Bulimia Nervosa

Patients with bulimia are overly concerned about their body image and may be normal weight, underweight, or overweight.

Darcy McLurg, BSc Pharm, Clinical Pharmacist, The Ottawa Hospital, General Campus

Bulimia nervosa is an eating disorder characterized by episodes of bingeing followed by recurrent purging, excessive exercise, or periods of fasting. As much as 20,000 calories can be consumed in a very short time during the course of a binge. To be diagnosed with bulimia, bingeing episodes should occur at least two days per week for a period of three months. The bulimic is aware that their eating is out of control and usually feels guilty or depressed afterwards.

As with other eating disorders, bulimia nervosa is most commonly seen in young women. Only 10 to 15 % of bulimics are male. Similar to anorexia, patients will fully recover in about 50% of the cases. Thirty per cent of patients will partially recover and up to 20% will never recover.

The cause of bulimia nervosa is unknown. One school of thought is that bulimia is a result of the malfunctioning of an area of the brain regulating mood and appetite. Risk factors for developing this condition include a family history of bulimia as well as a personal/family history of depression or bipolar disorder.

Patients with bulimia are overly concerned about their body image and may be normal weight, underweight, or overweight. Bingeing usually occurs in secrecy and bulimics tend to maintain social interaction so signs of bulimia may not be obvious. Up to one third of patients with bulimia may abuse or depend on alcohol or stimulants. Depression is often associated with this condition.

Self-induced vomiting and recurrent weight loss and gain of more than 10 lbs. can be hard on the body. Repeated vomiting can result in electrolyte imbalances, weakness, dehydration, and damaged teeth from gastric acid contained in the vomit. Patients may experience esophageal and/or gastric erosion. Chronic laxative abuse causes dysfunctional bowels resulting in sever chronic constipation, decreased intestinal motility, and delayed gastric emptying time.

The treatment of bulimia, as with other eating disorders is difficult and involves a combination of psychotherapy and medication. The goal of treatment is to institute healthy eating patterns. Patients with any eating disorder may not recognize their disease and be unwilling to participate in their treatment. Psychotherapy for the bulimic patient involves addressing the relationship between thoughts, mood and bingeing by using a combination of individual, group and family therapy. Fluoxetine (Prozac) at a dose of 60 mg per day has been shown to reduce bulimic symptoms and is the only agent approved for the treatment of bulimia in Canada. Other antidepressants, such as desipramine and imipramine, have demonstrated some efficacy as well.