Bulimia Nervosa

Definition:

Bulimia, also known as bulimia nervosa, is characterized by periods of binge-eating followed by inappropriate methods of weight control.  It is estimated that 90-95% of the people suffering from bulimia are female.  It is reported that among men who suffer from an eating disorder have a higher occurrence of a psychiatric illness and substance abuse.  Furthermore the incidence of homosexuality and bisexuality may also be increased in men with bulimia.  Eating disorders occur more in men who participate in sorts, usually as either a weight requirement or a low body fat requirement.

Eating disorders tend to develop in adolescents; however 5% of people develop disorders when they are about 25 years of age.  The highest rate of onset occurs at 18 years.  The development of bulimic behaviors at an earlier age may be associated with a more severe disease.

In the US it is reported that the lifetime occurrence of bulimia is 3%.  Bulimia affects about 6% of adolescent girls and 5% of college women.  It is estimated that 5 million individuals have experienced an eating disorder.  Up to 40% of college women have reported that they have experienced symptoms of bulimia, such as isolated episodes of binge eating and purging.  The occurrences of bulimia may be increasing however greater awareness of eating disorders may have resulted in more people reporting the conditions.

There are no clear causes of bulimia; it is believed that it begins with a dissatisfaction of the person’s body and intense anxiety with body size and shape.  People who have bulimia tend to have low self-esteem, feel helpless and are fearful of becoming overweight.  Genetic factors are believed to contribute to the onset of bulimia.  Also, western culture often promotes and supports the idea of being thin via movies, magazines and TV.  Peer pressure may also add to individuals developing an eating disorder.

Symptoms of Bulimia:

Binges usually occur in private; people may be home alone and raid the fridge and cupboards for food.  Some people visit numerous fast food restaurants and eat a meal at each one.  When the binge period has finished they may head to the bathroom, hit the gym for hours of exercise, take laxatives or fast.  As the eating disorder advances some people are able to induce vomiting at will.  Individuals with bulimia tend to be of normal weight or overweight.

Bulimia is characterized by:

• An episode of binge eating is characterized by:
  • Eating an amount of food that is definitely larger that what most people would eat in similar circumstances at a discrete period of time
  • A sense of lack of control over eating during the episode 
     
• Inappropriate methods of weight control may include self-induced vomiting, fasting, enemas and excessive use of laxatives and diuretics or compulsive exercise. 
   
• The binge eating and the inappropriate weight controlling behaviors occur usually at least twice a week for 3 months
   
• The individual is influenced by their body shape and weight
   
• Bulimia does not occur exclusively during episodes of anorexia nervosa

There are two types of Bulimia:

• Purging type
  • During the periods of bulimia the individual has engaged in self-induced vomiting or misuses laxatives diuretics or enemas.
• Nonpurging type
  • During the episodes of bulimia the person has used inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not self-induced vomiting or misused laxatives, diuretics or enemas.   

Physical symptoms

• Erosion of tooth enamel due to repeated exposure to acidic gastric contents
• Dental cavities, sensitivity to hot or cold food
• Swelling and soreness in the salivary glands
• Stomach Ulcers
• Ruptures of the stomach and esophagus
• Abnormal build up of fluid in the intestines
• Disruption in the normal bowel release function
• Electrolyte imbalance
• Dehydration
• Irregular heartbeat and in severe cases heart attack
• Decrease in libido
• Bloating
• Dry skin
• Menstrual irregularities or amenorrhea (loss of menstruation)
• Fatigue
• Sores, scars or calluses on hands or knuckles

Emotional and behavioral symptoms

• Constant dieting
• Depression or anxiety
• Visiting the bathroom after or during meals
• Unhealthy view on body shape, weight and body view
• Loss of control of eating behavior
• Eat to the extent of discomfort
• Hoarding food

Treatment for Bulimia:

Treatment for bulimia aims to provide the individual with a healthier sense of self, develop healthier eating habits and reverse some of the disorder’s more serious complications.  Given the serious health complications associated with bulimia, it is imperative that treatment is sought immediately.  Unfortunately this can be extremely difficult as many people with bulimia initially refuse treatment or believe they do not need help.  The desire to remain thin outweighs the desire to be healthy. 

Treatment for bulimia typically involves a team approach that includes a variety of professionals including doctors, psychiatrists or psychologists and dietitians.  The most common treatment regime includes:

• Medical care to treat physical conditions associated with bulimia
• Psychotherapy (individual, family or group therapy may all be beneficial) to help the individual deal with behaviors and thoughts that are associated with bulimia
• Nutritional therapy for guidance on a healthy diet
• Hospitalization is common due to the medical complications associated with bulimia

Medications are not used to treat bulimia; however it is common that such treatment is used to treat other psychiatric disorders associated with bulimia (such as depression or anxiety).

Treatment of bulimia utilizes a specific program that involves three main stages:

• Restoring weight that has been lost to severe dieting and purging
• Treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts
• Achieving long-term remission and rehabilitation, or full recovery

Early diagnosis and treatment significantly increases the success rate for treatment.