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Causes | Symptoms | Risk Factors | Diagnosis | Treatment

Bulimia Nervosa, often referred to as  ‘Bulimia’ is a serious eating disorder commonly found in girls in adulthood. It is very rarely found in men.  Person with bulimia eat a lot in a short amount of time (bingeing).  This binge eating usually ends with abdominal discomfort and then the patient attempts to undo the consequences of the binge through self-induced vomiting, misuse of laxatives, severe caloric restriction, diuretics, enemas, or excessive exercising and fasting etc.

Bulimics may devour huge quantities of food, during a binge, most typically foods that would  normally be not allowed in a healthy/weight reduction diet. It usually includes foods high in carbohydrates or sweets, meat, cheese etc.

There are also two subtypes of bulimia nervosa, purging and non-purging. The Purging type describes individuals who regularly compensate for the binge eating with self-induced vomiting, laxative abuse, diuretics, or enemas. The Non-Purging Type is used to describe individuals who compensate through dietary fasting or excessive exercising.

The use of vomiting by bulimics can easily become addictive. Although at first they may have done it to get rid of excess food calories, it soon becomes a form of security. They are afraid to stop because they fear their eating habits are out of control and without the use of vomiting they fear they will become grossly overweight. Self induced vomiting could also lead to further hunger and binging, thus creating a cycle.

The bulimic is dominated by a sense of lack of control over the eating. It can occur together with other psychiatric disorders such as depression, obsessive- compulsive disorder, substance dependence or self injurious behavior.  Characteristics of persons with bulimia is the worry about weight and shape and tendency to go on strict diets to achieve an ideal figure. Causes

The actual causes of Bulimia Nervosa remain unknown.
But there is a probability of genetic condition as well as neurological factors.  Excessive concern about the weight and shape of the body is regarded as the normal cause of this eating disorder resulting in abnormal eating patterns.  The attitude of the family about the patients appearance and diet could also affect the onslaught of this condition. Moreover periods of depression, boredom, and anger are likely to increase the risk especially when the sufferer is alone. Any kind of stress/tensions that may effect adversely such as being teased at, starting something new or traumatic events like rape can lead to the onset of bulimia.

As bulimia nervosa progresses, a person adjusts their lifestyle to accommodate their behaviors.

Symptoms

Bulimia can typically begin during the late teens or early twenties. Bulimic view themselves as unable to control their eating and feel guilty and angry after binging. They generally find their own behaviour disgusting and are deeply ashamed of it  so they try to keep it a secret.  Then the disorder can go undetected for years even by close family members. The weight of the patient will remain close to normal but the eating pattern becomes gradually worse.

This disorder is characterized by recurrent episodes of binge eating, occurring at least twice a month for a minimum of three months

*Binge eating, or eating uncontrollably
*Frequent trips to the bathroom during or after meals and remaining there for longer periods.
*Vomiting after meals or after eating regularly
*Swollen glands in the face or neck due to repeated/forced vomiting.
*Tendency to store/stock sugary or high-calorie junk foods
*Tendency to leave the table immediately after a meal.
*Not eating with the family
*Stockpiles of laxatives, diuretics and/or diet pills
*Decayed teeth
*Foul breath
*Scarring on the fingers used to induce vomiting
*Abuse of laxatives or diuretics in attempts to lose weight
*Mood swings
*Irregular periods
*Weight at or above normal
*Signs of depression
*Excessive, sometimes compulsive, exercise.

Risk factors

Many people with bulimia suffer from clinical depression, anxiety, obsessive compulsive disorder, and other psychiatric conditions. These problems, combined with their impulsive tendencies, place them at higher risk of suicide.

The most common physical problem is erosion of tooth enamel caused by stomach acid in the mouth from vomiting, a protein-calorie deficit and weight loss.  When diuretics and laxatives are used, electrolyte imbalances and dehydration can occur which can cause cardiac complications. Diuretic and laxative use can cause loss of potassium which is needed for muscle and heart functioning. Cardiac arrhythmia or irregular heartbeat can result. The frequent use of ipecac to induce vomiting can cause heart failure or death. Irregularity of the menstrual cycles is common and there is a possibility of ovarian cysts which may cause infertility.

If a woman with bulimia is pregnant, it may result problems like miscarriage, high blood pressure, low birth weight, depression after the baby is born etc.

Diagnosis

As the bulimic may keep his /her disorder a secret it may go undetected and sometimes may be diagnosed only years later when the problem is much advanced, maybe when the patient shows bizarre eating behaviour to the extend of even shoplifting food or  stealing money to buy food.

A diagnosis requires binge eating at least twice a week for three months. An open talk with the person is the only way to know the seriousness of the situation and extent of their behaviour. Laboratory tests can only reveal medical complications like low blood sugar, low potassium, dehydration etc

Treatment

A person with bulimia can get better. Early treatment is required, otherwise the behaviour pattern will become more complex  and hard to change.  Treatment options include Psycho therapy and medical treatment (Pharmacotherapy) as well as combination of both.

Different types of psychological therapy have worked to help people with bulimia. It aims to help individuals achieve a more competent , less painful way of handling their problems. This may involve individual, group and family therapy as well as includes behaviour therapy, cognitive- behaviour therapy, Inter Personal Psychotherapy etc. The behaviour and cognitive behaviour therapy targets at normalising or changing the eating behaviour of patients by addressing issues of disorganized eating, hunger, inadequate calorie intake and challenging the distorted or negative thinking and belief systems of the patient, while Interpersonal Psychotherapy involves resolving relationship issues and problems.

Most of the bulimia can be treated with individual therapy. Bulimics may accept the treatment but they usually expect quick solutions. They become frustrated if treatment does not produce immediate relief and may leave the treatment in between or turn to increased binge eating to deal with their frustration.  Group therapy is more effective for young adult women because in group therapy they can talk with people who have similar experiences and may not feel isolated by their symptoms.

Medicines are used for symptoms like depression in bulimics. Some antidepressants are found to be effective in reducing binge eating and purging frequency as well as depressive symptoms in bulimic patients having depressive mood disorders. Antidepressants such as Tricyclics and the serotonin repuptake inhibitors, especially fluoxetine have been seen to help in controlling bulimic behaviour, effecting carbohydrate metabolism, decreasing appetite and reducing weight.

Any serious medical problem related to an eating disorder may require hospitalisation. Electrolyte imbalances will be corrected and fluids will be given for dehydration.

Follow-up is a main part in the treatment of eating disorders. Monitoring of a person’s acceptance with any treatment program for bulimia, whether that involves behavior modification, scheduled medication, or both is vital to the success of treatment.