Bulimia Nervosa
It is an eating disorder characterized by recurring binge-eating along with compensatory behaviours. These compensatory behaviours include purging (self-induced vomiting),fasting, dieting, excessive exercising, or the usage of laxatives, diet pills, diuretics or enemas. The disorder mainly starts with dieting to a point where one is pre-occupied with dieting, that he or she rarely eats normal meals. Furthermore, bulimic persons tend to use the “all or nothing” approach which involves either eating a lot in one seating or staying hungry altogether, but rarely consuming normal meals.
Bulimia nervosa is common among women than men. In fact, an estimated 90% of bulimic patients are women. Normally, this eating disorder starts between the ages of 13 and 20 years, though it is also common among young adult women.
Types of Bulimia Nervosa
Generally there are two kinds of bulimics including the:
- Purging type-With the purging type, there is self-induced vomiting whereby after meals, the bulimic individual goes to the washroom to trigger vomiting before digestion takes place. In addition, individuals with this disorder may also use enemas, diuretics and laxatives, or fast or diet. However, the distinguishing characteristic of the purging bulimics is that the primary compensatory behaviour is purging.
- Non-purging type-With this type of bulimia, there is no purging. These bulimic persons do not engage in self-induced vomiting though they engage in other compensatory behaviours such as fasting or dieting, excessive exercising, or the use of laxatives or diuretics.
Causes
Actual causes of this eating disorder are unknown though the contributory factors include:
- Biological-Reduced levels of serotonin indicate an increased risk of bulimia incidences.
- Psychological-Conditions that contribute to low self-esteem e.g. depression, anxiety, childhood trauma are linked to high probability of this eating disorder.
- Social-Due to societal pressure to attain certain thinness, some individuals may be pushed to having this disorder as they try to match up with those standards. Further, certain professions e.g. gymnastics and ballet can predispose one to this eating disorder as a particular weight is required for one to qualify to work in the profession.
- Genetics-There is increased risk to have bulimia if someone in the family also had bulimia.
Risk Factors
- Psychological factors-issues to do with depression, anxiety and especially when one does not manage them well can increase likelihood of having this disorder.
- Personality disorders-Persons who seek to attain perfectionism are likely to be predisposed to bulimia as they search to achieve the ‘ideal’ weight and body shape. They may go to extra lengths of dieting, which can trigger the disorder.
- Dieting-Individuals who like dieting are also at high risk of bulimia. Dieting is unlikely to be sustainable and as such after long periods of dieting, one is unable to keep up and will tend to over-compensate by over-eating , then will later resort to restrictive eating to counter the effects of that over-eating. With time, it becomes a cycle, which can later become a disorder.
- Poor self image-Body dissatisfaction or low self-esteem increases the probability that one can get an eating disorder. With poor self -image, one is likely to pursue that which is termed acceptable or ideal, and hence likely to pursue unrealistic or extreme measures to achieve those standards.
- Certain professions-Being in certain professions that require one to be of certain weight e.g. gymnastics, ballet, athletics etc can also trigger bulimia because fear of adding weight may imply that such a person cannot continue to work in that profession. As such , persons working in such professions may develop this disorder as a means to prevent weight gain.
Physical signs and symptoms of Bulimia
- Weight fluctuations
- Puffy cheeks
- Scars on hands and knuckles resulting from the attempts made to induce vomiting.
- Discoloured teeth- When stomach acid triggered by vomiting comes in contact with the teeth.
Other signs that indicate that an individual could have bulimia nervosa
- Consuming large amounts in a seating-Bulimic persons can consume between 3000-5000 Kcals in one seating when bingeing, without significant changes in weight.
- Eating secretly-In most cases, bulimia patients tend to eat in secrecy. They often want to eat privately.
- No control over eating– Bulimics usually eat significant portions until they are uncomfortable or feel some discomfort.
- Visit the washroom after meals –Usually, bulimic persons, go to vomit immediately after eating food, before digestion. The person may also smell of vomit because they are from purging.
- Disappearance of food and stacking of junk food-There tends to be empty wrappers or boxes in their dust bins or piles of junk foods stashed.
- Exercising excessively-These individuals will usually be seen to engage in high-intensity work-outs normally just after eating, to burn out the calories.
Effects on the body
The binge and purge cycle can be repeated several times in a week or in severe cases it can be done several times in a day. This cycle is dangerous because it poses numerous health risks on an individual. Among the effects on the body that could occur are;
- The inflammation of the oesophagus
- Chronic gastric reflux –due to the repeated induced vomiting episodes
- Electrolyte imbalance-May occur due to vomiting leading to low potassium levels which can then lead to irregular heartbeat, lethargy, inattention and in severe cases kidney failure.
- Dental caries or decay- This is because stomach acid released during vomiting comes into contact with teeth causing erosion of the enamel. Teeth may also discolour due to exposure to the acid.
- Peptic ulcers
- Slowed gastric emptying
- Amenorrhoea-missed periods may be common.
- Swollen cheeks
- Sore throat or hoarse voice
- Swelling of feet and hands
- Abdominal discomfort
- Weight fluctuations
Diagnosis
Bulimia nervosa is difficult to identify in comparison to anorexia nervosa because it mainly affects individuals who are either normal weight or slightly overweight. However, persons involved in regular binge-eating and compensatory behaviours, and who place much emphasis on body weight and shape while utilizing food to cope with their emotions can be categorized as bulimic.
Treatment
Early treatment is critical thus bulimic persons should consult a professional for help to resolve any underlying emotional concerns that trigger the eating disorder. Approaches that can be used to treat this eating disorder include:
Therapy
CBT –This treatment approach first aims to stop the binge and purge cycle by training patients to re-evaluate their eating habits, to manage their emotions without having to control food, to identify and avoid environments or situations that trigger the disorder and how to incorporate regular meals in their diet.
The other phase then focuses on shifting patient’s perceptions and attitudes towards dysfunctional beliefs about dieting ,body weight and shape as well as address their eating habits on the “all or nothing” approach by requesting them to re-examine the ideology on self-worth and body weight.
Group therapy-This therapy allows patients not to feel as though they are the only ones suffering from this disorder. Moreover, they can learn from each other.
Interpersonal therapy-Through this therapy, the patients learn to resolve any relationship issues related to the disorder.
Family Behavioural Therapy (FBT)and Hypnotherapy may also be used to treat bulimic patients.
Medications-The patients may receive anti-depressants to manage depression, which is usually associated with the disorder.
Bulimia is an eating disorder marked by binge eating followed by compensatory behaviours. It is common among women than men. There are two types of bulimia including; the purging type and non-purging type. It is more difficult to identify than anorexia nervosa because bulimic persons tend to lie almost within normal weight range. It is imperative that bulimia treatment be sought out for immediately for proper management. Moreover, it is important that persons with bulimia stop dieting as this is the key resolution in managing the disorder. Once the restriction of eating practises is managed and normal meals are re-introduced, it becomes easier to break away from the binge and purge cycle.