Bulimia nervosa
The essential features of bulimia nervosa include eating binges followed by feelings of guilt, humiliation, and self-deprecation. These feelings cause the patient to engage in self-induced vomiting, the use of laxatives or diuretics, following a strict diet, or fasting to overcome the effects of the binges. Electrolyte imbalances (including metabolic alkalosis, hypochloremia, and hypokalemia) and dehydration can occur, increasing the risk of physical complications.
Bulimia nervosa usually begins in adolescence or early adulthood and can occur simultaneously with anorexia nervosa. It affects nine women for every man affected. Nearly 2% of adult women meet the diagnostic criteria for bulimia nervosa; 5% to 15% have some symptoms of the disorder.
Causes
Bulimia nervosa has no known cause, but psychosocial factors may contribute to its development, including family disturbance or conflict, sexual abuse, maladaptive learned behavior, struggle for control or self-identity, cultural overemphasis on physical appearance, and parental obesity.
Clinical TipBulimia nervosa is also associated with depression.
Signs and symptoms
The history of a patient with bulimia nervosa is marked by episodes of binge eating that may occur up to several times per day. The patient commonly reports a binge-eating episode during which she continues eating until abdominal pain, sleep, or the presence of another person interrupts it. The preferred food usually is sweet, soft, and high in calories and carbohydrate content.
The bulimic patient may appear thin and emaciated. Typically, however, although her weight frequently fluctuates, it usually stays within normal limits through the use of diuretics, laxatives, vomiting, and exercise. So, unlike the anorexic patient, the bulimic patient can usually hide her eating disorder.
Overt clues to this disorder include hyperactivity, peculiar eating habits or rituals, frequent weighing, and a distorted body image.
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