Sleep Apnea – Causes, Symptoms, Signs, Treatment

What Is Sleep Apnea?

It is quite common to see many people snore while sleeping. The first symptom of sleep apnea is loud snoring and feeling tired the next day. Sleep apnea is a serious condition in which breathing pattern gets interrupted having many stops/pause in between the session. Your breathing may get stopped for few seconds during the process of snoring. Since there is interruption in normal breathing pattern during sleep, the person may feel tired and sleepy the next day.

Sleep apnea in the above context can be defined as a serious medical condition that affects the breathing many times depriving the brain and other parts of the body from oxygen. It is nothing wrong if breathing gets stopped for few seconds once or twice during your sleep. But it can become life threatening if the breathing gets interrupted hundreds and millions of times while you are sleeping. This can cause vital damage to many organs including brain.

Who Gets Sleep Apnea?

It is popularly believed that only elderly people and that too overweight people develops sleep apnea. But it is not true. Sleep apnea is present even in children and people of any age group irrespective of their weight and structure. Statistics says that over 18 million people in America have sleep apnea disorder. Around 10-20% of children who snore loudly are seen to have sleep apnea.

Sleep Apnea Types

There are 2 types of sleep apnea. One is obstructive and the other is central apnea.

Obstructive sleep apnea is a condition in which the tissue at the back of the throat gets collapsed caused by blocked airway and central apnea is one in which the brain (due to lack of normal oxygen supply) fails to send signals to nerves and muscles to restore breathing. Central sleep apnea is more dangerous than the first one and it can be life threatening.

Can Sleep Apnea Kill You?

Yes. Medical practitioners believe that a person can survive for (maximum) about 6 minutes without oxygen. The brain can live up to 6 minutes without oxygenated blood supply and would die eventually if CPR is not done to restore the breathing of heart. Hence sleep apnea episodes (recurring frequently) can stop the breathing of heart and cut off oxygen supply to the brain leading to death. If your spouse/partner complains you of loud snoring you can always check with your doctor to prevent any complications.

What Are The Risk Factors That Trigger Sleep Apnea?

A person who is overweight, having loud snoring, having large neck structure, having big tonsils and having GERD (a kind of reflex disorder) is more likely to develop sleep apnea than others. Males are largely affected with sleep apnea when compared with females.

What Does Sleep Apnea Do To Your Body?

Sleep apnea need not always cause death or irreparable loss. Small intervals of interrupted breathing can induce Hypertension, irregular heartbeat, any other heart problems, Stroke, Diabetes and even Depression. Sleep apnea can leave you very tired and exhausted for the next day and people with sleep apnea can feel drowsy while driving, which can be dangerous.

Day time fatigue, poor concentration, mood swings and irritability are common in people with sleep apnea. In addition, sleep apnea can cause poor performance in school, workplace and daily activities which can damage your reputation.

What Are The Warning Signals Of Sleep Apnea?

• First and foremost, you will sleep with loud snoring
• There would be gap/intervals in the sleep, during which you would stop breathing. For few seconds there would not be any breathing which is followed by snoring
• You would sleep with the mouth wide open while sleeping and gasp for air during sleep
• Day-time fatigue and sleepiness is another signal to indicate that you may have sleep apnea
• There are people who would fall asleep while driving, leading to accidents
• You would wake up suddenly gasping for breath during sleep
• Some people would wake up with dry mouth and Sore Throat because of breathing through mouth
• Many times you would fall asleep while sitting motionless in a chair during a meeting or while watching television
• You may not be able to show full attention in your work as before after developing sleep apnea
• It can cause mild irritation and lack of energy during daytime
• You may feel that you didn’t have quality sleep during night and can develop Headache
• Reduced libido (sex drive) and mood changes are other signs of sleep apnea
• Sleeping Sickness or insomnia can develop causing intermittent awakening and sleeping episode
• You are likely to develop hypertension due to sudden stoppage and reduction of oxygenated blood supply to the heart leading to cardiac arrest and abnormal heartbeat. People living with existing heart problems are more likely to collapse during sleep due to repeated interruption of oxygen than others
• Sleep apnea can cause type 2 diabetes
• People with sleep apnea may have problems in recovering after administration of general anesthesia during a surgery
• Sleep apnea increases the risk of liver problems and scarring of liver.

