Eating disorders: Bulimia Nervosa

Eating disorders in mid-childhood are diverse and can be carried over from feeding difficulties during infancy or early childhood, or may signal fears of fatness and early struggles to control one’s weight. In addition, some children develop fears of choking and dying after they have experienced a traumatic event or witnessed someone else choking, and they avoid any foods that they fear would get stuck in their throat. In order to help affected children to overcome their fears, it is important to understand the factors that are troubling to them: is it the fear of being “fat,” the fear of eating new foods, or the fear of choking? In addition, the family needs to provide an environment in which these children can learn to regulate eating in accord with hunger and fullness and deal with their emotions more effectively.

The essential features of bulimia nervosa are binge eating and inappropriate compensatory methods to prevent weight gain. To qualify for the diagnosis, the binge eating and the inappropriate compensatory behaviors must occur, on average, at least twice/week for 3 months. The binge is defined as eating in a discrete period of time an amount of food that is larger than most individuals would eat, and is associated with a sense of loss of control. The compensatory behaviors can include vomiting, abuse of laxatives, fasting, and excessive exercise (Table 5). The most common onset of bulimia is during late adolescence and early adulthood, although some cases of bulimia have been reported in preadolescent children.38 Binge eating usually begins in the context of dieting and once purging begins, patients are often resistant to treatment and tend to keep their bingeing and purging secret. Although children with bulimia nervosa usually do not approach the low weights associated with anorexia nervosa, they may experience other medical complications, such as hypokalemia, gastric disturbances, and dehydration that may require hospitalization. The course of bulimia nervosa usually fluctuates with remissions and relapses. However, early onset of the disorder is associated with an increased risk for late adolescent and adult bulimia nervosa.

Treatment

  • Although the successful treatment of bulimia nervosa in young adults with cognitive therapy and with various medications has been well documented, the treatment of adolescents with bulimia nervosa (as with anorexia nervosa) through family therapy seems to be most promising.
  • There are no treatment studies of children with bulimia nervosa. However, it appears that the younger the child the more critical the involvement of the family becomes.

References

  • Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
  • Chatoor I. Feeding disorders in infants and toddlers: diagnosis and treatment. Child Adolesc Psychiatr Clin N Am. 2002;11(2):163-183.

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