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Bulimia Nervosa

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Summary

Bulimia is an eating disorder that causes teens to binge eat and then try to make up for the overeating by forcing vomiting or using other behaviors to drop weight. Teens and children with bulimia worry constantly about their weight, even though they often are normal weight.

Expanded Overview

A child with bulimia nervosa may have frequent episodes of binge eating (eating large amounts of food at once) followed by behaviors to prevent weight gain. This may mean forced vomiting after eating (purging), taking laxatives to promote a bowel movement after eating or doing excessive amounts of exercise to burn calories. Children with bulimia are usually average weight for their age. 

Causes

There is no single cause of bulimia. Though it’s true that society puts tremendous pressure on girls and young women to be thin and look a certain way, social pressure is not the only cause of bulimia and other eating disorders.

Genetics, stress, culture and other issues play a role in causing bulimia. Bulimia is more common than anorexia, and can affect up to 2% of U.S. adolescent and young adult women, according to the National Eating Disorders Association. Although bulimia affects mostly teen girls and young women, eating disorders occur in all neighborhoods and communities. Men and boys also have eating disorders. 

Symptoms

Symptoms

It is important to know the symptoms of bulimia so that your child can be diagnosed and treated early, before the eating disorder becomes more severe and causes health problems in your child.

Children and teens who have bulimia frequently and repeatedly eat large amounts of food with a sense that they have no control over their eating. This is called binge eating. Because bulimia causes your child to constantly worry about gaining weight, however, your child follows binge eating episodes with behaviors that will offset the eating.  Your child might force vomiting or use laxatives or diuretics (drugs that increase urination), exercise excessively, then engage in fasting or using some combination of these behaviors to avoid weight gain.

Behavioral signs of bulimia:

  • Constant talk or concern about food and weight
  • Spending long amounts of time in the restroom with the water running to cover the sound of vomiting, especially right after meals
  • Anxiety about eating in public or an unwillingness to share in family meals
  • Stealing, hiding or hoarding food
  • Depression or isolation
  • Constant exercise
  • Using pills such as laxatives and diuretics

Medical or physical signs of bulimia:

  • Tooth and gum decay
  • Red and inflamed throat
  • Dehydration
  • Weak muscles
  • Dizziness and weakness
  • Burst blood vessels in the face
  • Calluses on the fingers or knuckles that were used to induce vomiting
  • Acid reflux disease (GERD)
  • Chronic sore throat
  • Heart attach or stroke
  • Abdominal pain and intestinal problems
  • Swollen salivary glands in the neck and jaw

The continuous binging on food and vomiting or use of laxatives to empty the stomach can cause health problems. Your child continues trying to lose weight, but frequent episodes of binging and purging can cause serious problems with self-esteem and shame about their behavior.

You should be especially concerned if your child’s weight changes dramatically (either up or down), if her face or glands swell and if you notice hair loss, tremors or extreme thirst or cold. 

Tests and Diagnosis

Tests and Diagnosis

Anorexia usually is diagnosed only after a close relative or friend speaks up about their concerns. It is important that parents follow up when they notice typical behaviors or physical signs of bulimia. Parenting mistakes do not cause bulimia.

There are no laboratory tests to diagnose bulimia, but some tests can help doctors study signs or effects of the disorder:

  • A physical exam by your child’s doctor notes problems such as a dry mouth or changes to the cheeks.
  • A dental exam reveals the damage that acid from frequent vomiting can do to tooth enamel and gums.
  • Blood tests can show electrolyte imbalances. Electrolytes are minerals in the body that provide energy, such as calcium, potassium and sodium. Your child might not have enough of some electrolytes or might be dehydrated from vomiting and the use of laxatives or diuretics.

Family doctors and psychiatrists rely on guidelines that describe specific symptoms and medical signs of bulimia. It is important to rely on professionals who are trained in eating disorders to properly diagnose and treat bulimia.

Treatments

Treatments

Children and teens who have bulimia usually are frightened and caught in a cycle of unhealthy eating and purging habits that is difficult to break. Parents and other family members should recognize the psychological effects that bulimia has on a child or teen so that they can help them get better without anger and without adding to their shame.

Our psychiatrists, psychologists and other behavioral health professionals are specially trained in treating eating disorders and in working with children and adolescents.  Our goal is to help your child get better by working as a team with you, your child and family.  Every child’s situation is different, but treatment often includes:

  • An approach to treatment in steps, beginning with acceptance by your child and loved ones that your child has an eating disorder. It is important to first recognize the problem.
  • Use of psychotherapy. Your child may receive individual or group therapy. Sometimes, parents and the entire family receive therapy to help support your child.
  • Nutritional counseling with a dietitian, who can teach you and your child schedules and plans for healthy eating.
  • Medical treatment of complications from bulimia, such as low potassium or heart problems.
  • Dental care if necessary to treat damage to teeth and gums caused by years of bulimic behavior.  
  • Use of medications such as antidepressants to help reduce some of your child’s binging and purging behavior. 

Treating bulimia requires a team of professionals who usually care for your child as an outpatient. Some children and teens who have bulimia have more severe health problems, such as malnutrition or depression. They benefit from staying in the hospital until the eating disorder is under control.

Our professionals specialize in treating children and teens, including children under age 12, and boys. Our psychiatrists, psychologists, nurses, therapists and dietitian work together to meet your child’s medical, nutritional and psychological needs in one setting, and educate and support you and your family.

Prevention

The causes of bulimia are complex. Parents and their children cannot necessarily prevent the eating disorder. The best they can do is model behavior that reflects acceptance of all body images and provide healthy, nutritious meals without obsessing over calorie intake and weight. They also can watch for early warning signs in their children, such as excessive interest in weight loss and hoarding of food or avoiding family and public meals.

If you think your child might have symptoms of bulimia, approach your child supportively, and be persistent if the problem worsens. Treatment of bulimia is a long-term process and requires commitment from your child, you and your entire family.

Resources

Resources

For more information about bulimia in children and adolescents, please visit the following sites:

FAQs

FAQs

Won’t my teen just outgrow bulimia?

Bulimia occurs in children, and especially in teens, but it is not a disease associated with immaturity. Adults also have eating disorders. The younger your child starts bulimia behaviors, the harder it is to treat. This is a complex disorder that parents should not ignore. You should find help for your child.

If my child or teen doesn’t lose too much weight, why is bulimia a health problem?

Bulimia causes many problems in the body that are similar to malnutrition because your child or teen fails to eat a balanced diet or to allow nutrients from foods to be absorbed by the body. The vomiting or use of laxatives and diuretics can cause dehydration and serious imbalances that damage organs. If bulimia is left untreated, it can be fatal because of serious health problems or depression that leads to suicide.

Can my child take medications to treat bulimia?

An antidepressant called fluoxetine has been approved for treatment of bulimia. Be sure to discuss use of antidepressants with your child’s doctor. Some antidepressants can cause unwanted side effects in children and teens.

Can my child have anorexia and bulimia?

Many children or teens who have anorexia also have bulimia at some point. They may vomit because they missed exercise, or worry that they deviated from their eating plan and put on a small amount of weight.

Why did I not know about my child’s bulimia for so long?

Most people with bulimia are normal weight for their age or only slightly overweight. They also tend to plan their binging for times when they know they will be alone and nobody will see how much food they consume. Your child often feels ashamed of the behaviors associated with bulimia and becomes very good at hiding them.

Why involve the family in bulimia treatment?

Your child or teen benefits when your entire family understands how bulimia affects them and how to help them cope with their eating disorder. Children and teens with bulimia can manage their disorder best when their family joins together regularly for relaxed, healthy meals. 

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