Other Name : Bulimia nervosa; Binge-purge behavior; Eating disorder – bulimia
Description:
Bulimia is an eating disorder. It is characterized by uncontrolled episodes of overeating, called bingeing. This is followed by purging with methods such as vomiting or misuse of laxatives. Bingeing is eating much larger amounts of food than you would normally eat in a short period of time, usually less than 2 hours. The person may feel like thaty he or she can’t stop or control these episodes of binge eating.
The binge-purge cycles can happen from many times a day to several times a week.
Often, people with bulimia keep a normal or above normal body weight. This lets them hide their problem for years. Many people with bulimia don’t seek help until they reach the ages of 30 or 50. By this time, their eating behavior is deeply ingrained and harder to change.
It is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. The aim of this activity is to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.
Other efforts to lose weight may include the use of diuretics, stimulants, water fasting, or excessive exercise. Most people with bulimia are at a normal weight. The forcing of vomiting may result in thickened skin on the knuckles, breakdown of the teeth and effects on metabolic rate and caloric intake which cause thyroid dysfunction. Bulimia is frequently associated with other mental disorders such as depression, anxiety, borderline personality disorder, bipolar disorder and problems with drugs or alcohol. There is also a higher risk of suicide and self-harm.
Bulimia is more common among those who have a close relative with the condition. The percentage risk that is estimated to be due to genetics is between 30% and 80%. Other risk factors for the disease include psychological stress, cultural pressure to attain a certain body type, poor self-esteem, and obesity. Living in a culture that commercializes or glamorizes dieting and having parental figures who fixate about weight are also risks.
There are 2 ways people with bulimia restrict calories:
*Purging type. The person engages in self-induced vomiting or misuse of laxatives, diuretics, or enemas, or other medicines that clear the intestines.
*Nonpurging type. The person uses other behaviors, such as fasting or excessive exercise, rather than purging behaviors.
Symptoms:
These are the most common symptoms of bulimia:
*Usually a normal or above average body weight
*Recurrent episodes of binge eating and fear of not being able to stop eating
*Self-induced vomiting (usually secretive)
*Excessive exercise
*Excessive fasting
*Peculiar eating habits or rituals
*Inappropriate use of laxatives or diuretics
*Irregular or absence of menstruation
*Anxiety
*Discouraged feelings related to dissatisfaction with themselves and the way their body looks
*Depression
*Preoccupation with food, weight, and body shape
*Throat is always inflamed or sore
*Tiredness and decreased energy
*Dental problems due to erosion of enamel from vomiting
Most people with eating disorders also share certain traits including:
*Low self-esteem
*Feelings of helplessness
*Fear of getting fat
*Intense unhappiness with their body shape and sizeIf one has bulimia, he or she may binge to reduce stress and ease anxiety.
*With binge eating comes guilt, disgust, and depression.
*Purging brings only short-term relief.
*He or she may be impulsive and more likely to take part in risky behaviors, such as alcohol and drug use.The symptoms of bulimia may look like other medical problems or mental health conditions. Always talk with a healthcare provider for a diagnosis.
Causes:
Many more women than men have bulimia. The disorder is most common in teenage girls and young women. The person usually knows that her eating pattern is abnormal. She may feel fear or guilt with the binge-purge episodes.
The exact cause of bulimia is unknown. Genetic, psychological, family, society, or cultural factors may play a role. Bulimia is likely due to more than one factor.
Risk Factors:
Being female and having bulimia nervosa takes a toll on mental health. Women frequently reported an onset of anxiety at the same time of the onset of bulimia nervosa. Another concern with eating disorders is developing a coexisting substance use disorder.
Complications from bulimia can include:
*kidney failure
*heart problems
*gum disease
*tooth decay
*digestive issues or constipation
*ulcers and stomach damage
*dehydration
*nutrient deficiencies
*electrolyte or chemical imbalances
*absence of a menstrual period
*anxiety
*depression
*drug or alcohol misuseDiagnosis:
The onset of bulimia nervosa is often during adolescence, between 13 and 20 years of age, and many cases have previously experienced obesity, with many relapsing in adulthood into episodic bingeing and purging even after initially successful treatment and remission. A lifetime prevalence of 0.5 percent and 0.9 percent for adults and adolescents, respectively, is estimated among the United States population. Bulimia nervosa may affect up to 1% of young women and, after 10 years of diagnosis, half will recover fully, a third will recover partially, and 10–20% will still have symptoms.
Adolescents with bulimia nervosa are more likely to have self-imposed perfectionism and compulsivity issues in eating compared to their peers. This means that the high expectations and unrealistic goals that these individuals set for themselves are internally motivated rather than by social views or expectations.
