8.5 Bulimia Nervosa and Binge-Eating Disorder

Bulimia Nervosa

Bulimia nervosa is an eating disorder characterized by binge eating followed by compensatory behaviors.
Common compensatory behaviors include:
- Purging via induced vomiting.
- Use of laxatives.
- Excessive exercise.
This disorder is not limited to individuals of specific weight categories:
- Affected individuals may be underweight, of normal weight, or overweight.

Symptoms of bulimia nervosa include:

Chronically inflamed and sore throat: Damage due to frequent vomiting.
Swollen salivary glands: Particularly in the neck and jaw area, indicating frequent purging.
Worn tooth enamel: Resulting in increasingly sensitive and decaying teeth from exposure to stomach acid.
Acid reflux disorder: Other gastrointestinal problems associated with purging behaviors.
Intestinal distress: Distress and irritation from laxative abuse.
Severe dehydration: Due to fluid purging.
Electrolyte imbalance: Can lead to serious health conditions like stroke or heart attack.
- Example: Levels of sodium, calcium, and potassium may fluctuate dangerously.

Bulimia is associated with numerous adverse health outcomes:
- Kidney failure.
- Heart failure.
- Significant dental decay.
Psychological implications include:
- Anxiety.
- Depression.
Increased risk for substance abuse (Mayo Clinic, 2012b).

Lifetime prevalence rates:
- Estimated at around 1% for women.
- Less than 0.5% for men (Smink, van Hoeken, & Hoek, 2012).
Increased rates observed during the 1980s and early 1990s; current rates have stabilized.
Causes of bulimia are complex:
- Interaction of genetic, biological, behavioral, psychological, and social factors.

Binge-eating disorder (BED) is the most prevalent eating disorder, affecting approximately:
- 2.8% of females.
- 1% of males.
Characterized by recurrent binge eating episodes without compensatory behaviors to avert weight gain.
Most individuals with BED tend to be overweight or obese.

Unlike bulimia, BED binges are not followed by purging behaviors.
Core symptom is binge eating, but not everyone who binge eats has BED:
- Occasional binge eaters may not experience negative impacts indicative of a disorder.
Defining binge eating can be complex, but typical features include:
- Eating much faster than usual.
- Consuming large quantities when not hungry.
- A subjective feeling of loss control over eating.
- Planning binge episodes, sometimes purchasing special foods in advance.
- Eating alone due to embarrassment.
- Potential dazed mental state during binging, sometimes leading to memory lapses regarding the binge.
- Feelings of guilt, shame, or disgust following a binge.

BED emphasizes overeating rather than weight management or body shape concerns.
Commonly associated emotional symptoms include:
- Depression.
- Low self-esteem.
- Stress.
- Boredom.

Psychosocial Treatments for Bulimia:
- Cognitive Behavioral Therapy (CBT):
- Focuses on altering automatic thoughts and engaging in behavioral experiments (e.g., eating "forbidden foods" during sessions).
- Early treatment is crucial because individuals with eating disorders face higher suicide and medical complication risks.
- Treatment effectiveness varies, emphasizing personalized care that may include:
- Individual, group, and/or family psychotherapy.
- Medical care and monitoring.
- Nutritional counseling.
- Medications.

Family-based therapy (Maudsley approach):
- Involves parents in handling adolescents' eating habits, effectively aiding in weight gain and improving eating habits and moods.
Treatment in the form of family-based therapy is especially beneficial for adolescents in developing their eating behaviors more responsibly.

CBT focuses on helping individuals pinpoint distorted and unhelpful thinking patterns.
Patients document food intake and purging episodes to identify triggers leading to bulimia, aiming for behavioral change.
Positive outcomes noted with early behavioral adjustments. Other effective therapies include interpersonal psychotherapy and dialectical behavior therapy.

Antidepressants of the selective serotonin reuptake inhibitors (SSRI) class provide modest advantages:
- Fluoxetine: FDA approved for bulimia treatment.
- Sertraline: Also effective against bulimia but may not be FDA approved specifically for this indication.
- Topiramate: Useful but has increased side effects.
Effectiveness is evaluated against placebo in trials, demonstrating positive results.
Combining medication with psychotherapy may yield better outcomes:
- Benefits include:
- Abstinence from binge eating.
- Reduction in obsessive weight-loss behaviors.
- Improvement in social functioning.
- Lower relapse rates.

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