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Bulimia

Overview of bulimia

Bulimia takes its roots from the Greek, where bous means ‘ox’ and limos mean ‘hunger’, indicating a state of excessive hunger.

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Bulimia, also called as ‘bulimia nervosa’, is the most common eating disorder. It involves binge eating followed by inappropriate behavior to avoid weight gain. Binge eating means ‘eating large amounts of food in a short time’. Later, to get rid of the food they ‘vomit or purge’ using medicines or laxatives.

People with bulimia like to binge, because they experience a comfort feeling. After binging, they feel ashamed, guilty and are scared of gaining weight. This causes them to purge later. They are capable of self-evaluating based on their body shape and weight.1 The occurrence of binge eating and purging in a person suffering from this disorder is at least twice a week for 3 months.

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People having binge eating habit and not suffering with this disorder are overweight and people suffering with this disorder with binge eating habits are of normal weight. There are two types of bulimia nervosa.

  • Purging type—In this type, the people suffering with this disorder indulge in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
  • Non-purging type—In this type, the affected people indulge in inappropriate compensatory behaviors, such as fasting or exercising excessively.

Epidemiology

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Bulimia nervosa is a chronic disorder, which lasts for more than 6 months. Prevalence of the disorder has increased due to general awareness. Among women aged between 17 and 30 years, the incidence is 5000 per 100,000 population.2 This disorder manifests at a peak age of 18 years.2 Women are at more risk than men in the proportion of 20:1.3

About 30% develop additional conditions like depression, compulsive behavior etc. during the course of the disease. Many reports suggest that those suffering with bulimia might have a history of anorexia nervosa. Bulimia is common among those, who lose and gain weight rapidly like wrestlers. This is also common mainly in sports persons where slimming and body shape is of much importance. Some occupations like modeling, acting etc. are at a higher risk of getting affected by this condition. Recent studies suggest that bulimia is seen among middle and upper socioeconomic class of the society.

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Signs and Symptoms of bulimia

People suffering with bulimia generally tend to hide binging and purging habits, as they feel ashamed. They binge when others are not around.

Signs and symptoms of binge eating are:

  • Uncontrolled eating—Unable to control eating. Eating is continued until the point of discomfort and pain.
  • Try to maintain secrecy—Eating in the absence of anybody. Entering the kitchen when everybody has gone to bed.
  • Disappearance of food—Eating large quantities of food. Emptied vessels and food wrappers are found in the dustbin.
  • Alternates between overeating and fasting—When it comes to eating, it is about eating all or nothing. One hardly eats normal meals. Normal weight is maintained.

Signs and symptoms of purging include:

  • Frequent visits to bathroom or to throw up after eating. Opens the water tap to disguise the sound of vomiting.  
  • Use of laxatives, diuretics or enemas after eating.
  • Consumption of diet pills to restrain from eating
  • Use of Sauna to sweat out the water weight
  • Rigorous exercise after eating. Exercises include high-intensity calorie burners such as running or aerobics.

Following are the physical signs and symptoms:

  • Scars or calluses found on knuckles and hands.
  • Enlargement of the bilateral parotid gland due to noninflammatory stimulation of the salivary gland.
  • Puffy cheeks due to repeated vomiting are seen.
  • Teeth may look discolored or ragged due to exposure of stomach acids during vomiting.
  • Weight fluctuated frequently due to overeating and vomiting.

Causes of bulimia

Studies on bulimia have not indicated the actual cause of the disorder. It might be a mixture of environmental factors, social factors, personality traits and may run in families.4

Risk Factors for bulimia

Major risk factors for bulimia include:

  • Poor body image—Young women give importance to slimness and beauty, influenced by media and unrealistic ideas. Hence, having a poor body image poses a major risk.
  • Low self-esteem—Things that contribute to low self-esteem are depression, childhood abuse and critical home environment. Those who think themselves as useless, worthless and unattractive are at a risk.
  • Diet—People who diet more are at risk. This deprivation of drastic dieting leads to binge eating and purging.
  • Appearance-oriented professionals—Appearance-oriented professionals like ballet dancers, models, wrestlers, runners and actors who are under tremendous pressure may develop this disorder.  
  • Changes of life—Major changes in life like physical changes of puberty, going away from college, break up of a relationship etc. attempt binging and purging to cope up with stress.
  • Biological factors—Biological factors like eating disorder in families, heredity are responsible for this disorder.

Diagnosis of bulimia

Observing the signs and symptoms of this disorder may be helpful in being treated at the earliest. The person affected with bulimia usually does not consult with the practitioner until the problem becomes a serious state. Talking to the practitioner truthfully about the problems faced helps in proper diagnosis.

The following are some steps, which helps in diagnosis.

  • Repeated episodes of binge eating within 2-hour period and consuming large quantities of food.
  • Lack of control or a feeling that the person cannot stop eating during the episodes.
  • Along with binging, there is purging using inappropriate behavior like laxatives or medicines.
  • Occurrence of binging and purging atleast two times a week for three months.
  • Dissatisfaction with body shape and weight.

Treatment of bulimia

Treatment involves the following.5

Pharmacotherapy

This involves antidepressant treatment using selective serotonin reuptake inhibitors (SSRIs), like fluoxetine and sertraline are given. The drug bupropion is also given, in the treatment of bulimia to reduce the risk of seizures due to the medication.

Over-the-Counter Drugs

Dexedrine and benzedrine are the most common over-the-counter drugs available, but care should be taken, in not misusing it.

Psychotherapy

This includes the following psychological counseling:

InterpersonalTtherapy

This involves teaching the patient to eat three meals and two snacks a day, avoiding to eat unhealthy food, reduce concern about body weight and shape, controlling the triggers of binge eating by examining personal relationships and emotions, learning cope up skills to prevent further lapses.6

Family Therapy

This involves techniques, which make the person communicate and eat with the family.

In severe conditions of bulimia, which may lead to dehydration or esophageal tear, hospitalization may be necessary.

Prevention of bulimia

Bulimia cannot be prevented but can be treated when diagnosed early. Developing a healthy view of themselves and learning to approach food and exercise with a positive attitude may prevent some children and teens developing this disorder in later stage of life.

Living with the Disease

People suffering with this disease feel ashamed and disgusted by vomiting. This leads to isolation and depression. It is frustrating for the family to have a family member like this.The family always worries about the person who is suffering from this disorder fear that he or she may die. In such a situation, a lot of support is expected from family and friends.

References

1.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. 1994.

2.Cooper PJ, Charnock D. “From restraint to bulimic episodes: a problem of some loose connections”. Appetite. 1990; 14(2): 120–122.

3.Warheit GJ, Langer LM, Zimmermann RS. Prevalence of bulimic behaviors and bulimia among a sample of the general population. Am J Epidemiol. 1993; 137(5): 569–576.

4.Kaye WH, Lilefeld L, Halmi KA, for the Price Foundation Study Group. Susceptibility factors in eating disorders. Program and abstracts from the 153rd Annual American Psychiatric Association Meeting, May 13–18, 2000; Chicago.

5.Available at: www.emedicine.com/MED/topic255.htm#section~Treatment. Accessed on: 7th April, 2008.

6.Jansen A. Towards effective treatment of eating disorders: Nothing is as practical as a good theory. Behav Res Ther. 2001; 39: 1007–1022.