When To See Your Doctor?If you have any or some of the above warning signs you need to check with your doctor. You may still have sleep apnea even if you are not snoring loudly.

The Process Of Sleep Apnea

The throat muscles give support to the side walls, tongue, the tonsils and uvula (small tongue like structure that hangs inside your throat). When these muscles relax it closes the airway causing block in breathing pattern. Enough air is not sent to the brain and other vital organs leading to choking and gasping for breath.

Eventually due to lack of oxygen your brain senses some problem and rouses you from sleep which in turn reopens the blocked airway. This pattern of awakening and sleeping occurs several times (30-100 times) in an hour but you may not remember it. You are deprived of quality sleep during night causing daytime sleepiness. This process is known as obstructive sleep apnea which can become fatal if breathing stops for more than 6 minutes.

Which Doctor Treats Sleep Apnea?

Sleep specialists, ENT doctors, neurologists, psychiatrists, dentists and even primary health care provider can help in detecting sleep apnea.

Diagnosis

Depending on the warning signs and symptoms and tracking your sleep history, your doctor may refer you to a sleep specialist. He would further evaluate you with simplified home sleep test wherein specialized instrument is attached to your chest while going to bed, for measuring the heart rate, airflow and blood oxygen level. This machine helps in detecting sleep apnea and its kind.

Polysomnography is a precise test for monitoring the brain activity, your breathing patterns, and the heart function and primarily the oxygenated blood levels while you are asleep. This tool would record the sleeping pattern and interruption of breathing activity during the entire sleep which would be analyzed by the sleep specialist. Alternatively, you will be asked to stay in the sleep center in a separate bedroom. Before retiring to bed, you will be hooked to a specialized device for recording the sleep pattern.

What Are The Causes Of Sleep Apnea?

• Being male increases the risk of sleep apnea since it is more prevalent in men than women
• Being obese can increase the total body fat putting more Stress on the throat muscles which may relax causing breathlessness. However there are lean people living with sleep apnea
• If you are above 45 years of age you are more likely to get sleep apnea than others. There are cases of childhood sleep apnea also
• Having family history of sleep apnea increases the risk since you may inherit the genes that can trigger this problem
• Having large tonsils or unusual neck size and narrow airway passage and having small sized lower jaw adds risk of sleep apnea
• Smoking and drinking obviously increases the snoring effect making things worse
• People having Nasal Congestion and problems in nose like deviated septum or Nasal Polyps can face breathing difficulty and sleep apnea
• Using sleeping pills for extended period of time and using opium related medications can aggravate the risk of sleep apnea
• Having heart related disorders or having a stroke earlier puts more risk of sleep apnea than healthy adults.

Sleep Apnea Treatment 

• Can Sleep Apnea Be Treated and Cured?

Sleep apnea is not a disease by itself but the symptoms caused by it are dangerous and should be treated. Treatment of sleep apnea ranges from making small lifestyle changes like losing weight or using a mask or therapy and even surgery in extreme cases.

For mild cases of sleep apnea, changing lifestyle and sleeping on sideways can bring in dramatic improvement. However for moderate cases wearing a mask/device/implant is necessary. Surgery is the last option for severe cases of sleep apnea and for people where physical correction is absolutely necessary.

• Lifestyle changes
• Sleeping sideways

You can simply change sleep positions like turning sideways while sleeping. People lying on their back are at increased risk of loud snoring and breathlessness. Hence changing sleeping pattern can help in improve breathing. Start sleeping on your side and you can see much improvement in getting quality sleep with reduced snoring. When you are sleeping on your back it increases the risk of relaxing the muscles on the back of your throat leading to reduced breathing. Many times you may roll on your back while sleeping and hence attach any vibrating device on your back that can push back you on the sideways while sleeping.

• Shed some pounds- Reducing weight can reduce the symptoms of sleep apnea
• Quit smoking and avoid alcohol since both these habits can cause inflammation of respiratory tract which can worsen snoring
• Do regular exercises which can improve your metabolism helping in improved breathing. Brisk walking or jogging can help in losing your weight quickly
• If you are using sleeping pills talk to your doctor to find alternate method for getting quality sleep.

