Bulimia Nervosa

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Quick GuideEating Disorders: Anorexia, Bulimia, Binge Eating

Eating Disorders: Anorexia, Bulimia, Binge Eating

How do physicians diagnose bulimia?

Many providers of health care may help make the diagnosis of bulimia, including licensed mental-health therapists, pediatricians, other primary-care providers, specialists whom you see for a medical condition, emergency physicians, psychiatrists, psychologists, psychiatric nurses, and social workers. One of these professionals will likely conduct or refer the individual with bulimia for an extensive medical interview and physical examination as part of establishing the diagnosis. Bulimia may be associated with a number of other medical conditions, so health-care professionals may perform routine laboratory tests during the initial evaluation to rule out other causes of symptoms.

As part of this examination, a health-care professional may ask the sufferer a series of questions from a standardized questionnaire or self-test to help assess the presence of depression. Thorough exploration for any history or presence of mental-health symptoms will be conducted so that bulimia can be distinguished from other types of eating disorders like anorexia nervosa, binge eating disorder, or pica, or as part of a genetic disorder like Prader-Willi Syndrome. The mental-health professional will also explore whether other forms of mental illness are present.

What is the treatment for bulimia?

Studies on treatment effectiveness for bulimia seem to show that psychotherapy treatment for bulimia is superior to medication or behavior therapy. Cognitive behavior therapy is thought to be somewhat superior to other forms of psychotherapy in treating this eating disorder. This form of psychotherapy helps to alleviate bulimia and reduce the likelihood that it will come back by helping the eating disorder sufferer change his or her way of thinking about certain issues. In CBT, the therapist uses three techniques to accomplish these goals:

  • Didactic component: This phase helps to set up positive expectations for therapy and promote the person's cooperation with the treatment process.
  • Cognitive component: This helps to identify the thoughts and assumptions that influence the bulimic individual's behaviors, particularly those that may predispose the sufferer to disordered eating.
  • Behavioral component: This employs behavior-modification techniques to teach the person more effective strategies for dealing with problems.

Family therapy is also often used to treat bulimia, particularly for adolescent sufferers. It usually takes place in three phases:

  • Initially, the family works with the therapist to help the adolescent maintain appropriate food intake and limit negative ways the eating-disordered person uses to control their weight.
  • After the bulimic individual has begun to control their negative eating behaviors, he or she is encouraged to take responsibility for maintaining appropriate eating and refraining from purging behaviors.
  • In the final phase of treatment, more general life issues of the adolescent are addressed and the effects of bulimia on normal activities and normal development are examined.

Nutritional counseling involves teaching the bulimic individual how to diet in a healthy way. It has been found to help decrease the sufferer's tendency to engage in purging behaviors.

Regarding medication treatment of bulimia, fluoxetine (Prozac) has been approved by the U.S. Food and Drug Administration for treatment of this condition. Fluoxetine is a member of the serotonergic antidepressants (SSRIs). Other SSRIs, as well as serotonin/norepinephrine-reuptake inhibitors like venlafaxine (Effexor) and duloxetine (Cymbalta), and tricyclic antidepressants like imipramine (Tofranil) and amitryptiline (Elavil), have also been shown to decrease the binge eating and purging symptoms of bulimia.

SSRIs tend to have fewer side effects than the tricyclic antidepressants (TCAs). Also, SSRIs do not cause orthostatic hypotension (sudden drop in blood pressure when sitting up or standing) and heart-rhythm disturbances like the TCAs do. Therefore, SSRIs are often the first-line treatment for bulimia. Examples of other SSRIs include paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro).

SSRIs are generally well tolerated, and side effects are usually mild. The most common side effects are nausea, diarrhea, agitation, insomnia, and headache. However, these side effects generally go away within the first month of SSRI use. Some patients experience sexual side effects, such as decreased sexual desire (decreased libido), delayed orgasm, or an inability to have an orgasm. Some patients experience tremors with SSRIs. The so-called serotonergic (meaning caused by serotonin) syndrome is a rare but serious neurologic condition associated with the use of SSRIs. It is characterized by high fevers, seizures, and heart-rhythm disturbances. This condition tends to occur only in very ill psychiatric patients taking multiple psychiatric medications.

The antiepileptic medication topiramate (Topamax) has also been shown to significantly decrease binge eating and is sometimes used to treat people who do not respond to or have intolerable side effects from the other medications.

Medically Reviewed by a Doctor on 3/16/2016

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