Bulimia Nervosa Treatment

People who have bulimia nervosa routinely "binge," consuming large amounts of food in a very short period of time, and immediately "purge," ridding their bodies of the just-eaten food by self-inducing vomiting, taking enemas, or abusing laxatives or other medications. If left untreated, bulimia nervosa can lead to serious and even life-threatening problems, such as depression, anxiety disorders, heart damage, kidney damage, injury to all parts of the digestive system, and severe dental damage. Those with bulimia nervosa are at risk for dangerous impulsive, self-destructive behaviors, such as sexual promiscuity, kleptomania, self-mutilation, and alcohol and/or drug abuse.

An estimated 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime. Symptoms of bulimia nervosa include:

  • Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode
  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medications (purging); fasting; or excessive exercise
  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months
  • Self-evaluation is unduly influenced by body shape and weight

Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.

Treating Bulimia

The primary goal of treatment for bulimia is to reduce or eliminate binge eating and purging behavior. To this end, nutritional rehabilitation, psychosocial intervention, and medication management strategies are often employed. Establishment of a pattern of regular, non-binge meals, improvement of attitudes related to the eating disorder, encouragement of healthy but not excessive exercise, and resolution of co-occurring conditions such as mood or anxiety disorders are among the specific aims of these strategies. Individual psychotherapy (especially cognitive-behavioral or interpersonal psychotherapy), group psychotherapy that uses a cognitive-behavioral approach, and family or marital therapy have been reported to be effective.

Psychotropic medications, primarily antidepressants such as the selective serotonin reuptake inhibitors (SSRIs), have been found helpful for people with bulimia, particularly those with significant symptoms of depression or anxiety, or those who have not responded adequately to psychosocial treatment alone. These medications also may help prevent relapse.

A Note About Bulimia and the Brain

Researchers have found that women with a history of bulimia show key differences in their brain's regulation of a hormone that controls mood and appetite, possibly suggesting an inherent susceptibility to the eating disorder.

"These alterations may make some women vulnerable for developing an eating disorder," lead author Dr. Walter H. Kaye, of the University of Pittsburgh School of Medicine in Pennsylvania, told Reuters Health.

Kaye's team studied nine women who have recovered from bulimia for at least one year. Bulimia nervosa is an eating disorder in which patients alternate between binge eating and purging. They suffer from a distorted body image and, often, mood disturbances such as depression.

All the women were scanned using positron emission tomography, or a (PET) scan, to gather images of brain activity. These were compared with brain scans from 12 women who had never had an eating disorder.

The researchers found that the bulimic patients' brains showed a reduction in the ability of the chemical serotonin to bind to receptors in certain brain regions. They also found that these women did not show the normal decline in serotonin binding that comes with aging.

Serotonin is a neurotransmitter that helps regulate appetite, mood and impulse control. The findings are published in the July issue of the American Journal of Psychiatry.

"I suspect this finding suggests that there is a dysregulation of the serotonin system, which contributes to extremes of impulse control--undereating as well as overeating--both of which are often found in bulimia," Kaye said.

He and his colleagues suspect the brain alterations were not a result of the bulimia, but a possible cause.

"While this finding could be a consequence of having bulimia, there is other data that suggests that certain traits, such as anxiety, may occur in childhood in people who later develop bulimia," Kaye said. "Serotonin alterations could contribute to such traits."

Previous research, he noted, has also found some evidence that bulimia has a genetic component.