Devices For Sleep Apnea

CPAP

• Pros

A small mask is tied over your nose that assures continuous oxygen supply thus preventing reduced breathing. Continuous positive airway pressure or CPAP is a device that delivers free flow of air without any interruption. This device gives guaranteed regular breathing since it keeps the airways open thus preventing relaxation of throat muscles. CPAP is commonly used mask for sleep apnea which gives enough air supply to your nose.

There are ways to adjust the straps to reduce the tension for feeling the mask comfortable and secure. There are various types of CPAP masks available in the market and it is for you to choose the right one.

• Cons

You may feel awkward to attach a machine to your nose while sleeping and it can cause discomfort until you are used to it. If you are still snoring after using this mask, contact your doctor immediately to find alternative way for treating sleep apnea.

Dental DeviceYour dentist can implant a special device on your teeth that helps in keeping the airway open while you sleep. This machine holds your tongue and jaw forward so that there is enough space at the back of your throat preventing relaxing of throat muscles. Wearing this simple device ensures free continuous air supply to your organs while sleeping.

• Pros

Oral devices are safe and easier to use and you may not feel discomfort while using this device.

• Cons

Dental devices are not as effective as CPAP in treating sleep apnea.

SurgerySurgical intervention is done only when there is no other option for sleep apnea. People having strange jaw structure, defective throat muscles and nasal block are considered for surgery.

UvulopalatopharyngoplastyIn this procedure, uvula (a small tongue like organ inside your throat), both tonsils and adenoids are surgically operated and removed. This option can help in preventing snoring since it stops the throat muscles from vibrating and relaxing.

However this procedure is not effective when compared with wearing a CPAP mask.

RF AblationThis is similar to the above process wherein radiofrequency waves are used to shrink the tissue at the back of your throat. It is minimally invasive surgery but has effects equal to the first procedure. When the tissues of the throat are made to shrink it stops relaxation and resting of the throat muscles, thus allowing free flow of air.

Repositioning Of JawA dental surgeon can perform this procedure where he moves the jaw bone forward giving enough space between the tongue and soft palate facilitating breathing. This surgery is termed as maxillomandibular advancement or MAD which is effective in treating sleep apnea and in preventing snoring.

Nerve CorrectionSurgery is done for stimulating the hypoglossal nerve which controls the tongue movement. Tongue is kept in right position so that there is increased space for free airway.

TracheostomyThis is a complicated surgery and considered as last option for treating sleep apnea. Your surgeon would create a fresh opening in your neck where he implants a plastic tube like structure so that you can breathe normally without any interruption. A new passage is created for free flow of air through the neck. After the surgery, you are asked to cover the opening of the neck during daytime using a small tissue and while you go to sleep you can uncover the cap so that air can easily enter and pass through the opening.

However this surgery carries some risk of infection and side effects.

Read more on Natural Sleep Aid Drinks

Is Having Sleep Apnea Dangerous?

Sleep apnea itself is not dangerous, but the effect it causes can be threatening. Sleep apnea can cause cardiac arrest rapidly if breathing stops for few minutes. In some people tissues of the brain can die due to lack of oxygen supply leading to brain death or coma.

If you think you have sleep apnea symptoms do not ignore it. Book an appointment with your doctor and get it treated as soon as possible.

Can You Prevent Sleep Apnea?

You cannot directly prevent sleep apnea, but you can always take efforts to prevent its causes.

• Control your weight
• Eat a balanced diet
• Exercise regularly

If you have any of the warning signs check with your doctor promptly.

Narcissistic Personality Disorder – Causes, Symptoms, Test, Treatment

What Does “Narcissism” Mean?

Narcissism can be defined as showing great interest in getting admired by others for one’s talent or physical features even when they are not present in reality. In psychological point of view, narcissistic people are extremely self centered without caring for others and they often crave for admiration from others. They are often arrogant and show no sympathy or empathy for other’s feelings and they exhibit this character to identify themselves from others.

Personality Disorder

A person is said to have personality disorder if his/her behavior and inner feelings differ from the society. There are certain norms set for each society and whenever a person behaves in different way that is not accepted as “normal” he/she is said to have problems in personality. This kind of enduring pattern can be seen in interpersonal functions and the behavior is not consistent in nature. It typically causes significant diStress to others at home, school and office.

