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How is bulimia nervosa diagnosed and treated?

Bulimia nervosa is a psychological eating disorder.
• This disorder is characterized by binge eating and purging, or consuming a large amount of food in a short amount of time.
• Bulimia is felt to be related to a person’s dissatisfaction with their own body image.
• Bulimia is diagnosed according to defined criteria.
• There are two types of bulimia: the purging and nonpurging types.
• Bulimia can have serious medical complications.
• The successful treatment of bulimia is often multidisciplinary involving both medical and psychological approaches.
• The goals of treatment are to restore physical health and normal eating patterns.

How is Bulimia nervosa diagnosed?

• As with anorexia, denial and secrecy complicate the diagnosis of bulimia.
• The individual usually does not come to the attention of the practitioner until an associated medical condition or serious psychological problem manifests itself.
• Truthful disclosure of behaviors is critical for an accurate diagnosis.
• The actual criteria for bulimia nervosa are found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

Five basic criteria in the diagnosis of bulimia:

1. Recurrent episodes of binge eating
• This is characterized by eating within a two-hour period.
• This is an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
2. A sense of lack of control
• The patient lacks control over the eating during the episode, or a feeling that one cannot stop eating.
3. Compensatory behavior
• In addition to the binge eating, there is an inappropriate compensatory behavior in order to prevent weight gain. These behaviors can include:
– self-induced vomiting
– misuse of laxatives
– diuretics
– enemas
– other medications
– fasting
– excessive exercise
– Both the binge eating and the compensatory behaviors must occur at least two times per week for three months
4. It must not occur exclusively during episodes of anorexia.
5. There is dissatisfaction with body shape and/or weight.

What are signs that may suggest a person has bulimia?

– Overweight
– Underweight
– Normal body weight

Some warning signs may be present, although these do not confirm the diagnosis of bulimia:
• going to the bathroom after every meal (to induce vomiting)
• compulsive or excessive exercising
• physical signs arising from excessive vomiting
• swollen cheeks or jaws
• broken blood vessels in the eyes
• teeth that appear clear due to damage to tooth enamel
• excessive preoccupation with body image or weight

How is bulimia treated?

• Treatment can be managed by either a physician, psychiatrist, or in some cases, a clinical psychologist.
• The extent of the medical complications generally dictates the primary treatment manager.
• A psychiatrist, with both medical and psychological training, is perhaps the optimum treatment manager.
• A number of antidepressant medications have been shown to be beneficial in the treatment of bulimia.
• Several studies have demonstrated that fluoxetine (Prozac), a member of the selective serotonin reuptake inhibitor (SSRI) class of anti-depressants.
• SSRI has been effective in the treatment of bulimia.

Other types of antidepressants include:
• Monoamine oxidase inhibitors (MAOIs)
• Tricyclic antidepressants
• Buspirone (Buspar)
• Antiepileptic drug topiramate
• The serotonin antagonist ondansetron

Treatments associated are:
• Some patients may require hospitalization due to the extent of the medical or psychological complications.
• Others may seek outpatient programs.
• Others may require only weekly counseling and monitoring by a practitioner.
• Stabilization of the patient’s physical condition will be the immediate goal.
• The primary goals of treatment should address both physical and psychological needs of the patient.
• This is in order to restore physical health and normal eating patterns.
• The patient needs to identify internal feelings and distorted beliefs that led to the disorder initially.
• An appropriate treatment approach of issues of control, self-perception, and family dynamics are required.
• Nutritional education and behavior management provides the patient with healthy alternatives to weight management.
• Group counseling or support groups can assist the patient in the recovery process as well.

Bulimia: A Guide to Recovery The Overcoming Bulimia Workbook Help Your Teenager Beat an Eating Disorder

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