Bulimia Nervosa – Causes, Symptoms, Treatment

Bulimia in Greek is called ravenous hunger and nervosa means nervous, hence it means “nervous ravenous hunger.”  It is one of the many eating disorders which if not treated can be potentially a serious and life threatening condition.

A person suffering from Bulimia Nervosa binges on large amounts of food and then purges (vomits out) everything with the belief that this will help them to not put on weight. This cycle of binge and purge followed by diet becomes a continuous process.

Who Is Affected?

• It is seen in mostly teens and also adults
• Girls and women are more affected than men
• It is seen in 0.5% population, 2 to 3% of women mostly in age group of 12-25

What Is The Cause?

The exact cause is unknown. The two main causes are:

• Biological (genetic)
• Psychological or emotional triggers

Biological :  Studies have found a genetic cause for bulimia. First-degree relatives, parents, children or siblings of patients may have this condition.

Psychological or Emotional :

• People having Anxiety or Depression
• People who have had a traumatic event
• Increased amount of Stressors
• Substance abuse
• Have low-self esteem about oneself, negative body image
• Always worried about one’s weight and body image due to societal pressure to look a certain way
• Mood swings, anger and sadness.

Bulimia Nervosa Symptoms

Symptoms of bulimia nervosa are,

• Bingeing on large amounts of food, then forcing to vomit
• Lose control over the amount of food while eating
• Always having fear and worry about body image and weight gain
• Does not like to eat in public, prefers to eat alone
• Keeps food in strange places like closets, cupboards etc.
• Tries to hide body wearing loose clothes
• Use laxatives and enemas even when not necessary, thinking that they will help in weight control after bingeing
• Going on a diet after bingeing and purging, avoiding certain types of food, again start to binge and eating the same food which was avoided while on diet
• Using various types of Weight Loss supplements
• Exercise vigorously, more than required amount, in order to burn the calories because of bingeing.

What Are The Signs?

• Bulimic person can be of normal weight or of slightly more weight than normal
• The person’s knuckles may be scarred or sore due to their frequent use to induce vomiting
• Damaged teeth and gums, abrasion of enamel (the outermost layer of tooth). This is because of the gastric contents coming out frequently while vomiting which are highly acidic in nature
• Swelling of facial and cheek areas due to the enlarged salivary glands
• Weakness and fatigue after vomiting several times causing Dehydration.

What Are The Complications?

Bulimia nervosa can lead to serious life threatening complications if left untreated. A person suffering from bulimia nervosa develops a low self-esteem, thinking always negative about his/her body image and in the quest for having that perfect body image which peers and society have set standards, may go into depression and become suicidal. The frequent binge and purge cycle may lead to dehydration and in turn affect the Kidneys leading to Kidney Failure. It affects the heart causing irregular heartbeat called arrhythmia (due to dehydration). Dental complications such as Xerostomia, dry mouth, sensitivity in teeth due to enamel erosion and bleeding of gums etc.

Other complications include,

• Complications In Throat :  Hoarseness of voice, dysphagia (difficulty swallowing), burning and irritation in the throat, Edema (swelling) of vocal cords.
• Gastrointestinal :  Gastroesophageal reflux disease commonly called GERD, esophagitis (inflammation of the esophageal lining), Ulcers and erosions in the lining of esophagus.
• Electrolyte Imbalance :  Frequent episodes of vomiting can lead to imbalance in sodium, potassium and other electrolytes which are important for fluid level in blood and for electrical impulses in heart.  Due to vomiting, there will be low level of potassium.  There is sodium retention in kidneys, causes fluid imbalance which results in peripheral edema (swelling of extremities, limbs).  Abnormal beats in heart called arrhythmia can also cause cardiac arrest in severe condition.

Bulimia Nervosa Treatment

Treatment for bulimia is with psychotherapy and medications or combination of both.

Psychotherapy consists of Cognitive Behavioral Therapy which helps treat the main signs of bulimia nervosa.  CBT is divided into three parts:

• Psychoeducation :  The patient is educated about adverse effects to the body due to binge eating, purging, dieting.  The therapist helps the patient establish a regular eating pattern with periodic monitoring of weight and keeping food record that includes the frequency of bingeing and purging.
• Reduce Concerns About Body Shape And Weight :  The therapist helps patient identify the triggers that cause the patient to binge and purge, counsels on weight and body images issues and the food choices of the patient.
• Maintenance :  The third part is maintenance planning and prevention of any relapse by regular follow up.

Family TherapyThis is very effective for teenagers or adolescents as parents are involved during counseling sessions.  Involving parents helps in controlling unhealthy eating habits in teenagers and also helps know the emotional state of their children.

MedicationTreatment for bulimia involves antidepressants like fluoxetine which is found to be very effective in controlling vomiting and also bingeing.

Nutritionist CounselingIt helps form a proper food plan for eating healthy nutritious food and avoid cravings.  Counseled to eat regular meals at intervals and avoid fasting or crash dieting.

Support GroupsAttending support groups, meeting people suffering from the same helps to know that you are not alone, there are many people with bulimia nervosa.  Sharing your thoughts, knowing about others’ thoughts and how they are dealing with it helps a lot in overcoming this disorder.

Prevention

There is no exact way to prevent bulimia. Certain preventive measures can be taken to prevent bulimia nervosa such as following healthier habits, taking professional help.

