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.