Bulimia nervosa (BN) is part of a cluster of diagnoses called the feeding and eating disorders. Feeding and eating disorders are a group of psychiatric conditions that include:
Feeding and eating disorders are characterized by a persistent disturbance in eating behaviors. These disorders are linked to alterations in the consumption of food or absorption of nutrients, and can result in severe distress, physical health problems, and psychosocial impairment. People with anorexia nervosa are significantly underweight because they eat very little food in an effort to lose weight or prevent weight gain. People with binge eating disorder and bulimia nervosa eat large quantities of food in a short period of time (called a "binge"); people with bulimia nervosa also attempt to prevent weight gain by compensating for these binges in an inappropriate way, usually by vomiting, excessively exercising, fasting, or misusing laxatives or other medications. People with pica regularly eat non-nutritious, non-food substances. People with avoidant/restrictive food intake disorder have little interest in food or avoid many types of foods, which results in nutrition deficits.
Several of these disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, are characterized by serious disturbances in body image and a preoccupation with weight and shape. Other disorders, including pica and avoidant/restrictive food intake disorder, are characterized by atypical eating behaviors but are not prominently associated with body image disturbances. Some feeding and eating disorders, including anorexia nervosa and avoidant/restrictive food intake disorder, cause the individual to be significantly underweight or malnourished as a result of their eating behaviors. Other disorders, including bulimia nervosa and binge eating disorder, do not produce marked weight loss and are typically associated with normal or higher than expected weight.
BN is a psychiatric disorder that affects approximately 1 - 2% of adolescent females and 0.5% of adolescent males.
BN is characterized by three main symptoms:
For a child or adolescent to be diagnosed with BN, eating binges and accompanying purging behaviors must occur, on average, at least once per week for three months or longer. If these behaviors are associated with significantly low body weight and occur within the context of anorexia nervosa, anorexia nervosa (binge-eating/purging type) would be diagnosed instead of BN.
Several factors can be useful to distinguish a binge from normal overeating. The definition of "a very large amount of food" is subjective, but is usually defined as an amount that is significantly greater than most individuals would eat in a similar situation. Often the individual will feel uncomfortably or painfully full after a binge. Individuals with BN often describe a sense of dissociation or complete inability to control their food consumption once a binge has started, and they may eat foods they might otherwise avoid. These binges often lead the individual to feel ashamed; consequently, many individuals with BN will binge and purge in secret. These individuals may not be forthcoming about their binging or purging behaviors due to guilt, shame, or fear of stigma.
BN severity can range from mild to very severe. In severe cases, BN can lead to serious medical complications, including fluid and electrolyte disturbances, esophageal tears, and disturbances in the cardiac and gastric systems.
BN severity can range from mild to very severe. In severe cases, BN can lead to serious medical complications, including fluid and electrolyte disturbances, esophageal tears, and disturbances in the cardiac and gastric systems. More generally, children and adolescents with BN may have significant difficulty attending or concentrating at school and may have strained family and peer relationships. Children and adolescents with BN also have other psychiatric conditions, most commonly depressive disorders, bipolar disorder, anxiety disorders, substance use disorders, and personality disorders.
BN is characterized by abnormalities of brain function which are thought to contribute to symptoms. In particular, evidence points to dysregulation in the serotonergic and striatal dopaminergic systems in the brain. Neurobiological models of BN suggest that regularly binging on palatable food may alter the dopamine, acetylcholine, and opioid systems in reward-related brain areas, leading to the maintenance of symptoms. In addition, overconcern about weight and shape is thought to lead to the adoption of purging behaviors, which results in a vicious cycle of binging, purging, and restricting. The disorder is thought to have a genetic component, although having a predisposition to BN does not necessarily mean that someone will develop BN.
BN is treatable. Published treatment guidelines for pediatricBN include those from the American Academy of Child and Adolescent Psychiatry.
As BN can cause serious medical complications, a thorough medical evaluation should be conducted and the need for medical hospitalization should be assessed.
Treatment of BN should typically include a multidisciplinary team that includes a pediatrician, psychologist, and dietician. In the absence of an acute medical need, outpatient therapy is generally preferable to inpatient hospitalization as a first-line treatment for children and adolescents with BN.
Clinical research and expert guidelines suggest that the following treatments are effective for children and adolescents with BN:
In addition, research suggests that the following treatments are promising:
The antidepressant medication fluoxetine improves symptoms by altering the amount of serotonin in the brain. Antidepressant medications should not be used as a monotherapy for BN but may have some benefit as a second-line treatment for adolescents with BN.
Treatment of BN should typically include a multidisciplinary team that includes a pediatrician, psychologist, and dietician. In the absence of an acute medical need, outpatient therapy is generally preferable to inpatient hospitalization as a first-line treatment for children and adolescents with BN.
Clinical research and expert guidelines suggest that the following treatments are effective for children and adolescents with BN:
In addition, research suggests that the following treatments are promising:
The antidepressant medication fluoxetine improves symptoms by altering the amount of serotonin in the brain. Antidepressant medications should not be used as a monotherapy for BN but may have some benefit as a second-line treatment for adolescents with BN.