Bulimia Nervosa

Overview

Preoccupation with self-image is not unique to modern times. However, it appears that today, more than ever before, we would be justified in speaking of an ‘epidemic’ of eating disorders such as anorexia or bulimia. As with any other mental illness, bulimia nervosa is highly complex. It is not well understood by the average individual, with the result that those suffering from it are often unable to find the support and care that they need to overcome it.

It is erroneous to assume that extreme starvation and weight loss are the only indicators of an eating disorder. Nor is it a question of lifestyle choices. Those suffering from bulimia tend to overeat and then violently purge themselves out of guilt. To assuage this guilt, they end up indulging themselves on food once again and the vicious cycle continues. This, however, is an oversimplified picture of a complex disease that can affect different individuals in different ways. It can leave permanent damage both on the psyche and body. Taken to extremes, it can even be fatal.

Definition

Bulimia nervosa is a mental illness, specifically an eating disorder, that is characterized by alternating episodes of binge eating followed by compensatory behaviors. Patients usually have very low self-esteem and are excessively preoccupied with their weight and body image. Their sense of self-worth is almost solely defined by their appearance and they subscribe to unrealistic ideals of beauty.

In order to cope with this, they lapse into episodes of overindulgence in food. This is known as binge eating. As they binge, they suffer extreme guilt, shame and loss of self-control for having succumbed to the temptation to overeat. However, the urge to eat is uncontrollable. Afterward, they attempt to compensate through starvation, excessive exercise or by purging themselves. Usually, purging involves induced vomiting and the abuse of laxatives, diuretics or drugs for weight loss. Their feelings of disgust and shame will typically lead them into another episode of bingeing. Some may even commit self-harm.

This cycle of bingeing and compensatory behavior is the classic hallmark of bulimia. Patients will also go to great lengths to conceal these behaviors from friends and family. As a result, of the bingeing and purging, the person’s weight typically fluctuates a lot. Those suffering from bulimia may never actually become extremely underweight. In fact, some may even gain weight.

Causes

This is a complex disease and cannot be attributed to a single causative factor. Typically, the person has overwhelmingly low self-esteem and may be unable to process these feelings in a healthy way. They may exhibit a perfectionist or obsessive personality streak as a result of which they are extremely self-critical.

In general, the media tends to portray and aggressively reinforce highly unrealistic ideals of beauty. There may be pressures to conform to certain standards of physical appearance in professions such as modeling. Such pressures can be, for instance, an existing history of emotional trauma or sexual abuse, further contributing to their sense of self-loathing or burden of pent-up emotion. Sometimes such changes in behavior are precipitated by the onset of puberty. Bingeing serves as a coping mechanism for releasing or shutting out feelings of shame, guilt, loneliness or even anger.

Symptoms

Episodes of bingeing and compensatory behavior may range in frequency from a few times a week to a few times within a day. The inability to maintain a healthy eating pattern starves the body of essential nutrition. The person feels lightheaded and weak, unable to concentrate mentally and may even lose sleep. He or she may develop intolerance to certain foods and exhibit external signs of habitual purging such as bruised knuckles. Women begin to experience disturbances in their menstrual cycles. Often, bulimics suffer from other psychiatric disorders such as depression or obsessive-compulsive disorder.

Symptoms include:

• Low self-esteem.
• Obsession with food, body image, and body weight to the extent that this interferes with one’s daily life and usual patterns of behavior.
• The cyclical pattern of binge eating followed by compensatory behaviors. Binge eating is the consumption of large quantities of food within short periods of time. Compensatory behaviors may include excessive exercising, abuse of laxatives and diuretics or induced vomiting.
• Being exceedingly averse to gaining weight.
• Being secretive about one’s food habits.
• Avoiding eating in the presence of others.
• Swollen salivary glands.
• Thinning of hair.
• Developing food intolerance.
• Dehydration.
• Feeling bloated.
• Loss of sleep.
• Changes in a menstrual cycle such as missed periods.
• Signs of habitual induced vomiting, such as callused knuckles, sore throat, bad breath, sore gums, mouth ulcers and cavities in the teeth.
• Constipation.
• Dizziness or fainting.
• Frequent fluctuations in body weight.
• The tendency to undertake the extreme exercise.
• Anxiety.
• Mood swings.
• Self-harming behaviors such as cutting oneself.

Types of Bulimia Nervosa

There are two main types of bulimia depending on the nature of the compensatory behavior that follows binge eating. These are:

• Purging type: Here the person attempts to deliberately get rid of the food that has been consumed. This is done by means of induced vomiting or by taking laxatives and diuretics to force the body to eliminate the food. They may also self-administer enemas.
• Non-purging type: This involves other types of compensatory behaviors such as starvation, fasting or intense exercise in order to shed calories gained by bingeing.

These categories are not watertight or mutually exclusive. A patient may exhibit both types of behaviors or switch from one to another over time.

Clinical Complications

There may be permanent physical damage to the body. For instance, habitual induced vomiting can cause permanent scarring and narrowing of the esophagus. The patient may develop a habit of substance abuse or self-harming behavior. They may also suffer from depression and self-imposed isolation. The irregularity of menstruation can adversely impact fertility. The patient may become anemic. Extreme dehydration and electrolyte imbalances can lead to renal and cardiac complications that can be fatal.

Diagnosis

Unlike anorexics, those suffering from bulimia do not usually achieve extreme weight loss although their weight will typically fluctuate a lot. Because they do not appear extremely underweight, the disorder may go unnoticed by others. A bulimic individual may recognize the disorder themselves. But even if they do, the underlying sense of embarrassment and inadequacy can prevent them from revealing their condition to others and seeking help.

Since it is a mental illness, bulimia cannot be diagnosed based solely on laboratory tests or physical examination, although these are important as well. The patient may exhibit some outward signs of induced vomiting or even signs of self-harm. Blood and urine tests will be needed for evidence of electrolyte imbalance, general malnutrition or anemia for instance. The condition of internal organs may need to be assessed by means of diagnostic imaging.

If an eating disorder is suspected, the patient will be referred to a mental health professional who would begin by asking a number of questions about eating and exercise habits, the patient’s self-esteem and relationship with their body. Tests such as the SCOFF questionnaire are useful as they are quick and effective.

In making a positive diagnosis for bulimia, it is important to first rule out anorexia nervosa or another eating disorder with shared characteristics such as binge eating. The severity of the illness is judged based on the number of episodes of purging or compensatory activities per week. Up to 3 such events in a week amounts to a mild case whereas 14 or more is extreme.

Treatment and prevention

Treatment – This condition needs the consideration of both physical and psychological needs of the person.

• Psychological counseling – Psychological counseling is done to make sure that the patient suffering from bulimia nervosa can express their emotions. The psychologist will help them get a nutritional counselor to set a diet and treatment plan for the patient. The psychological counselor makes a list of weekly appointments with the bulimia patient to see the progress of the treatment.
• Medication – antidepressants can be given to those suffering from bulimia nervosa and anorexia.
• Nutritional counseling – This may be provided to the person suffering from bulimia to help them understand and fix a diet plan for themselves. This is done by giving them small quantities of food to eat during a certain time. This treatment method progress week-by-week followed by month-by-month and then yearly.

Prevention

• Make sure to understand that nothing is perfect and that there is no perfect body shape or size.
• Parents need to make sure that they do not constantly criticize their children about their body weight or force them to exercise.
• Do not allow topic such as body size, food consumption, perfect shape etc. be a part of your conversation for too long.
• Do not body shame or judge anybody’s body.
• Do not blindly follow the medias’ portrayal of the perfect body structure.

References