Bulimia nervosa is caused due to continuous binge eating followed by self-induced vomiting, diuretic or laxative abuse, excessive exercising for at least 3 months or fasting. This is a somewhat compensatory behavior following excessive eating. More women than men indulge in this kind of behavior.
Symptoms of bulimia affect 1.6% pubescent and young women and 0.5% young men of similar age. Those who are affected by bulimic symptoms are overly worried about external appearances – especially body weight and shape. Bulimia nervosa is different from anorexia nervosa for it affects people of normal weight.
The exact reasons why people become bulimic is unknown. Psychological or genetic factors, family, society or cultural pressures play a big role in a person indulging in binge-purge episodes that cause bulimia.
Symptoms of Bulimia
Symptoms of bulimia are elaborated below. Most of the external symptoms occur due to the purging-vomiting episodes. Since bulimic patients are of normal weight, many will not recognize that they have an eating disorder.
Binge eating: This is the first symptom that a person is bulimic. He or she will indulge in binge eating that is rapid consumption of large quantities of food (more than normally eaten in a specific time). Some people feel they have lost control over the quantities they consume.
The food that is consumed during binge eating is normally very high in calories – like cake or ice cream. In some extreme symptoms of bulimia, even thousands of calories will be consumed at one time. Since this is a form of guilt eating, it will be carried out secretly – e.g. behind closed doors in a bedroom. It can occur more than once a day.
Compulsive exercise: This happens due to a guilty feeling after binging and the person feels the need to exercise more than normal to lose weight.
Purging: Indulging in binge eating causes people to become disgusted with themselves and attempt to bring out all the food they have eaten to prevent gaining weight. Such symptoms include:
- Using the bathroom for long periods after meals without explanation
- Using enemas, laxatives or diuretics that cause diarrhea and loose stools – done to pass out excessive food consumed
- Irregular periods
- Heartburn, bloated feeling or indigestion
Vomiting: A person forces food out by vomiting. This can be done privately but certain external signs will be seen.
- Induced vomiting can cause scars on knuckles
- Swollen parotid glands or salivary glands
- Dental erosion
- Swollen jaw or cheeks
- Broken blood vessels in eyes (bloodshot eyes) – due to straining during forced vomiting episodes
- Sore throat due to forcing food out
- Heartburn, bloated feeling or indigestion (sign of excessive purging and vomiting)
Mental symptoms: Since bulimia occurs due to mental problems, these symptoms must also be noticed.
- Depression due to low self-esteem, is a classic symptom of eating disorders
- Anxiety and shame about body image and shape
- Drug addiction
- Withdrawn from society
Severe symptoms of bulimia
Complications from bulimia can occur if the early warning signs are not recognized and dealt with at once. These symptoms could be:
- Enamel on the teeth getting eroded due to constant exposure to stomach acids from repeated vomiting
- Dental cavities from eating high calorie foods
- Stomach ulcers from the constant binge-purge cycle that makes the stomach and other digestive organs function overtime
- Sensitivity of teeth to cold or hot food due to erosion of the enamel
- Ruptured esophagus and stomach
- Low sex drive
- Tendency towards suicidal behavior increases
- Disruptive bowel movements
- Heart attack can happen in severe cases
- Swelling of throat
What to do?
A patient with bulimic symptoms requires both medication and psychiatric intervention. Call your doctor if you or your family member exhibits symptoms of bulimia. If you know someone close who displays these symptoms, you must help them, for often they will not recognize these symptoms themselves. Talk to them, express your concerns, ask your loved one to seek professional help, avoid being critical, do not blame the person, try not to give simple suggestions like telling them to stop eating – for this is easier said than done. Finally, be there to help your friend or family member conquer bulimia nervosa.
Treatment of bulimic symptoms
For those with early symptoms of bulimia, support groups are recommended especially if there are no other health problems. When these do not work, CBT and nutritional therapy is recommended.
Cognitive-behavioral therapy (CBT) is the treatment most used for bulimic patients. This therapy requires 16-20 individual sessions over a 5-month or more period. This can be a group therapy or one-to-one session. The aim is to motivate the person to change, provide healthier eating patterns, identify the mental problems that led to bulimia and prevent relapses.
Interpersonal psychotherapy (IPT) helps the patient identify he or she has a problem and alter it to prevent eating disorders. The treatment can be an alternative for CBT.
SSRIs are anti-depressants that can reduce the binge-purge frequency and control depression and anxiety. SSRIs in combination with CBT are more effective than when used alone.
Many patients could drop out of therapy if they feel it is not helping them. They should be encouraged to stay on by telling them that symptoms are likely to relapse, the process is painful and they require the help of professionals, friends and family to overcome their problem.
Bulimic symptoms : Prevention and Precaution
Bulimia is dangerous when pregnant women are actively bulimic. It can cause miscarriages or problems with the fetus like premature babies, babies with developmental disorders etc. Pregnant bulimic women can suffer from high blood pressure, depression, diabetes, breastfeeding problems and such. The fetus can be harmed when the mother takes excessive diuretics and laxatives.
There is no real known cause for bulimia. So preventing it is difficult. However, parents and educators can help young people with self-image issues realize that the ‘ideal’ woman or man does not exist. It is because such expectations weigh heavily on the minds of young women in particular that they become bulimic.
Seeing pictures of ideally proportioned models and movie stars make young people believe that they need to look a certain way to succeed or to be accepted by society. Society must make adolescents realize that there is no such thing as ideal body weight and that other characteristics like intelligence and hard work will help them succeed. Feelings of self-confidence and self-worth can prevent many teenagers from becoming bulimic.