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Bulimia is a chronic eating disorder. It is characterized by periods of eating and then trying to avoid weight gain. Bulimia has important physical, psychological, and social components. Effective treatment must address all three of these.

What is going on in the body?

• fasting
• inducing vomiting
• using laxatives to have bowel movements
• taking diuretics, or water pills

What are the signs and symptoms of the condition?

• amenorrhea, which refers to decreased or absent menstruation
• denial of the behavior
• excessive exercise, even if the person is underweight
• fear of gaining weight or becoming fat
• feeling of disgust or self-loathing
• need for frequent weighing
• overachievement in a variety of areas
• periods of not eating followed by eating binges
• problems with body image
• purging (inducing vomiting)
• unusual eating habits and rituals

What are the causes and risks of the condition?

Bulimia is thought to be a result of social, psychological, and biological factors. Genetics may contribute. Mood disorders are more common in family members of those who develop bulimia.

Social factors play a major role, especially in Western societies that promote an ideal of thinness. Family problems, self-esteem, and identity conflicts are also factors. Bulimia is most common in females in adolescence or young adulthood.

What can be done to prevent the condition?

There are no specific ways to prevent bulimia. Promoting good nutrition and self-esteem are important. Changes in society's attitudes about thinness would help.

How is the condition diagnosed?

Diagnosis of bulimia begins with a history and physical exam. The healthcare professional may order tests to check the person's health status, including:

• blood tests, such as a complete blood count (CBC) and thyroid function tests
• an electrocardiogram (ECG) to check for heart problems
• urinalysis, to check for dehydration and infection
• chest X-ray to check for rib fractures, heart problems, or lung infection
• abdominal X-ray to look for digestive tract problems

What are the long-term effects of the condition?

Bulimia can cause dehydration, malnutrition, and salt imbalances. Damage to the brain, muscles, reproductive tract, bowels, stomach, and other body organs can occur because of the irregularity of food and fluid intake.

Serious heart problems can also result, including:

• arrhythmias
• congestive heart failure
• sudden death

In addition, an individual who induces vomiting repeatedly may damage the throat and esophagus.

Someone with bulimia may have trouble developing healthy relationships. The person also may be limited in the ability to succeed at school or work.

What are the treatments for the condition?

• aggressive medical management
• nutritional rehabilitation and counseling
• individual, group, and family psychotherapy
• cognitive behavioral therapy

Bulimia may be treated in the hospital or other inpatient facility, or on an outpatient basis. The person's weight, cardiac status, and overall health influence the treatment choice.

Some people become so malnourished that they need to be fed through tubes to stay alive. They will have strict rules about eating and weight management. Any physical consequences (ranging from salt and water imbalance to esophageal scarring) that have resulted from bulimic behavior will also need to be treated.

A combination of cognitive behavioral therapy and family therapy are often effective:

• Cognitive therapy helps individuals identify and question the reality of their beliefs about eating and weight.
• Behavioral therapy is designed to help change the behaviors that keep the illness going.
• Family therapy helps family members learn about the illness. They learn what they can do to help their loved ones recover. Sometimes, family problems need to be addressed before recovery can begin.
• Spiritual or pastoral counseling can be helpful for many people.

Medications are rarely used to treat bulimia. If the person has significant depression, antidepressants may be used.

What are the side effects of the treatments?

If antidepressants are used, they may cause drowsiness, dry mouth, and constipation.

What happens after treatment for the disease?

Psychotherapy usually continues for at least one year after treatment starts. Some individuals may need 5-6 years of therapy. People who recover from bulimia need to be aware that this illness can recur.

How is the disease monitored?

The individual needs to make regular visits to the healthcare professional and report progress as well as any new or worsening symptoms.