Bulimia nervosa

Bulimia nervosa is an eating disorder characterized by out-of-control eating offset by fasting, extreme exercise, or purging—voiding food by self-induced vomiting or other means. Children with bulimia, unlike those with anorexia, often maintain healthy weight—they can even be overweight—but the way they go about it is anything but healthy. Like anorexia, the vast majority of those diagnosed with bulimia are female, though actual prevalence in males is unknown. There is evidence that societal norms of appearance propagated through the media—the “beauty ideal”—could contribute to the prevalence of bulimia. Perhaps 3 to 5% of the population has the disorder, which typically manifests in late adolescence and early adulthood, around 18.

If your child has bulimia nervosa, she may well seem a healthy weight for her age, and appear to eat normally—bulimia is much harder to detect than anorexia, and secretiveness is a key facet of the disorder. But there are signs to look for. She may be dehydrated, and experience acid reflux from frequent vomiting, along with sore throats, and swollen glands. You may notice the deterioration of her teeth due to contact with stomach acids. Sudden absences from the dinner table or routine trips to the bathroom right after eating are key signs. An unrealistic body image is also a possible sign of bulimia, as with anorexia. Bulimics often prefer to binge and purge in private.

The causes of bulimia nervosa are elusive, but appear to be a combination of familial factors, geneticrisk, hormonal dysfunction, and environment-possibly including social pressures. Whatever the causes, people with bulimia seem to experience a sort of short-lived relief or pleasure when they purge alien to those without the disorder. The binging and purging becomes self-perpetuating, and the sufferer’s senses of hunger and satiety become terribly confused.

The key to diagnosing bulimia nervosa is whether a child is a binge eater, meaning that she consumes much more in a given period than average, and has a “sense of lack of control” during the binge episode, which is often described as a sort of “out-of-body” experience. The diagnosis also requires that she compensate for the binge episode inappropriately—self-induced vomiting, off-label use of laxatives or diuretics, fasting, or excessive exercise—and her self-image be dominated by her body weight and appearance.

Psychotherapeutic: Behavioral management is the first-line treatment for bulimia—professionals will address the dangerous and worrying purging behavior and ensure that your child is healthy before moving on to more long-lasting interventions.

 

Cognitive behavioral therapy is employed to alter your child’s body image and eating habits by teaching them how their thoughts turn into unwanted, even disturbing feelings and actions. CBT is effective in 50 to 60% of those treated. Interpersonal therapy, which focuses on how the child’s relationships with others impact her feelings and actions, is also employed.

 

Pharmacological: If behavioral therapy does not yield the desired results, antidepressant medications—particularly selective serotonin reuptake inhibitors or SSRIs—can have positive results.

 

In addition, nutrition education may be necessary to convince your child of the disastrous effects of her disorder, and may help her amend her behavior.

Children with bulimia are also at increased risk for other psychiatric disorders, primarily depression,obsessive compulsive disorder, and substance abuse and dependence.

Like anorexia, the unhealthy behaviors associated with bulimia can lead to severe medical problems and even death. Associated conditions include irregular heartbeat and heart failure, tooth decay, and severe digestive problems. Individuals with bulimia are also more likely than most to become dependent on alcohol and drugs, including those that they may use to purge. 

Can it be cured?
No. While many people with bulimia find that they can effectively manage the desire to binge and purge after treatment, it is a lifelong undertaking.

Can it be fatal?
Yes. Though fewer deaths are associated with bulimia than anorexia, because a child with bulimia may maintain a relatively normal weight, the activities she uses to maintain it put stress on the body that can prove fatal. Suicide is also a serious risk.

Is there medication for bulimia?
While psychotherapy, particularly cognitive behavioral therapy and interpersonal therapy, are preferred treatments, some antidepressants have proven effective in combating the symptoms of bulimia.

What is a binge episode?
A binge episode is defined as “eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances” and having “a sense of lack of control over eating during the episode.” Experts note that while the first criteria may be hard to quantify, the sense of lack of control during the binge episode, and the attempt to compensate by purging, are the keys to a diagnosis of bulimia.

How can I tell?
It’s not easy to tell—especially if your child is not underweight, or is even overweight—when a child has been using drastic measures to void food from her body. But there are signs—secretive absences from the table, abnormal intake of water, going long periods without eating at all, teeth eroded from exposure to stomach acids, even scars on the fingers from self-induced vomiting.

When do symptoms usually start?
The onset of bulimia is later than anorexia; while anorexia usually presents around puberty, say 14, bulimics start to show symptoms around the transition to adulthood, say 19. But the disorder can also manifest earlier—and later.