Bulimia Nervosa in Adolescents

What is bulimia nervosa?

Bulimia nervosa, usually referred to as bulimia, is defined as uncontrolled episodes of overeating (bingeing), usually followed by purging (self-induced vomiting), misuse of laxatives, enemas, or medications that cause increased production of urine, fasting, or excessive exercise to control weight. Bingeing, in this situation, is defined as eating much larger amounts of food than would normally be consumed within a short period of time (usually less than 2 hours). Eating binges occur at least twice a week for 3 months and may occur as often as several times a day.

What causes bulimia?

The cause of bulimia is not known. Factors believed to contribute to the development of bulimia include cultural ideals and social attitudes toward body appearance, self-evaluation based on body weight and shape, and family problems.

Who is affected by bulimia?

The majority of bulimics are female, adolescent, and from a high socioeconomic group. All westernized industrial countries have reported incidences of bulimia. Adolescents who develop bulimia are more likely to come from families with a history of eating disorders, physical illness, and other mental health problems, such as mood disorders or substance abuse. Other mental health problems, such as anxiety disorders, or mood disorders, are commonly found in teens with bulimia.

What are the different types of bulimia?

There are two subgroups of bulimia aimed at reducing caloric intake, including the following:

  • Purging type. This type regularly engages in self-induced vomiting or misuse of laxatives, diuretics, enemas, or other cathartics (medications, through their chemical effects, that serve to increase the clearing of intestinal contents).

  • Nonpurging type. This type uses other inappropriate behaviors, such as fasting or excessive exercise, rather than regularly engaging in purging behaviors to reduce caloric absorption of excessive amounts of food by the body.

What are the symptoms of bulimia?

The following are the most common symptoms of bulimia. However, each adolescent may experience signs differently. Symptoms may include:

  • Usually a normal or low body weight (sees self as overweight)

  • Recurrent episodes of binge eating (rapid consumption of excessive amounts of food in a relatively short period of time; often secretive), coupled with fear of not being able to stop eating during the bingeing episodes

  • Self-induced vomiting (usually secretive)

  • Excessive exercise or fasting

  • Peculiar eating habits or rituals

  • Inappropriate use of laxatives, diuretics, or other cathartics

  • Irregular or absence of menstruation

  • Anxiety

  • Discouragement related to dissatisfaction with themselves and their bodily appearance

  • Depression

  • Preoccupation with food, weight, and body shape

  • Scarring on the back of the fingers from the process of self-induced vomiting

  • Overachieving behaviors

The symptoms of bulimia may resemble other medical problems or psychiatric conditions. Always consult your adolescent's health care provider for a diagnosis.

How is bulimia diagnosed?

Parents, teachers, coaches, or instructors may be able to identify the child or adolescent with bulimia, although many people with the disorder initially keep their illness very private and hidden. However, a child psychiatrist or a qualified mental health professional usually diagnoses bulimia in children and adolescents. A detailed history of the adolescent's behavior from parents and teachers, clinical observations of the adolescent's behavior, and, sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of bulimia in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Bulimia, and the malnutrition that results, can adversely affect nearly every organ system in the body, increasing the importance of early diagnosis and treatment. Consult your adolescent's health care provider for more information.

Treatment for bulimia

Specific treatment for bulimia will be determined by your adolescent's health care provider based on:

  • Your adolescent's age, overall health, and medical history

  • Extent of your adolescent's symptoms

  • Your adolescent's tolerance for specific medications or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Bulimia, in adolescents, is usually treated with a combination of individual therapy, family therapy, behavior modification, and nutritional rehabilitation. Among adults, cognitive behavioral therapy and antidepressant medications have both been shown to be effective. Treatment should always be based on a comprehensive evaluation of the adolescent and family. Individual therapy usually includes both cognitive and behavioral techniques. Medication (usually antidepressants or antianxiety medications) may be helpful if the adolescent with bulimia is also anxious or depressed. The frequent occurrence of medical complications during the course of rehabilitative treatment requires both your adolescent's health care provider and a nutritionist to be active members of the management team. Parents play a vital supportive role in any treatment process.

Prevention of bulimia

Preventive measures to reduce the incidence of bulimia are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the process of normal growth and development, and improve the quality of life experienced by adolescents with bulimia. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.