Criteria:
Bulimia nervosa can be difficult to detect, compared to anorexia nervosa, because bulimics tend to be of average or slightly above average weight. Many bulimics may also engage in significantly disordered eating and exercise patterns without meeting the full diagnostic criteria for bulimia nervosa. Recently, the Diagnostic and Statistical Manual of Mental Disorders was revised, which resulted in the loosening of criteria regarding the diagnoses of bulimia nervosa and anorexia nervosa. The diagnostic criteria utilized by the DSM-5 includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight. The diagnosis also requires the episodes of compensatory behaviors and binge eating to happen a minimum of once a week for a consistent time period of 3 months. The diagnosis is made only when the behavior is not a part of the symptom complex of anorexia nervosa and when the behavior reflects an overemphasis on physical mass or appearance. Purging often is a common characteristic of a more severe case of bulimia.
Exams and Tests:
A dental exam may show cavities or gum infections (such as gingivitis). The enamel of the teeth may be worn away or pitted because of too much exposure to the acid in vomit.
A physical exam may also show:
*Broken blood vessels in the eyes (from the strain of vomiting)
*Dry mouth
*Pouch-like look to the cheeks
*Rashes and pimples
*Small cuts and calluses across the tops of the finger joints from forcing oneself to vomitBlood tests may show an electrolyte imbalance (such as low potassium level) or dehydration.
Treatment:
There are two main types of treatment given to those with bulimia nervosa; psychopharmacological and psychosocial treatments.
Psychotherapy
Cognitive behavioral therapy is the primary treatment for bulimia. Antidepressants of the selective serotonin reuptake inhibitor (SSRI) or tricyclic antidepressant classes may have a modest benefit. While outcomes with bulimia are typically better than in those with anorexia, the risk of death among those affected is higher than that of the general population. At 10 years after receiving treatment about 50% of people are fully recovered.
Cognitive behavioral therapy (CBT), which involves teaching a person to challenge automatic thoughts and engage in behavioral experiments (for example, in session eating of “forbidden foods”) has a small amount of evidence supporting its use.
By using CBT people record how much food they eat and periods of vomiting with the purpose of identifying and avoiding emotional fluctuations that bring on episodes of bulimia on a regular basis. Barker (2003) states that research has found 40–60% of people using cognitive behaviour therapy to become symptom free. He states in order for the therapy to work, all parties must work together to discuss, record and develop coping strategies. Barker (2003) claims by making people aware of their actions they will think of alternatives. People undergoing CBT who exhibit early behavioral changes are most likely to achieve the best treatment outcomes in the long run. Researchers have also reported some positive outcomes for interpersonal psychotherapy and dialectical behavior therapy.
Maudsley family therapy, developed at the Maudsley Hospital in London for the treatment of anorexia, has been shown promising results in bulimia.
The use of CBT has been shown to be quite effective for treating bulimia nervosa (BN) in adults, but little research has been done on effective treatments of BN for adolescents. Although CBT is seen as more cost-efficient and helps individuals with BN in self-guided care, Family Based Treatment (FBT) might be more helpful to younger adolescents who need more support and guidance from their families. Adolescents are at the stage where their brains are still quite malleable and developing gradually. Therefore, young adolescents with BN are less likely to realize the detrimental consequences of becoming bulimic and have less motivation to change, which is why FBT would be useful to have families intervene and support the teens. Working with BN patients and their families in FBT can empower the families by having them involved in their adolescent’s food choices and behaviors, taking more control of the situation in the beginning and gradually letting the adolescent become more autonomous when they have learned healthier eating habits.
Medication
Antidepressants of the selective serotonin reuptake inhibitors (SSRI) class may have a modest benefit. This includes fluoxetine, also known as prozac, which is FDA approved, for the treatment of bulimia, other antidepressants such as sertraline may also be effective against bulimia. Topiramate may also be useful but has greater side effects. Compared to placebo, the use of a single antidepressant has been shown to be effective. Combining medication with counseling can improve outcomes in some circumstances. Some positive outcomes of treatments can include: abstinence from binge eating, a decrease in obsessive behaviors to lose weight and in shape preoccupation, less severe psychiatric symptoms, a desire to counter the effects of binge eating, as well as an improvement in social functioning and reduced relapse rates.
Alternative medicine:
Some researchers have also claimed positive outcomes in hypnotherapy. The first use of hypnotherapy in Bulimic patients was in 1981. When it comes to hypnotherapy, Bulimic patients are easier to hypnotize than Anorexia Nervosa patients. In Bulimic patients, hypnotherapy focuses on learning self-control when it comes to binging and vomiting, strengthening stimulus control techniques, enhancing ones ego, improving weight control, and helping overweight patients see their body differently (have a different image)
Yoga Therapy:
Regular doing Yoga and meditation under the guideline of a proper teacher can improve Bulimia very fast.
Prognosis:
Bulimia is a long-term illness. Many people will still have some symptoms, even with treatment.
People with fewer medical complications of bulimia and those willing and able to take part in therapy have a better chance of recovery.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
https://en.wikipedia.org/wiki/Bulimia_nervosa
https://medlineplus.gov/ency/article/000341.htm
