, it is not uncommon for symptoms of depression and anxiety to be associated with the disorder. About one-third of individuals may also have to contend with Substance Abuse or Dependence that has arisen as a result of attempts to contol mood disturbances or appetite and weight.

In addition to these clinical features, Bulimia Nervosa has also been classified as having two subtypes: Purging Type and Nonpurging Type. The former denotes a person who regularly engages in self-induced vomiting or the inappropriate use of laxatives, diuretics, or enemas. The latter denotes a person who typically does not engage in the behaviors noted above, but, instead, tends to use other compensatory methods, such as strenuous exercise or fasting, on a regular basis.

The disorder is reported to occur with similar frequencies in many of the world's industrialized nations. In North America, the majority of clinical cases tend to be white and female (approx. 90%); the disorder has also been reported in other ethnic groups. Its prevalence among adolescent and young adult females has been estimated at about 1% - 3%; for males, it is about one-tenth that figure.

Symptoms

A number of symptoms have been associated with Bulimia Nervosa. Several have been identified above, but to reiterate, they may include the following:

• recurrent episodes of binge eating accompanied by feelings of loss of control during the episode
• recurrent episodes of inappropriate compensatory behaviors to prevent weight gain, e.g., self-induced vomiting, misuse of laxatives and/or diuretics, strict dieting and/or fasting, excessive strenuous exercise
• the aforementioned behaviors occur at least twice a week for three months
• self-evaluation is largely influenced by body shape and weight
• restriction of food or fluids
• loss of appetite
• weight gain or loss of greater than ten pounds (4.5 kg) or more
• physical symptoms include: dehydration, menstrual irregularities, electrolyte imbalance, swollen parotid glands, severe tooth decay

Cause(s)

A singular cause for the disorder has yet to be identified and may not be realistically forthcoming; research to date, for example, is showing that eating disorders lend themselves to a wide range of possible causal explanations. Scientists from a variety of disciplines are currently studying the possible impact of psychological, social, familial, cultural, biochemical, and genetic factors.

Personality factors research has been investigating a number of questions, such as how the disorder may develop as an adaptive response to stress and anxiety, and whether the possession of certain personality characteristics can leave individuals more predisposed to contracting the disorder.

Research into possible genetic explanations have arisen from repeated observations that eating disorders often run in families; such observations, however, have also drawn attention to possible environmental influences. Recent studies, for example, have found that family members' criticisms or undue preoccupation with weight and attractiveness may put young women at increased risk for such disorders.

Biochemical studies are considering the role of the neuroendocrine system and neurotransmitters in the development of eating disorders. The neuroendocrine system is involved in the regulation of sexual functioning, physical growth and development, appetite and digestion, sleep, heart and kidney function, emotions, thinking and memory. Neurotransmitters are chemicals that facilitate the transmission of signals between nerve cells (neurons). Both have been found disturbed in individuals with with eating disorders.

Course

Bulimia Nervosa typically begins in late adolescence or early adulthood and binge eating behavior might begin during or after an episode of dieting. A pattern of disturbed eating may persist for several years; it may also take a chronic or episodic course. The long-term outcome of the disorder is presently unknown.

Treatment

Effective treatment of eating disorders involves a variety of treatments implemented by an expert team of health professionals, including physicians, nutritionists, therapists, and psychopharmacologists (specialists in drug therapy). Treatment plans may include a combination of individual, group and/or family therapy, cognitive-behavioral therapy, behavior therapy, psychodynamic therapy, nutritional counseling, hospitalization, and medication.

If an individual's health has deteriorated to critical levels, medical or psychiatric hospitalization may be required. Conditions that may warrant hospitalization include excessive and rapid weight loss, serious metabolic disturbances, clinical depression, a risk of suicide, severe binge eating and purging, and extreme disorientation. A major objective of institutional care is to control and carefully monitor the person's eating and eliminatory functions until his/her condition stabilizes. Personal control of these functions may be slowly and gradually returned as health improves. In most cases, long-term therapy and medical follow-up are essential for continued successful management of the disorder.

Dealing with Relapse

If signs of relapse occur, an individual should contact the health professional that they have arranged to be responsible for follow-up. If such a person has not been designated, a GP or the family physician should be contacted.

Signs of relapse can include an increase or decrease in weight that is five pounds (2.3 kg) or more out of the target range, an increase in addictive behaviors (e.g. food, exercise, drugs &/or alcohol), a decrease in appetite or ability to eat, a reoccurrence of binge eating, purging or vomiting, the use of pills or diuretics, as well as a marked increase or decrease in sleep.

Emergencies

In the case of an emergency, individuals should call their physician, therapist, or the emergency ward of their local hospital. Additional assistance may also be obtained by clicking on the Further Information and Support link below.

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