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Bulimia Nervosa

Bulimia Nervosa is alternatively known as Binge-Purge Behavior. Bulimia Nervosa is a serious disorder that can be life threatening, if left untreated. It is characterized by a cycle of food binging, followed by induced vomiting. The patient often has a feeling of being "out of control" when they binge. This is countered by extreme measures, including purging, abuse of laxatives, enemas, diuretics and diet pills, and intensive exercise regimens. Patients with Bulimia Nervosa may exhibit extreme weight fluctuations, normal at times, then losing and gaining weight in cycles.

The vicious cycle of binging and purging results in feelings of guilt, failure, and low self esteem. Patients practice the ritual of binge and purge in private. The food they eat is often sweet, high in calories, and of a size and texture that makes it easy to eat fast, so the patient is not interrupted while they are eating. For some bulimics, any amount or type of food -- a green salad or half an orange -- is seen as a binge. Binges may occur several times a day, over many months.

Many patients manage to maintain normal, or even above normal body weight, so they can hide their problem for years. Some Bulimia Nervosa patients may also suffer from Anorexia Nervosa, an eating disorder characterized by severe and chronic weight loss, and a condition of ‘starvation’. Bulimia can be coincident with other psychiatric disorders like depression, obsessive-compulsive disorder (OCD), and substance abuse.

The exact cause of bulimia is not known, but contributory factors may include family conflict, and the current cultural obsession with the very thin body image as perfection. Patients are often perfectionists, with a family environment that overemphasizes a thin body. Some research supports the idea that a child who is ‘chubby’ in adolescence, or has a genetic tendency toward obesity, may be predisposed to this disorder.

What are the symptoms?

The binging and purging of Bulimia can lead to serious medical complications. Like most eating disorders, symptoms of the disorder are separated into primary symptoms– visible signs of weight loss, strange eating behaviors – and secondary medical symptoms that occur over time, as a result of the disorder.

Primary Symptoms

• Weight may be normal, or it may fluctuate up and down over time
• Regular use of laxatives, diuretics, enemas
• Extreme exercise regimens or fasting routines
• Secretive eating habits, significant quantities of food missing from pantry, excessive empty wrappers in garbage
• Overly concerned about body image and weight
• Calluses on back of the hand and knuckles from induced vomiting
• Swelling in cheek or jaw area, discoloration of teeth
• Binging and purging behaviors, evidenced by eating alone and/or frequent trips to the bathroom around meal time

Secondary Symptoms

• Pancreatitis, gastrointestinal problems
• Dehydration
• Inflamed throat, tears or ruptures in esophagus
• Heart problems
• Gastric rupture in severe cases
• Dental Cavities
• Electrolyte imbalance
• Depression, personality disorder, bipolar disorder, addictions
• Constipation, hemorrhoids
• Loss of menstrual cycle

The recurring binge-purge cycles of Bulimia Nervosa can be very harmful, damaging the digestive organs and leading to chemical and electrolyte imbalances that damage the heart and major organs.

How is it diagnosed and treated?

Bulimia Nervosa is sometimes difficult to diagnose. Binging and purging are usually done in secret and are easily concealed if the family and friends of the patient are not looking for symptoms, especially since Bulimics often maintain a normal weight. Doctors will perform a dental exam to look for an unusually high occurrence of cavities or gum infection. A series of blood tests can uncover imbalances in blood, electrolytes. There are five criterions for bulimia diagnosis:

• Reported lack of control over eating during the binge episodes
• Inappropriate behavior to prevent weight gain (induced vomiting, use of laxatives, diuretics, enemas or medications, fasting, or extreme exercise regimens)
• Recurrence of binge eating episodes
• Behavior is unduly influenced by body image
• Binge eating and compensating behavior must occur 2 or more times per week for at least 3 months, and cannot occur exclusively during anorexia episodes

Treatment includes:

• Support Groups for patient, family counseling for patient and family
• Medications like antidepressants
• Psychotherapy
• Treatment of medical symptoms, if severe, may require hospitalization
• Nutritional counseling
• Cognitive behavioral therapy

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