Bulimia Nervosa
Bulimia is an eating disorder. It is characterized by uncontrolled episodes of overeating, called bingeing. This is followed by purging with methods such as vomiting or misuse of laxatives. Bingeing is eating much larger amounts of food than you would normally eat in a short period of time, usually less than 2 hours. You may feel like you can’t stop or control these episodes of binge eating.
The binge-purge cycles can happen from many times a day to several times a week.
Often, people with bulimia keep a normal or above normal body weight. This lets them hide their problem for years. Many people with bulimia don’t seek help until they reach the ages of 30 or 50. By this time, their eating behavior is deeply ingrained and harder to change.
There are 2 ways people with bulimia restrict calories:
Purging type. The person engages in self-induced vomiting or misuse of laxatives, diuretics, or enemas, or other medicines that clear the intestines.
Nonpurging type. The person uses other behaviors, such as fasting or excessive exercise, rather than purging behaviors.
Symptoms
Bulimia symptoms may include:
Living in fear of gaining weight and trying to lose weight in unhealthy ways.
Repeatedly eating unusually large amounts of food in one sitting.
Feeling a loss of control during binge eating. You may feel like you can't stop eating or can't control what you eat.
Vomiting on purpose or exercising to extremes after binge eating so that you don't gain weight.
Using medicines that make you urinate, called water pills or diuretics, or laxatives or enemas to pass stool when they're not needed.
Fasting, limiting calories or not eating certain foods between binges.
Using dietary supplements or herbal products for weight loss. These products can be dangerous.
Being very unhappy with your body shape and weight.
Letting your body shape and weight guide how you feel about yourself and your worth.
Having extreme mood swings.
People with bulimia may use different methods to purge. The severity of bulimia depends on the number of times a week that you purge and the problems caused by doing so.
Treatment Options
When you have bulimia, you may need one or more types of treatment. Treatment includes proven therapies and medicines that may help you get better.
Treatment generally involves a team approach that includes you, your family, your primary healthcare professional, a mental health professional and sometimes a dietitian who knows how to treat eating problems.
Here's a look at bulimia treatment options.
Talk therapy, also known as psychotherapy, involves talking to a mental health professional about your bulimia and related issues.
Studies show that these types of talk therapy can reduce symptoms of bulimia:
Enhanced cognitive behavioral therapy, also known as CBT-E, to help teenagers and adults with bulimia create healthy-eating patterns and replace unhealthy, negative beliefs and behaviors with healthy, positive beliefs and behaviors.
Family-based treatment, also known as FBT, to help the parents of children and teenagers with bulimia learn what to do about unhealthy-eating behaviors and help their child regain control over what is eaten.
Dialectical behavioral therapy, to help people better tolerate distress, become more emotionally balanced, be more mindful and get along better with others.
Ask your mental health professional which type of therapy will be used and how that therapy helps treat bulimia.
Medicines:
Specific antidepressants may reduce the symptoms of bulimia. The only antidepressant that the U.S. Food and Drug Administration (FDA) has approved specifically to treat bulimia is fluoxetine (Prozac). This is a selective serotonin reuptake inhibitor, also known as an SSRI. It may help with symptoms of bulimia, even if you're not depressed. This medicine works better when it's used with talk therapy.
Nutrition education:
Dietitians with special training in treating eating disorders can help. They can design an eating plan to help you eat healthier, manage feelings of being overly hungry or having too many cravings, and provide good nutrition. Eating regularly and not limiting the amounts or types of food you eat is important in overcoming bulimia.
Hospitalization:
Usually, bulimia can be treated outside of the hospital. But if symptoms are severe and you have serious health complications, you may need to be treated in a hospital. Some programs for eating disorders may offer day treatment rather than a hospital stay.
Treatment challenges in bulimia:
Although most people with bulimia get better, some find that symptoms don't go away entirely. Periods of binge eating and purging may come and go through the years. For example, some people may binge eat and purge when they're under a lot of stress.
If you find yourself back in the binge eating-purge cycle, get help. Follow-up sessions with your primary healthcare professional, dietitian or mental health professional may help you before your eating disorder gets out of control again. Learning positive ways to cope, finding healthy ways to get along with others and managing stress can help keep an eating problem from returning.
If you've had an eating disorder in the past and you notice your symptoms returning, seek help from your medical team right away.