The onset of any personality disorder begins during adolescence or sometimes in early adulthood. People affected with narcissistic personality disorder are self centric and crave for admiration and attention from the society. They believe them to be special and superior to others and live in an inflated feeling and thinking high. A person with NPD has very low self esteem and cannot tolerate even mild criticism. It is difficult for any spouse/partner to live with them since they show no empathy for anyone except him/her. NPD people have trouble in making and sustaining any relationships and have problems in school or workplace.

They often crave for special attention and favors since they strongly believe that they deserve it. No relationship can satisfy and fulfill them and it is difficult for any person to be happy with them. They have the feeling of getting primary importance even with strangers they meet. They show disdainful and snobbish behavior and are often complaining about other’s rudeness. People with NPD are highly sensitive and react wildly for even small criticism.

What Are The Warning Signs To Identify NPD?

People with NPD have the following signs ranging from mild to severe.

They are self centric and have inflated feelings of their appearance and talents.

They expect to be admired constantly even for silly things.

Though they have not done anything great, still they wish to be treated as special and superior.

It becomes a habit for them to exaggerate their talents and achievements in front of others.

NPD people have a tendency to think about their power, success and beauty and they often get involved with these thoughts.

They consider themselves as superior and would like to talk with famous and powerful people around them.

While indulging in conversation they are always dominant and demean and under-value other people, since they believe others to be inferior.

It is usual for them to expect unique favors and immediate compliance from others.

They are likely to take advantage of feelings of others.

NPD people just don’t bother and care about others and they may not even fulfill their basic needs even for spouse and children.

They have tendency to be jealous of others.

They have considerable difficulty in handling criticism since they are highly sensitive.

While talking with others they are mostly arrogant and have a tendency to boast about their pride.

They get short tempered and become impatient if they are not treated as special.

A person with NPD cannot sustain relationship since they have zero tolerance and they seldom respect their partner’s feelings.

It is quite common for them to have interpersonal problems in life.

They are more likely to act with emotional outburst since they have problem in controlling emotions.

It is difficult for them to deal with stress and it is not easy for them to change their behavior since they believe that they are right.

In the inner mind they have feelings of shame and insecurity.

What Are Marked Features Of People With NPD?

Feelings Of Grandiose An interesting feature of NPD is the affected person would have the feeling of grandeur although he/she is not. The affected person shall have an unrealistic feeling of pride and superiority. They always consider them to be “special” and demands special treatment. Since they believe they are more than average they would like to move with rich and affluent people. Though they have done nothing to recognize them as “special” still they believe and think big about their talents, appearance and achievements.

Living In An Imaginary WorldPeople with narcissistic personality have magical thinking and live in an imaginary world deceiving themselves and the society. They constantly tell some fantasy stories to backup their unlimited potential, success and achievements. In reality they are filled with feelings of guilt, shame and inferiority. To fill up the space of emptiness they build up success and brilliance in their path that are exactly opposite to what they really possess. If anyone tries to condemn their power and success stories they tend to react defensively and even go the extent of violence and anger. In other words, they cannot tolerate anybody to overpower their imaginary world. For this reason even trained psychotherapist can have difficult times with such clients.

Crave For Attention and Admiration A person with NPD would constantly need support and encouragement from the people around him/her. They are very choosy in maintaining relationships and move with people who cater to their needs of constant admiration. A husband with Narcissistic personality seeks attention and appreciation from his spouse repeatedly and never would try to understand her talents. Their ego demands constant admiration and they don’t care for anybody’s feelings. In case the spouse confronts/tries to point out his inability he would suspect that she is betraying him.

Outrage and Aggression Narcissist person expect special kind of treatment and wants everyone dear and near to adhere to their wish. You will be ridiculed as useless if you ever try to refuse their wishes. And if you are expecting some favor or appreciation from them, you should be ready to face outrageous behavior from them. For this reason even the close relation faces challenge living with them.

Lack Of Empathy NPD people do not care for other’s feelings since they live in their own world filled with fantasies and power. They will do anything to take advantage of others for fulfilling their needs. A narcissistic person would never think about his family and how is he affecting their lives. At any cost they want to satisfy their needs without bothering what impact it would have on others.

A person is said to have NPD if he/she has some of the above mentioned characters at least for a year or more. Often narcissistic personality begins during early adolescence and becomes full-fledged when the person becomes an adult. For reasons unknown, men are more in number than women affected with NPD. The symptoms of NPD reduce in intensity with age and only very few symptoms are present when the person is of 50 years.

