The term "nervosa" was added to "bulimia" to emphasize the features it shares with anorexia nervosa—the pursuit of lower weight and the fear of fatness.
Patients with bulimia may be over, under or at their ideal body weight, with normal weight range most common. A diagnosis of anorexia nervosa takes precedence over bulimia if weight is below 85 percent of normal.
Bulimia includes two elements:
- Binge eating
- Self-induced vomiting, laxative abuse, excessive exercise, or other measures to avoid weight gain
Two specific criteria for bulimia are repeated episodes of binge eating (an average of twice a week for three months), and when patients feel they cannot control their eating. Purging is not necessary for the diagnosis, but occurs in 80 percent of cases.
Like anorexia nervosa, bulimia nervosa usually begins by dieting. Dieters tend toward bulimia rather than anorexia when their hunger overcomes their attempt to restrict food and they begin binge eating. The clinical disorder emerges when an intense fear of fatness entrenches itself. Patients suffer psychological distress or medical complications after binge eating and subsequent purging, especially when binges are provoked by emotional pain rather than hunger.
Bingeing is promoted by restriction of food early in the day—skipping breakfast and very little for lunch— and hunger builds through late afternoon or evening, the most common times for bingeing.
Patients can develop bulimia at any age, from the preteens to the 50's, with the peak onset a few years later than anorexia nervosa, 18 to 20 year olds. Half of patients have a history of anorexia nervosa or an anorexia-like episode. Bulimia may alternate with anorexia nervosa in an irregular sequence over several decades.
Bulimia has complications including:
- Persistent reflux
- Problems with bowel functions
- Heart problems
- Electrolyte imbalance
Most deaths among patients with bulimia are caused by arrhythmias or suicide.
Management of Bulimia Nervosa
After diagnosis, many patients with bulimia nervosa can be treated as outpatients. Those struggling with bulimia are usually surprised and relieved to learn that eating moderate quantities of food three times a day does not make them fat, as they had feared.
However, some patients require hospitalization to interrupt their behavior and break the cycle, especially:
- In severe cases
- If accompanied by suicide plans
- If there are medical complications
Once bingeing and purging behavior is stopped and medical complications are treated, cognitive-behavioral therapy is used to inhibit the binge/purge behavior. Regular moderate exercise is helpful in both managing stress and promoting a healthy body shape and composition
In addition, research has found that 50 percent of bulimic patients benefit from an antidepressant drug. Studies have also found that cognitive behavioral psychotherapy and interpersonal psychotherapy produce significant and lasting improvements, greater than antidepressants alone.
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