Three features are required to make a diagnosis of bulimia nervosa. First, recurrent episodes of binge eating. Second, the regular use of extreme methods of weight control. Third, certain attitudes about shape and weight, such as an intense dissatisfaction with shape, fear of fatness, and an intense pursuit of thinness.
Incidence/Age
The incidence is not clear, but there are consistent reports that the prevalence among young adult women is in the region of 1% in developed countries. Bulimia is much less common in men. Bulimia is very uncommon in childhood, but increases in frequency in adolescence.
Bulimia nervosa causes
The risk factors include being female, living in a western society, exposure to a social environment that encourages dieting, exposure to factors that increase the risk of psychiatric disorder, certain personality traits (e.g. perfectionism) and a family history of similar problems. Once bulimia nervosa is established, it can be perpetuated by ongoing concerns about weight, and by certain patterns of dieting.
Signs/Symptoms
A patient with bulimia characteristically goes through periods of strict dieting alternating with episodes of binge eating. The amount of food eaten during binges can involve the consumption of two or three thousand calories at a time. Typically the food eaten comprises items that are usually avoided such as high fat foods and pastries.
Binges are often followed by considerable distress, and measures to counteract the effects of over eating such as vomiting and taking laxatives. In addition to unusually intense attitudes to shape and weight, people with bulimia nervosa often have general psychiatric symptoms such as depression and anxiety.
Complications of Disorder
Physical complications such as dental problems or occasionally more serious medical problems can develop.
Bulimia nervosa treatment
Most patients with bulimia can be treated as outpatients. Psychological treatment techniques are the treatment of first choice, and there are several self-help books available. Treatment programmes typically involve providing information about bulimia nervosa, and the learning of certain techniques to control binges.
People who are not helped by psychological treatments sometimes benefit from treatment with anti-depressant drugs, and occasionally need admission to hospital.
Outcome
Community studies suggest that many people with bulimia nervosa do not come for treatment, and it is likely that many of these improve without intensive treatment. Follow up studies of clinical samples suggest that there is a tendency to recovery and that the mortality is much lower than in anorexia nervosa.
