Eating Disorder: Bulimia

What are eating disorders?

Eating disorders are illnesses in which the people experience severe disturbances in their eating behaviors and related thoughts and emotions. People with eating disorders typically become pre-occupied with food and their body weight.

People with anorexia nervosa and bulimia nervosa tend to be perfectionists with low self-esteem and are extremely critical of themselves and their bodies. They usually “feel fat” and see themselves as overweight, sometimes even despite life-threatening semi-starvation (or malnutrition). An intense fear of gaining weight and of being fat may become all-pervasive. In early stages of these disorders, patients often deny that they have a problem.

Eating disorders affect several million people at any given time, most often women between the ages of 12 and 35. There are three main types of eating disorders: 

anorexia nervosa, bulimia nervosa and binge eating disorder.

In many cases, eating disorders occur together with other psychiatric disorders like anxiety, panic, obsessive compulsive disorder and alcohol and drug abuse problems. New evidence suggests that heredity may play a part in why certain people develop eating disorders, but these disorders also afflict many people who have no prior family history. Without treatment of both the emotional and physical symptoms of these disorders, malnutrition, heart problems and other potentially fatal conditions can result. However, with proper medical care, those with eating disorders can resume suitable eating habits, and return to better emotional and psychological health.

Bulimia nervosa

Although they may frequently diet and vigorously exercise, individuals with bulimia nervosa can be slightly underweight, normal weight, overweight or even obese. But they are not as underweight as people with anorexia nervosa. Patients with bulimia nervosa binge eat frequently, and during these times sufferers may eat an astounding amount of food in a short time, often consuming thousands of calories that are high in sugars, carbohydrates and fat. They can eat very rapidly, sometimes gulping down food without even tasting it.

Their binges often end only when they are interrupted by another person, or they fall asleep or their stomach hurts from being stretched beyond normal capacity. During an eating binge sufferers feel out of control. After a binge, stomach pains and the fear of weight gain are common reasons that those with bulimia nervosa purge by throwing up or using a laxative. This cycle is usually repeated at least several times a week or, in serious cases, several times a day.

Many people don’t know when a family member or friend has bulimia nervosa because people almost always hide their binges. Since they don’t become drastically thin, their behaviors may go unnoticed by those closest to them. But bulimia nervosa does have symptoms that should raise red flags:

  • Chronically inflamed and sore throat
  • Salivary glands in the neck and below the jaw become swollen; cheeks and face often become puffy, causing sufferers to develop a “chipmunk” looking face
  • Tooth enamel wears off; teeth begin to decay from exposure to stomach acids
  • Constant vomiting causes gastroesophageal reflux disorder
  • Laxative abuse causes irritation, leading to intestinal problems
  • Diuretics (water pills) cause kidney problems
  • Severe dehydration from purging of fluids

Bulimia can lead to rare but potentially fatal complications including esophageal tears, gastric rupture, and cardiac arrhythmias.

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.

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 vomit

Blood tests may show an electrolyte imbalance (such as low potassium level) or dehydration.

Treatment

People with bulimia rarely have to go to the hospital, unless they:

Most often, a stepped approach is used to treat bulimia. Treatment depends on how severe the bulimia is, and the person’s response to treatments:

  • Support groups may be helpful for mild bulimia without other health problems.
  • Counseling, such as talk therapy and nutritional therapy are the first treatments for bulimia that does not respond to support groups.
  • Medicines that also treat depression, known as selective serotonin-reuptake inhibitors (SSRIs) are often used for bulimia. Combining talk therapy with SSRIs may help, if talk therapy alone does not work.

People may drop out of programs if they have unrealistic hopes of being “cured” by therapy alone. Before a program begins, people should know that:

  • Different therapies will likely be needed to manage this disorder.
  • It is common for bulimia to return (relapse), and this is no cause for despair.
  • The process is painful, and the person and their family will need to work hard.

Eating disorders clearly illustrate the close links between emotional and physical health. The first step in treating anorexia nervosa is to assist patients with regaining weight to a healthy level; for patients with bulimia nervosa interrupting the binge-purge cycle is key. For patients with binge eating disorder it is important to help them interrupt and stop binges.

However, restoring a person to normal weight or temporarily ending the binge-purge cycle does not address the underlying emotional problems that cause or are made worse by the abnormal eating behavior. Psychotherapy helps individuals with eating disorders to understand the thoughts, emotions and behaviors that trigger these disorders. In addition, some medications have also proven to be effective in the treatment process.

Because of the serious physical problems caused by these illnesses, it is important that any treatment plan for a person with anorexia nervosa, bulimia nervosa or binge eating disorder include general medical care, nutritional management and nutritional counseling. These measures begin to rebuild physical well-being and healthy eating practices.

Shall you have any more questions regarding bulimia or any other eating disorders, do not hesitate in contacting us. 

Post made possible thanks to: Montse M.

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