Bulimia nervosa is an eating disorder that is characterized by strong urges to eat large quantities of food followed by a period of regret where the individual makes attempts to purge the calories and avoid weight gain.
There are many factors that may be involved in causing bulimia nervosa, including:
- Genetic susceptibility
- Hormonal changes
- Low self-esteem
- Predisposition to depression or anxiety
- Stressful or emotional life events
- Extreme pressure to maintain low body weight
Most patients with bulimia nervosa have several of these risk factors and develop symptoms of bulimia nervosa due to multiple causes. However, the exact cause is not well established, and many other individuals with similar risk factors are not affected by the disorder.
People with bulimia nervosa tend to cycle through the following distinct stages:
- Strict dieting and fear of gaining weight
- Anxiety due to cravings for prohibited
- Consumption of large quantity of food in short timeframe
- Purging calories by inducing vomiting, or using laxatives or diuretics
- Shame of binge eating episode and renewed strict diet to control weight
As the cycle continues, the affected individuals feel their consumption of food is increasingly out of control and their obsession with body weight heightens. This leads to the enforcement of a stricter diet and, as a result, an increased likelihood of binge eating.
Patients with bulimia often feel embarrassed about the condition and may try to hide the symptoms or evidence of binge eating from friends and family members.
There are several complications that may affect people with bulimia, particularly associated with the purging methods after a binge-eating episode.
An imbalance of electrolytes in the blood can have serious consequences, such as causing arrhythmias in the heart, which is potentially fatal. Additionally, the psychological issues associated with the condition can increase the likelihood of suicidal thoughts and behaviors.
Other complications associated with purging by vomiting or using laxatives include tooth decay, gum disease, esophageal damage, intestinal damage, and permanent constipation.
The diagnostic criteria for bulimia nervosa according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are:
- Recurrent episodes of binge eating
- Feeling of shame or guilt after episodes
- Purging of extra to avoid weight (by vomiting, excessive exercise, fasting, use of diuretics or laxatives)
- Binge and purge at least once a week for three consecutive months
- Self-confidence significantly affected by body weight and shape
- No diagnosis of anorexia
The diagnostic process will usually include a patient consultation, physical examination and psychological evaluation in order to make an accurate diagnosis of bulimia nervosa. Other diagnostic tests, such as a blood test, urine test or echocardiogram may also be required to investigate the severity and possible complications.
The primary component of bulimia nervosa treatment is psychotherapy to address the underlying psychological issues that are linked to the negative body image and unhealthy eating habits. Cognitive behavioral therapy (CBT), family-based therapy and interpersonal therapy are among the most common types of psychotherapy used for bulimic patients.
In some cases, pharmacotherapy with antidepressant medications such as fluoxetine may also be indicated.
It is essential that patients have access to a strong support network that can encourage and support them during their recovery period. This often involves a combination of understanding family members, support from health professionals and an eating disorder support group with other individuals that have similar struggles.
Bulimia nervosa is most common in adolescent and young women, with approximately 1-2% of this population group affected. In fact, 80% of bulimia nervosa patients are female, although the incidence in males in on the increase.
In the United States, there are an estimated 24 million individuals currently suffering from an eating disorder, such as bulimia nervosa, anorexia nervosa or binge eating disorder. This includes some young children, adolescents and adults.