Narcissistic Personality Disorder Tests

Any psychiatrist or psychologist can detect NPD based on the symptoms and behavior of the affected person. There are no concrete tests to assess the intensity of narcissism. People with NPD generally do not admit that they have some problem and seldom seek any treatment.

It is for the family and friends to detect that something is wrong with their personality and bring them to a trained psychologist. In many cases, even close relations would suspect some issue only when their relationship at workplace gets significantly damaged. Several sessions of psychotherapy is needed to treat a person with NPD.

What Factors Cause NPD?

• Exact cause of NPD is not clearly known. Since it deals with personality in the developmental stage, it is more complex and difficult to understand it in the initial stages.
• Genetics play a role in determining the shape of a person’s personality and you are likely to develop NPD if your parents have had such trait.
• Environmental factors can also cause NPD if a person grows in disturbed childhood atmosphere either with over criticism or excess of appreciation.
• Many professionals believe that a combination of factors like psychological, genetic, and biological factors can cause NPD.
• A neglected child or abused child can develop narcissistic personality later and similarly improper parenting style can trigger such behavior in children.

Consequence of NPD

To begin with a person with narcissistic personality have significant problem in sustaining relationship both at home and workplace.

The person can face serious problems in adjusting to school environment or at office.

People with NPD are constantly complaining and never compromise.

They may develop Depression, Anxiety and other psychological problems.

It is easy for them to get addicted to alcohol and other substance.

Treatment

Psychotherapy is the only available method of treating narcissistic personality disorder. It might take long time for the affected person to accept his/her behavioral problem. Psychiatrists can prescribe some medications to manage anxiety and uncontrolled anger.

Stage 1: AcceptanceFirst stage is the most vulnerable one in the method of treating NPD. It is very difficult for the NPD person to accept that something is wrong. Since they live in a fantasy world and think superior of themselves it is hard to convince them even for the psychotherapist.

A person with NPD may feel insecure if someone disturbs his “self” importance. It may create a feeling of panic and quickly he may feel that his world is being shattered. For this reason the affected person may find fault about the psychotherapist and may develop disregard for him/her. The frightened person would try to dominate the doctor/therapist by his arrogance and mock at him and may even comment his/her inability to treat him.

An expert psychotherapist would first convey her feelings of respect and admit the person’s importance. Only then would the patient be able to connect with the therapist/doctor. Initial support should be given by the health care professional to the patient so that he feels comfortable and confident. This would help in easing out the pressure in the mind of the patient.

Stage 2: Confrontation The psychotherapist should establish rapport with the client affected with NPD. Slowly he would enlighten the client’s vulnerabilities. This phase involves step by step confrontation and several arguments in repeated sessions. The client would be enabled to increase his self confidence which is very much needed to understand the situation. Therapist would set small realistic goals to the client supporting him in every possible manner to achieve it. The client would slowly emerge out of fantasy world reducing his shame and guilt feeling to face the real life. Self image of the client is reinforced in every session by the therapist to rebuild his character and personality.

Finally the therapist would explain to him/her the implication of the disorder and the consequences of his behavior on his family and office. In this stage medications are supplemented to manage anger and depressive signs.

Stage 3: Reconstructing Personality The patient can continue with sessions for individual therapy combined with cognitive behavioral approach. Once the symptoms of grandiose and self importance are reduced, the client will be helped to rebuild his personality with life skill training program.

For some clients, family therapy would produce the desired outcome wherein the close relatives of the client would be made to understand the client’s weakness and ego. It takes several weeks or months for the patient to reconstruct his personality which is realistic and acceptable. Hidden talents of the client is exposed and used creatively and a sense of self worth is inculcated on the client.

In most of the cases continuous presence to the therapy sessions will help the client to recover fully. Only in severe cases of NPD in-patient treatment is given to cope with impulsive and self destructive behavior. The period of treatment varies with the intensity of disorder and symptoms. Early intervention of diagnoses can help the patient to recover quickly.

Can NPD Be Prevented?

Since NPD is a kind of personality disorder where changes in thoughts, behavior and emotions happen inside, nothing can be done to prevent it. The family can intervene to offer support and start treatment as soon the initial symptoms of excessive self importance and grandiose begin. Individual therapy can be given to talk and interact with the society in healthy ways. The patient can be trained with effective ways of dealing with conflict and ego weakness.

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.