BULIMIA NERVOSA

What Is Bulimia Nervosa?  Bulimia nervosa is an eating disorder that affects mainly young women who are constantly worried about their body shape and weight. Those suffering from bulimia have repeated incidents of uncontrollably eating large amounts of food at a time (bingeing) and then, fearing weight gain, try a number of extreme methods to get rid of the “excess” calories. These methods include self-induced vomiting, abuse of laxatives or diuretic drugs, excessive exercise or fasting, and are known as purging. Among patients diagnosed with bulimia, the binge-purging cycles on average occur about two times  a week.

What Causes Bulimia Nervosa?  Like anorexia, bulimia has no known single cause. Bulimia is much more common than anorexia and it is believed that anywhere from 1% to 10% of young women suffer from bulimia. Its frequency is difficult to estimate, since the effects of bulimia are not as visible as anorexia. In fact, most patients with bulimia are of normal weight. Some believe that bulimia and anorexia are based on the same psychological disorder; however, each is expressed differently from the other. For a more detailed description of the causes of bulimia, please refer to the article on this web site on anorexia. There have been studies that report that a biological basis exists for the bingeing and purging cycles of bulimia. These studies report that the process of vomiting and use of laxatives may stimulate the production of natural “opioids”, narcotics in the brain that cause a person to become addicted to the bulimic cycle.

What Are The Signs And Symptoms Of Bulimia Nervosa?  Because bulimia is considered a psychiatric disorder, it can be associated with other psychiatric illnesses. Many patients also show signs and symptoms of depression and obsessive-compulsive behavior. The relationship between bulimia and other psychiatric illnesses is unclear (i.e. whether one causes the other). However, they often co-exist in bulimic patients. Most of the physical complications from bulimia result from purging. Excessive vomiting leads to visible enlargement of the salivary glands and also to the erosion of dental enamel, particularly of the two front teeth. Vomiting can also result in serious imbalances of fluid and electrolytes (i.e. potassium and sodium), which can become life-threatening. Cardiomyopathy, a heart disease which affects the muscle cells of the heart,  may result from the long term abuse of ipecac, a syrup used by bulimics to cause vomiting.

With What Can Bulimia Nervosa Be Confused?  Bulimia can be confused with other eating disorders such as anorexia. While both disorders involve distorted body images and extreme fear of weight gain, patients with anorexia restrict their diet, while bulimic patients binge on food and purge the food through methods such as self-induced vomiting, laxative and diuretic use, and excessive exercise. Unlike patients with anorexia, who can become extremely thin and sick looking, bulimic patients, as mentioned, usually have normal weights. Patients with bulimia also tend to be more conscious than patients with anorexia of their behaviour and they express feelings of guilt and remorse. Bulimic patients respond better and are more likely to admit what has been happening in their lives to sympathetic family members, physicians and other health care workers. They also tend to be less introverted and more likely to experience impulsive behavior, drug and alcohol abuse, and overt depression than those suffering from anorexia.

How Is Bulimia Nervosa Treated? The two major aspects of treating bulimia comprise psychotherapy and the use of antidepressants. Psychotherapy includes cognitive-behavioural therapy and interpersonal therapy. Cognitive-behavioral therapy works on the principle that a pattern of false thinking and belief about one's body can be recognized objectively and altered, thereby changing the response and eliminating the unhealthy reaction to food. Therapy can be in the form of private counseling with a health professional and in the form of group counseling, in which others who are undergoing the same difficulties of the illness gather to talk and provide support. Antidepressants have been shown to help even patients who do not have clinical depression. A combination of psychotherapy and medical therapy has been observed to be the most effective form of treatment. The care of patients with bulimia is thus best undertaken by a multidisciplinary team, which can include medical doctors, dietitians, behavioral-cognitive therapists, psychotherapists and nurses.