What is bulimia nervosa?
Bulimia is an eating disorder characterised by repeated episodes of overeating and a preoccupation with the control of body weight. Studies have shown that up to 1 per cent of the population is suffering from bulimia nervosa at any one time, and this may well be an underestimate. Other studies show that up to 7 per cent of young women consulting their GP have the symptoms of bulimia nervosa.

What are the symptoms?
According to the World Health Organisation, the criteria for a diagnosis of bulimia nervosa include the following:

persistent preoccupation with eating and an irresistible craving for food.

episodes of overeating in which large amounts of food are consumed in short periods of time.

excessive exercise, induced vomiting after eating, starving for periods of time or taking medicines such as laxatives or diuretics to counteract the bingeing.

fear of obesity, which is also seen in people with anorexia nervosa, and there is some overlap in the symptoms of these two diseases.

What is the cause of the disease?
The cause of bulimia nervosa is unknown. Factors in the patient's social environment are important, including the cultural pressure for women in the Western world to aspire to an unnaturally slim body weight. However, most people with bulimia nervosa maintain a normal body weight. Patients with bulimia nervosa often suffer from low self-esteem.

What are the symptoms of bulimia nervosa?
Often the person feels too fat and generally dissatisfied with their physical appearance. They may decide to eat less and avoid fattening foods. The patient with bulimia nervosa becomes preoccupied with food and eating. They will have episodes of craving for food and bingeing, which may take place in secret. After bingeing, sufferers feel guilty, and may make themselves sick.

What can people with bulimia nervosa do to help themselves?
Recognise that you are suffering from bulimia nervosa and seek help from your family doctor. There are also several good self-help books available.

What is the course of the disease?
While some cases of bulimia nervosa are short-lived, usually the symptoms will be present for some months or years before a sufferer seeks help. The disease can persist for years, and in some people the symptoms may be present all their lives.

Bingeing and vomiting can cause physical problems including damage to teeth from stomach acid, and heart problems due to the body being depleted of salts.

How is bulimia nervosa treated?
Treatment is aimed at the bulimia nervosa and any associated problems such as low self-esteem or depression.

Research suggests that cognitive behavioural therapy, a form of psychological therapy, is an effective treatment for many patients. Further research is being carried out into other forms of psychological therapy that may also be helpful.

Antidepressant medication can also be effective at treating the symptoms of bulimia nervosa. Sometimes a combination of psychological therapy and drug therapy is used.

Key sources of evidence
Hay PJ, Bacaltchuk J. Psychotherapy for bulimia nervosa and bingeing (Cochrane Review) In: The Cochrane Library, Issue 1, 2000. Oxford: Update Software.

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