• Parents of teenagers should keep a watch on their children to see for any signs of depression or anxiety or any stressors leading to bingeing.  If they see any signs or symptoms of bulimia nervosa as described above, they must talk to their children and take expert help.
• Parents should also instill positive body image thoughts in their kids from childhood, educating them that a certain body size or shape set by the society should not be taken seriously and being comfortable about their body and personality.
• Listening to children, their feelings, what they are going through in school is very important to know about their thought processes.
• Adults having this condition should take help from therapists and family.

Differential Diagnosis

How can we differentiate between bulimia nervosa and other eating disorders like Anorexia nervosa or binge eating disorder?

• Patients with anorexia nervosa have fear of gaining weight; they starve themselves in order to lose weight.  They look very underweight and malnourished.
• Patients of binge eating disorder are mostly obese.  They eat large amounts of food as a compensatory mechanism for stress, anxiety or any other factor but do not purge the food.
• As opposed to the above, patients with bulimia nervosa is mostly normal in weight or slightly more than normal weight.

Outlook (Prognosis)

About 45% patients fully recover, 27% of patients improve and 23% patients have a chronic (long) course.  Some patients may relapse later on in life.

Many celebrities have come out in public stating they have suffered from bulimia nervosa or other eating disorders at some time in their life.  They sought help from therapists and overcame the disorder.  Many people do not even know that they have an eating disorder until it becomes severe.  Getting help at right time, confessing with family and friends helps overcome the disorder and lead a happy life ahead.

Bulimia Nervosa

Bulimia Nervosa






Bulimia nervosa is an eating disorder which can become serious and life threatening if symptoms become worse. The affected people will involve in binge eating and then purge by forcing vomiting to lose extra calories.

Basically there are two types of bulimia nervosa:-

One is purging type in which the affected person will force vomiting or use laxatives or enemas. Second one is non-purging type in which the individual will go on fasting or strict dieting or do strenuous exercises to lose calories. People with bulimia nervosa will be preoccupied with their body weight and shape. This is not an eating disorder alone but is a serious emotional problem relating to self image. It is difficult to treat this disorder since the affected person may not accept that he/she is sick.

Eating lots of food gives them a comfortable feeling and hence they always involve in binge eating. After eating they will feel guilty and have fear of gaining weight and that is the reason they purge.

Symptoms :

Some of the common signs of bulimia nervosa are:-

• Preoccupied thoughts of gaining weight and self image

• Eating until one gets discomfort feeling

• Forcing vomit or indulge in strenuous exercises for losing weight

• Often use laxatives or diuretics or enemas after binge eating

• Always worried about body shape and gaining weight

If you have any of these symptoms seek medical help at the earliest since it becomes difficult to treat when the symptoms get worsen.

The following are some of the warning signals you can observe in someone with bulimia nervosa:-

• Talking constantly about being fat or having poor self image

• Eating unusually heavy foods that are rich in fat

• Visiting bathroom right after eating to purge

• Having sores or scars on his hands

• Doing strenuous exercises for losing weight

It is difficult to identify a person with this disorder since they will remain in normal weight and normal shape. Only through the behavior and eating habits you can detect their problem.

Causes :

Exact cause of bulimia nervosa is unknown. It can be due to genetics, environmental and social pressure.

Who are at risk?

Girls are more likely to develop this problem than boys. It begins in teenage or early adulthood. Individuals with peer pressure, those working in media and public figures have risk for developing this problem. Persons with psychological problems like low self esteem, anxiety/Depression disorders can get this disorder. Athletes and gymnasts will have serious pressure from their coach for losing weight and to maintain right weight which may indulge them in poor eating.

Diagnoses :

Your doctor will complete physical examination and collect your medical history, your behavior and emotional problems from your relatives and friends. He may order for blood test, urine test, chest X-ray and ECG for testing heart function.

The diagnoses can become accurate only if the affected person engages in binge eating and purging at least two times in a week. He/she should be more concerned about the looks and body shape. Since right diagnoses cannot be made unless the affected person actually reveals it, often bulimia nervosa gets identified only in severe forms of symptoms.

Treatment :

Treatment should be in the form of combined approach of psychotherapy and medications given for curing depression. Apart from the affected person, his/her family, friends and a counselor will together be involved in treating bulimia nervosa. Some of the psychotherapy methods used largely is cognitive behavior approach, interpersonal psychotherapy, dialectical behavior therapy, and family therapy.

In case any teenaged person in your family is affected with this disorder then the entire family should cooperate to develop healthy eating pattern. The affected person will be taught about the importance of healthy diet and nutrition education. This will help him to cultivate healthy weight through normal eating habits. For people with binge eating habit, medical programs are available for losing weight and controlling the urge to eat more. There is every chance for relapse of symptoms when the person is under stress. Hence you should be in constant touch with your GP for monitoring your weight regularly.

Alternative Treatment :

Some people resort to massage and chiropractic healing to reduce anxiety related eating disorders. It is necessary to follow healthy diet, and develop positive attitude towards life by boosting your self esteem.

Prevention :

You cannot prevent bulimia nervosa but you can cultivate healthy eating habit in your children. Get help from your pediatrician since they can sense the problems of your children in early stage.