Bulimia (cont.)

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How do physicians diagnose bulimia?

As with anorexia, denial and secrecy complicate the diagnosis of bulimia. The individual usually does not come to the attention of the health-care professional 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. There are five basic criteria in the diagnosis of bulimia:

  1. Recurrent episodes of binge eating: This is characterized by eating within a two-hour period an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
  2. There is a sense of lack of control over the eating during the episode, or a feeling that one cannot stop eating.
  3. 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 or other medications, fasting, or excessive exercise.
  4. Both the binge eating and the compensatory behaviors must occur at least once per week for three months and must not occur exclusively during episodes of anorexia.
  5. Finally, there is dissatisfaction with body shape and/or weight.

How is bulimia treated?

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Patients with bulimia present a variety of medical and psychological complications that are usually considered to be reversible with a multidisciplinary treatment approach. 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 antidepressants, has been effective in the treatment of bulimia, and the U.S. Food and Drug Administration has approved fluoxetine for the treatment of bulimia. Other members of the SSRI class of drugs may also be used in the management of bulimia.

Other types of antidepressants, including the monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and buspirone (Buspar) have all been shown to decrease bingeing and vomiting in people suffering from bulimia. However, the SSRIs remain the first choice for treatment due to their relative safety and low incidence of side effects.

Some patients may require hospitalization due to the extent of the medical or psychological complications. Others may seek outpatient programs. Still others may require only weekly counseling and monitoring by a health professional. Stabilization of the patient's physical condition will be the immediate goal if the individual is in a life-threatening state. The primary goals of treatment should address both physical and psychological needs of the patient in order to restore physical health and normal eating patterns. Cognitive behavioral therapy (CBT) has been shown to be a particularly effective form of psychotherapy for those suffering from bulimia. In CBT, patients learn to identify and correct negative thoughts and feelings that lead to undesired behaviors. The patient needs to identify internal feelings and distorted beliefs that led to the disorder initially. An appropriate treatment approach addresses underlying issues of control, self-perception, and family dynamics. 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.

The ultimate goal should be for the patient to accept herself/himself and lead a physically and emotionally healthy life. Restoration of physical and mental health will probably take time, and results will be gradual. Patience is a vital part of the recovery process. A positive attitude coupled with much effort on the part of the affected individual is another integral component to a successful recovery.

Medically Reviewed by a Doctor on 1/28/2014

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