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Bulimia Nervosa
Patients with bulimia are overly concerned about their body
image and may be normal weight, underweight, or overweight.
Darcy McLurg, BSc Pharm, Clinical Pharmacist,
The Ottawa Hospital, General Campus
Bulimia nervosa is an eating disorder characterized by episodes
of bingeing followed by recurrent purging, excessive exercise,
or periods of fasting. As much as 20,000 calories can be consumed
in a very short time during the course of a binge. To be diagnosed
with bulimia, bingeing episodes should occur at least two days
per week for a period of three months. The bulimic is aware that
their eating is out of control and usually feels guilty or depressed
afterwards.
As with other eating disorders, bulimia nervosa is most commonly
seen in young women. Only 10 to 15 % of bulimics are male. Similar
to anorexia, patients will fully recover in about 50% of the
cases. Thirty per cent of patients will partially recover and
up to 20% will never recover.
The cause of bulimia nervosa is unknown. One school of thought
is that bulimia is a result of the malfunctioning of an area
of the brain regulating mood and appetite. Risk factors for
developing this condition include a family history of bulimia
as well as a personal/family history of depression or bipolar
disorder.
Patients with bulimia are overly concerned about their body
image and may be normal weight, underweight, or overweight. Bingeing
usually occurs in secrecy and bulimics tend to maintain social
interaction so signs of bulimia may not be obvious. Up to one
third of patients with bulimia may abuse or depend on alcohol
or stimulants. Depression is often associated with this condition.
Self-induced vomiting and recurrent weight loss and gain of
more than 10 lbs. can be hard on the body. Repeated vomiting
can result in electrolyte imbalances, weakness, dehydration,
and damaged teeth from gastric acid contained in the vomit.
Patients may experience esophageal and/or gastric erosion. Chronic
laxative abuse causes dysfunctional bowels resulting in sever
chronic constipation, decreased intestinal motility, and delayed
gastric emptying time.
The treatment of bulimia, as with other eating disorders is
difficult and involves a combination of psychotherapy and medication.
The goal of treatment is to institute healthy eating patterns.
Patients with any eating disorder may not recognize their disease
and be unwilling to participate in their treatment. Psychotherapy
for the bulimic patient involves addressing the relationship
between thoughts, mood and bingeing by using a combination of
individual, group and family therapy. Fluoxetine (Prozac) at
a dose of 60 mg per day has been shown to reduce bulimic symptoms
and is the only agent approved for the treatment of bulimia in
Canada. Other antidepressants, such as desipramine and imipramine,
have demonstrated some efficacy as well.
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The information in this newsletter was prepared and reviewed
by pharmacists for the Canadian Pharmaceutical Journal.
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Ask Your Pharmacist newsletter is produced through
an unconditional educational grant from APOTEX/PACE. |
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