Diagnosis 

The American Academy of Pediatrics defines bulimia nervosa as:

• Recurrent episodes of binge eating, characterized by:

1. Eating a substantially larger amount of food in a discrete period of time (i.e. in 2 hours) than would be eaten by most people in similar circumstances during that same time period.
2. A sense of lack of control over eating during the binge.

• Recurrent inappropriate compensatory behavior to prevent weight gain; ie, self-induced vomiting, use of laxatives, diuretics, fasting, or hyperexercising.

• Binges or inappropriate compensatory behaviors occuring, on average, at least twice weekly for at least 3 months.

• Self-evaluation unduly influenced by body shape or weight.

• The disturbance does not occur exclusively during episodes of anorexia nervosa

source: American Academy of Pediatrics, "Policy Statement: Committee on Adolescence."Pediatrics Vol. 111 No. 1, January 2003

Treatment

Bulimia nervosa is a well-studied disorder known to respond to treatment with cognitive behavioral therapy and (in many cases) medication. At the Kartini Clinic we have begun a manualized treatment program designed by researchers at Stanford University. It involves 18-20 sessions divided into three phases over about six months. It begins with a "rapid start" (twice weekly sessions for two weeks) followed by weekly sessions thereafter. The first phase focuses on ordered eating, reducing dietary restrictions, and reducing frequency of bingeing and purging. Phase II consolidates progress made in Phase I as well as expansion of food choices, identification of personal triggers, and reduction of binge frequency. Phase II lasts 3-4 sessions spaced two weeks apart. Medical supervision of the program is achieved through an initial medical examination and lab studies followed by a monthly check-in with one of our MD's.

It is important also to distinguish bulimia nervosa from those who have "purging variant" anorexia nervosa (AN B/P). Like those with bulimia, patients with AN B/P may also throw up their food or use exercise, laxatives or other methods to rid themselves of calories; but unlike patients with bulimia, those with AN B/P severely restrict their calories for more than a few days at a time. Restricting is a prominent feature of their illness. Patients with AN B/P are often misdiagnosed as having "bulimia." However, AN B/P is a very different illness from bulimia nervosa, where restricting either doesn't take place or takes a backseat to large amounts of bingeing and subsequent vomiting. Because these illnesses are markedly different, treatment for them is also different. If you feel you or your child fall into the AN B/P category, click here for more information. Patients with anorexia can only be seen at the Kartini Clinic between the ages of 8 to 22. For the names of other centers that treat older patients with anorexia click here.