Commonly Asked Questions: Bulimia Nervosa (continued)

Self-esteem Is Tied to Body Image

For most of us, our self-esteem is partly related to our thoughts about how we look. It's natural to feel better about yourself when you think that you look pretty good. However, the self-esteem of people with bulimia hinges almost completely on their thoughts about how they look, and specifically, whether they are overweight.

Do People Have Bulimia Forever?

In most cases the answer is "no." Some people are successfully treated while others seem to "grow out" of the problem. However, researchers are not yet sure of the long-term course of bulimia.

Part of the problem is that bulimia has only been frequently diagnosed in the past 20 to 30 years. In many cases it can take several years before the bulimic behaviors are reduced or eliminated.

Sometimes the binging and compensating activities may disappear for months or even years only to come back. Other times they may disappear and never return. And yet other times they continue, especially if left untreated, without ever stopping.

Are There Any Medical Complications?

Unfortunately, yes. As with anorexia nervosa, women with bulimia may menstruate (have their periods) irregularly. These problems may be due to malnutrition, emotional stress, or rapid changes in weight.

Also, the extreme changes in diet often seen with bulimia may cause cardiac (heart) or gastrointestinal (stomach and intestines) problems. Frequent vomiting may cause tooth decay or chipping of teeth.

What are the Psychological Factors?

There is no set "personality" that describes people with bulimia. However, people with bulimia often feel ashamed about their eating problems. They may attempt to hide their binge-eating while others are around. Food may be hidden away in closets or at work for times when no one can see them.

Most people with bulimia are afraid of gaining weight. They may become very nervous about any changes in their body shape.

People with bulimia are more likely to be depressed or have problems with anxiety as compared to others. These emotional difficulties may have been part of the reason they developed bulimia, or they may be in response to their eating problems.

Also, people with bulimia are more likely to abuse alcohol and drugs (especially stimulants) to cope with depression and anxiety or to lose weight.

Can Bulimia be Treated?

Fortunately health care professionals are having increasing success in treating bulimia. Typically, treatment is coordinated among a physician, psychologist or other mental health professional, and a registered dietitian.

The first step in getting help for people with bulimia nervosa is to have them seen by a doctor. A physician can assess their general health and provide more information about their current and expected weights.

Long-term nutritional counseling may also be indicated. This counseling can best be accomplished by a registered dietitian who can assess the individual's current dietary practices and establish an eating plan that meets their individual needs.

Mental health professionals often provide psychotherapy designed to help these individuals understand their perception and expectations for themselves, family members and significant others, or the world in general. Individual or family therapy is often used to address the person's perceptions of food and body image, as well as help to resolve family issues.

References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (text revision). Washington, DC: Author.

Florida Dietetic Association. (1997). Handbook of medical nutrition therapy (2nd ed.).