Bulimia nervosa is an eating disorder characterized by periods of binge eating. In some cases, the person will compensate for this overeating by forcing vomiting; misusing laxatives, diuretics, or enemas; fasting; or excessive exercising. People with bulimia cannot control their eating and have a paralyzing fear of becoming fat. Bulimia is associated with depression and other psychiatric disorders and shares symptoms with anorexia nervosa, another major eating disorder. Because many individuals with bulimia maintain a normal or above-normal body weight, they are able to keep their condition a secret for years.

Bulimia is often accompanied by the following signs and symptoms:

• Binge eating of high-carbohydrate foods, usually in secrecy
• Loss of control over eating, with guilt and shame
• Body weight that goes up and down
• Constipation, diarrhea, nausea, gas, abdominal pain
• Dehydration
• Blood-tinged vomit
• Irregular menstruation or cessation of menstrual periods
• Eroded tooth enamel
• Bad breath
• Throat irritation and inflammation
• Calluses on hands from forcing the body to vomit
• Stealing, especially food
• Depression
• Substance abuse, especially alcohol

There are several different theories about what is involved in the development of bulimia. Bulimia may have a hereditary component, and some experts believe that a family environment with an overemphasis on achievement may be another contributing factor. The role of sexual abuse in the development of bulimia is controversial. Other psychological and environmental factors may be involved -- these may include mood disorders and substance abuse in families of people with bulimia. Individuals with bulimia may also experience depression, self-mutilation, substance abuse, and obsessive-compulsive behavior. Cultural pressures to appear slender contribute to the disorder, particularly among dancers and athletes.

People with the following conditions or characteristics are at higher risk for developing bulimia:

• White, middle-class women (primarily adolescents and college students)
• People with a family history of mood disorders and substance abuse
• Individuals with low self-esteem

Often, people with bulimia are ashamed of their condition and do not seek help for many years, by which time their behaviors are deeply ingrained and harder to change. If you are experiencing symptoms associated with bulimia, you should see a doctor as soon as possible. The doctor should check for physical signs such as eroded tooth enamel and enlargement of the salivary glands, as well as signs of depression, possibly including marks from self-mutilation. Laboratory tests can reveal chemical changes caused by bingeing and purging, and psychological tests may point to obsessive-compulsive or antisocial behaviors.

Treatment Plan

The most successful treatment is a combination of interpersonal therapy, family therapy, patient education, and medication.

Drug Therapies

The most common antidepressants prescribed for bulimia are selective serotonin reuptake inhibitors (SSRIs). They include:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluvoxamine (Luvox)

Prozac is considered the drug of choice, although some studies suggest that other SSRIs, such as Luvox, may be even more effective.

Important note: Recent studies indicate that the use of Prozac and other antidepressants may cause children and teenagers to have suicidal thoughts. Children who are taking these drugs must be monitored very carefully for signs of potential suicidal behavior.

Your health care provider may prescribe potassium supplements.

Complementary and Alternative Therapies

Psychotherapy is a cornerstone of bulimia treatment. Using biofeedback may also help you to better manage stress. Other mind-body and stress-reduction techniques, such as yoga, tai chi, and meditation, may help you become more aware of your body and form a more positive body image. A 6-week clinical trial showed that guided imagery helped people with bulimia reduce bingeing and vomiting, feel more able to comfort themselves, and improve their feelings about their bodies and eating. More studies are needed to verify these findings and to determine if guided imagery has long-term benefits. Always tell your health care provider about the herbs and supplements you are using or considering using.

Nutrition and Supplements

Bulimic individuals with low body weight, low body mass index (BMI), and low serum albumin (the main protein in blood) levels are at increased risk for vitamin and mineral deficiency. Vitamin abnormalities may contribute to cognitive difficulties such as poor judgment or memory loss and other psychiatric conditions. These deficiencies can often be corrected with dietary interventions.

Some natural therapies, including dietary supplements, may help the general health and well-being of a person struggling with bulimia to become more balanced.

Following these nutritional tips may help reduce symptoms:

• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Use quality protein sources -- such as organic meat and eggs, whey, and vegetable protein shakes -- as part of balanced program aimed at gaining muscle mass and preventing wasting.
• Avoid refined sugars, such as candy and soft drinks.

You may address nutritional deficiencies with the following supplements:

• A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil two to three times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources, but supplementation is recommended.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
• 5-hydroxytryptophan (5-HTP), 50 mg two to three times daily, for mood stabilization. Talk with your health care provider if you are on prescription medications before taking 5-HTP.
• Creatine, 5 - 7 grams daily, when needed for muscle weakness and wasting.
• Probiotic supplement (containing Lactobacillus acidophilus among other strains), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Refrigerate your probiotic supplements for best results.
• L-glutamine, 500 - 1000 mg three times daily, for support of gastrointestinal health and immunity.
• L-theanine, 200 mg one to three times daily, for nervous system support.
• Melatonin, 2 - 5 mg one hour before bedtime, for sleep and immune protection. Talk with your health care provider about possible drug interactions wen using melatonin.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Ashwagandha (Withania somniferum) standardized extract, 450 mg one to two times daily, for general health benefits and stress.
• Holy basil (Ocimum sanctum) standardized extract, 400 mg daily, for stress balance. You can also prepare teas from the plant.
• Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
• Grape seed (Vitis vinifera) standardized extract, 100 - 200 mg three times daily, for antioxidant effects, and heart and blood vessel protection.
• Catnip (Nepeta spp.), as a tea two to three times per day, to calm the nerves and in particular to sooth the digestive system.

Homeopathy

No scientific literature supports the use of homeopathy for bulimia. However, an experienced homeopath will consider your individual case and may recommend treatments to address both your underlying condition and any current symptoms.

Acupuncture

No scientific literature supports the use of acupuncture for bulimia. However, there is a long history of successfully treating a full range of psychiatric disorders with acupuncture. A trained acupuncturist may be able to recommend acupuncture treatments to support your overall health.

Massage

Therapeutic massage can be an effective part of a bulimia treatment plan. In one study, adolescent women with bulimia were assigned at random either to receive massage therapy for 5 weeks or be in a control group (not receiving massage therapy). The 24 women receiving massage improved immediately, while the control group did not improve. Women in the massage group were less anxious and depressed right after their initial massages. They also had better scores on the Eating Disorder Inventory, which helps providers assess psychological and behavioral traits in eating disorders.

Relapse is common in people with bulimia. Possible complications from repeated bingeing and purging include problems with the esophagus, stomach, heart, lungs, muscles, or pancreas. Suicidal individuals or those with severe symptoms may need to be hospitalized to prevent further complications. Pregnancy may be difficult emotionally for women with bulimia because of the changes in body shape that occur. Poor nutritional health of the mother may also have a negative impact on the unborn child. Women who have stopped menstruating because of bulimia will be unable to become pregnant.

Since bulimia is usually a long-term disease, the person's weight, exercise habits, and physical and mental health need to be checked periodically by a health care provider.

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