Bulimia Nervosa

By Nutrition Expert – Trupti Gurav,Mumbai

Bulimia nervosa, commonly called bulimia, is a serious, potentially life-threatening eating disorder. People with bulimia may secretly binge eating large amounts of food with a loss of control over the eating and then purge, trying to get rid of the extra calories in an unhealthy way.

A serious eating disorder marked by bingeing, followed by methods to avoid weight gain. People with this condition binge eat. They then take steps to avoid weight gain. Most commonly, this means vomiting (purging). But it can also mean excessive exercising or fasting. [1]

Bulimia tends to develop late in childhood or in early adulthood. It affects females more often than males. People with bulimia usually weigh within the normal range for their age and height. However, they may fear gaining weight, have desire to lose weight, and may feel intensely dissatisfied with their bodies.

Types of Bulimia

There are two common types of bulimia nervosa, which are as follows:  [2]

  1. Purging type –Majority of cases of those suffering from this eating disorder.  In this form, individuals will regularly engage in self-induced vomiting or abuse of laxatives, diuretics, or enemas after a period of bingeing.
  2. Non-Purging type – In this form the individual will use other inappropriate methods of compensation for binge episodes, such as excessive exercising or fasting.  In these cases, the typical forms of purging, such as self-induced vomiting, are not regularly utilized.

What Causes Bulimia Nervosa?

The exact cause of bulimia nervosa is currently unknown; though it is thought that multiple factors contribute to the development of this eating disorder, including genetic, environmental, psychological, and cultural influences.  Some of the main causes include:

  • Stressful transitions or life changes
  • History of abuse or trauma
  • Negative body image
  • Poor self-esteem
  • Professions or activities that focus on appearance/performance

The fact that bulimia tends to run in families also suggests that a susceptibility to the disorder might be inherited.

Symptoms

An individual suffering from bulimia nervosa may reveal several signs and symptoms, many which are the direct result of self-induced vomiting or other forms of purging, especially if the binge/purge cycle is repeated several times a week and/or day. [1][2][4]

  • Being preoccupied with your body shape and weight
  • Living in fear of gaining weight
  • Repeated episodes of eating abnormally large amounts of food in one sitting
  • Feeling a loss of control during bingeing — like you can’t stop eating or can’t control what you eat
  • Forcing yourself to vomit or exercising too much to keep from gaining weight after bingeing
  • Using laxatives, diuretics or enemas after eating when they’re not needed
  • Fasting, restricting calories or avoiding certain foods between binges
  • Using dietary supplements or herbal products excessively for weight loss
  • Constant weight fluctuations
  • Electrolyte imbalances, which can result in cardiac arrhythmia, cardiac arrest, or ultimately death
  • Broken blood vessels within the eyes
  • Enlarged glands in the neck and under the jaw line
  • Oral trauma, such as lacerations in the lining of the mouth or throat from repetitive vomiting
  • Chronic dehydration
  • Inflammation of the esophagus
  • Chronic gastric re-flux after eating  or peptic ulcers
  • Infertility
  • Switching between periods of overeating and fasting
  • Frequent use of the bathroom after meals
  • Having the smell of vomit
  • Constantly worrying or complaining about being fat
  • Not wanting to eat in public or in front of others
  • Exercising too much
  • Having damaged teeth and gums
  • Changing weight
  • Swelling in the hands and feet
  • Facial and cheek swelling from enlarged glands

Risk factors

Bulimia often begins in the late teens or early adulthood. Factors that increase your risk of bulimia may include: [5]

  • Biology – People with first-degree relatives (siblings, parents or children) with an eating disorder may be more likely to develop an eating disorder, suggesting a possible genetic link. Being overweight as a child or teen may increase the risk.
  • Psychological and emotional issues-Psychological and emotional problems, such as depression, anxiety disorders or substance use disorders are closely linked with eating disorders. People with bulimia may feel negatively about themselves. In some cases, traumatic events and environmental stress may be contributing factors.
  • Dieting– People who diet are at higher risk of developing eating disorders. Many people with bulimia severely restrict calories between binge episodes, which may trigger an urge to again binge eat and then purge. Other triggers for bingeing can include stress, poor body self-image, food and boredom.

This study was published by Dennis Gibson, 01 Jun 2019; they concluded that; bulimia nervosa are mental illnesses with associated complications affecting all body systems with arguably the highest mortality of all mental health disorders. A comprehensive medical evaluation is an essential first step in the treatment of bulimia nervosa. Weight restoration and cessation of purging behaviors are often essential components in the management of medical complications of these illnesses. [7]

How Is Bulimia Treated?

Bulimia treatment requires the consideration of the physical as well as the psychological needs of the person. Bulimia Treatment usually includes: [2] [6]

  • Foster and reinforce a healthy body image in your children, no matter what their size or shape. Help them build confidence in ways other than their appearance.
  • Have regular, enjoyable family meals.
  • Avoid talking about weight at home. Focus instead on having a healthy lifestyle.
  • Discourage dieting, especially when it involves unhealthy weight-control behaviors, such as fasting, using weight-loss supplements or laxatives, or self-induced vomiting.
  • Talk with your primary care provider. He or she may be in a good position to identify early indicators of an eating disorder and help prevent its development.
  • If you notice a relative or friend who seems to have food issues that could lead to or indicate an eating disorder, consider supportively talking to the person about these issues and ask how you can help.
  • Don’t delay and risk serious medical complications. Seek out an eating disorder treatment facility in your area.

If you think you may benefit from inpatient treatment for bulimia, talk to your therapist or psychiatrist to determine the best course of action. If you feel you are an immediate danger to yourself or someone else, seek help and medical treatment immediately.

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