Last reviewed: 14 Nov 2022 Show
Last updated: 18 Aug 2022 SummaryBulimia nervosa is an eating disorder, characterized by severe preoccupation about weight and body shape. Includes recurrent episodes of binge eating with compensatory mechanisms, such as self-induced vomiting to prevent weight gain. Most common in women in their 20s and 30s. Patients usually appear physically normal, although they may have low self-esteem and depressive thoughts, as well as lack of confidence. Parotid hypertrophy and erosion of the teeth are the most common physical signs and may prompt diagnosis. Cognitive behavioral therapy (CBT) is considered optimal primary treatment for bulimia, but it may not always be available. Selective serotonin-reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may be used adjunctively to CBT, or as an alternative when CBT is not available. Treatment of comorbid psychiatric disorders, such as major depressive disorder and obsessive-compulsive disorder, is necessary to optimize the chance of recovery from bulimia nervosa. SSRIs are effective in additional treatment of comorbid psychiatric disease. DefinitionBulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating, followed by behaviors aimed at compensating for the binge. Binge-eating episodes are characterized by eating an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances, and a sense of lack of control over eating during the episode.[1] Recurrent inappropriate compensatory behaviors occur in order to prevent weight gain. These behaviors include self-induced vomiting; fasting; excessive exercise; and misuse of laxatives, diuretics, enemas, or other medication. Binge-eating episodes typically occur, on average, at least weekly for 3 months.[1] History and examKey diagnostic factors
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More investigations to consider Treatment algorithmnonpregnant adultschildren and adolescentspregnantContributorsAuthorsDebra L. Safer, MDAssociate Professor Co-Director of Stanford Eating and Weight Disorders Program Stanford University School of Medicine Department of Psychiatry & Behavioral Sciences Stanford CA DisclosuresDLS is an author of a reference cited in this topic. AcknowledgementsDr Debra L. Safer would like to gratefully acknowledge Dr David C.W. Lau and Dr C. Laird Birmingham, the previous contributors to this topic. DCWL declares that he has no competing interests. CLB is an author of several references cited in this topic. Peer reviewersMimi Israel, MD, FRCPCChair of Psychiatry McGill University Quebec Canada DisclosuresMI declares that she has no competing interests. Joel Yager, MDProfessor Department of Psychiatry University of New Mexico School of Medicine Albuquerque NM DisclosuresJY is an author of a reference cited in this topic.
What is considered the treatment of choice for bulimia nervosa?The primary treatment for bulimia often combines psychotherapy, antidepressants, and nutritional counseling. It is helpful to find a psychologist or psychiatrist experienced in dealing with eating disorders.
Which therapy appears to be most effective for treating bulimia?Controlled studies have shown cognitive behavioral therapy (CBT) to be the most effective treatment for adults with bulimia and binge-eating disorder.
What is the firstCognitive behavior therapy (CBT) and behavior therapy (BT) are first-line treatment and the most often used types of psychotherapy for bulimia nervosa. In general, CBT has several components, each equally important to break the cycle of unhealthy thoughts and behaviors and replace them with positive, healthy behaviors.
Which class of drugs is widely used to treat bulimia nervosa?Selective serotonin reuptake inhibitors (SSRI antidepressants) are the most studied medication for the treatment of bulimia nervosa and are generally well-tolerated by patients.
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Which type of treatment is most appropriate for a patient with bulimia nervosa?
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