Bulimia Nervosa

Bulimia nervosa (usually referred to simply as bulimia) is a serious, potentially life-threatening eating disorder characterized by cycles of overeating (bingeing) followed by self-induced vomiting or use of other methods of elimination (purging), or excessive exercise, to reverse the effects of the binge eating. The cycle of eating and purging can occur anywhere from several times a week to multiple times per day. This behavior is associated with feelings of disgust and shame and is usually hidden.
Although most persons with bulimia are adolescent and young adult women, the disorder may also affect men and older women. High rates may be found among those in professions or activities that emphasize thinness, such as modeling, dancing, gymnastics, wrestling and long-distance running.
Causes of Bulimia
The cause of bulimia is unknown. Factors thought to contribute to the onset of bulimia include cultural ideals and social attitudes toward body appearance, self-valuation based on body weight and shape and family problems. Because eating disorders tend to run in families and female relatives are most often affected, genetic factors likely play a role.
Adolescents who develop bulimia are more likely to come from families with a history of eating disorders, physical illness and other mental health problems, such as mood disorders or substance abuse . Most people with eating disorders share certain personality traits and use abnormal eating rituals as a means of handling stress and anxiety:
  • Low self-esteem
  • Feelings of helplessness
  • Fear of becoming fat
  • Consuming huge amounts of food — often junk food

With binge eating, however, comes guilt and depression and purging brings only temporary relief. Individuals with bulimia are usually impulsive and more likely to engage in risky behaviors such as abuse of alcohol and drugs.
Types of Bulimia
There are two common subgroups of bulimia:
  • Persons with the purging type regularly engage in self-induced vomiting or misuse of laxatives, diuretics, enemas or other medications that increase the clearing of intestinal contents.
  • Those with the non-purging type of bulimia use other inappropriate behaviors, such as fasting or excessive exercise, for purging
Symptoms of Bulimia
Although each individual may have different symptoms of the disorder, common symptoms include:
  • Chronically inflamed and/or sore throat
  • Swollen salivary glands
  • Worn tooth enamel or decaying teeth (caused by excessive exposure to gastric secretions)
  • Gastrointestinal problems such as acid reflux
  • Severe dehydration
  • Scarring on the back of the fingers from the process of self-induced vomiting
  • Electrolyte (sodium, calcium, potassium) imbalance

Complications of Bulimia
 Many medical complications are commonly associated with bulimia nervosa:
  • Stomach rupture
  • Heart failure (due to loss of vital minerals, such as potassium)
  • Irregularity or absence of menstruation

Many people with bulimia suffer from clinical depression, anxiety, obsessive-compulsive disorder, addictions and other psychiatric illnesses and are at increased risk for suicidal behavior. In addition, individuals with bulimia are usually impulsive and more likely to engage in risky behaviors such as abuse of alcohol and drugs. 

Diagnosing Bulimia
Parents, family members, spouses, teachers, coaches and instructors may be able to identify an individual with bulimia, although many people with the disorder initially keep their illness very private and hidden. A detailed history of the individual's behavior from family, parents and teachers, clinical observations of the person's behavior, and, sometimes, psychological testing contribute to the diagnosis. Family members who note symptoms of bulimia in a loved one can help by seeking an evaluation and early treatment.
Treating Bulimia
Early diagnosis and treatment of bulimia are critical because the disorder and the malnutrition that results can adversely affect nearly every organ system in the body and can be fatal.
Treatment for bulimia is complex and usually involves a combination of approaches, including:
  • Psychotherapy, whether provided in Individual or group sessions, aims to help change the thoughts and beliefs that led to the bulimia and to teach the affected person how to replace unhealthy habits with healthy ones.
  • Nutritional rehabilitation plays a key role in helping to restore normal eating habits and good nutrition.
  • Medication (usually antidepressants or antianxiety medications) may be helpful.

Families also play a vital supportive role in the treatment process.