Introduction

Bulimia nervosa is a serious psychiatric disorder that is characterized by consuming large quantities of food (binge-eating) and then attempted compensation for the excess food consumed through physical activities such as exercising and fasting.

As an eating disorder, bulimia nervosa is a potentially life-threatening condition just like most other mental health disorders. Persons with eating disorders are obsessed about food and weight and this ends up having a negative effect on their physical appearance.

In bulimia nervosa, there is a pattern of eating that is characterized by:

• Binge-eating.  This refers to consumption of excessive quantities of food in short periods of time.

• Purging. The individual gets rid of the food that has been taken. This can happen through vomiting or taking drugs such as laxatives (they ensure faster movement of food within the gastrointestinal tract).

Other characteristics may include:

• Misusing diuretic agents. Diuretic agents are used to enhance diuresis (water loss from the body).
• Fasting. Consuming very little or no food.

 

 Key Facts & Statistics

Key facts and statistics that surround bulimia nervosa

• Eating disorders affect more than 5 million individuals in the US alone. Mostly, these are young women aged between 14 and 40 years.
• Bulimia nervosa has a prevalence of about 3% for women in the US.
• It occurs in 2.3% of women from the white race as compared to 0.4% of black women.
• In 1979, Rusell gave a description of Bulimia nervosa as an ominous variant of anorexia nervosa.

 

 Risk Factors

What are the risk factors for bulimia nervosa?

• Genetics. Having a relative with an eating disorder raises the risk of developing the condition.
• Childhood sexual abuse
• Low self-esteem
• Dieting
• Occupations that focus on weight such as modelling and athletics.
• Poor glycemic control.
• Eating alone.

 

 Causes

What are the causes of bulimia nervosa?

The exact cause(s) of bulimia nervosa are  yet established to be stablished.

However, it is believed by researchers that genetic predisposition in combination with learned behaviors play roles in its development.

 

 Signs & Symptoms

What are the signs and symptoms of bulimia nervosa?

It can be quite difficult to notice the condition since most people with this disorder binge then purge privately.

 

Physical signs and symptoms:

• Dental problems. These occur when acid from the stomach erodes tooth enamel due to self-induced vomiting.
• Gastrointestinal (GI) symptoms such as bloating, flatulence and constipation. Again, there may be delayed gastric emptying and motility.
• Bloodshot eyes.
• Irregular menstruation.
• Fainting.
• Muscle weakness.
• Swollen cheeks.
• Dehydration.

 

Behavioral and emotional signs and symptoms:

• Frequent physical exercise.
• Being ashamed of eating.
• Fear of weight gain.
• Preoccupation with body image.
• Regularly visiting the bathroom after meals (to purge).
• Taking laxatives without prescription (or without a proper medical reason)

 

Types

What are the common types of bulimia nervosa?

2 distinct subtypes of bulimia nervosa are:

•  Purging bulimia nervosa. Patients get rid of the binged food by inducing vomiting, misusing laxatives and diuretics.
•  Non-purging bulimia nervosa. Individuals undergo a process of fasting or engage in excessive physical exercise. They do not purge frequently.

 

 Diagnostic Procedures  & Tests

How is bulimia nervosa diagnosed?

 

• Performance of a clinical examination.
• Review of patient history(medical history and presenting signs and symptoms).
• The following criteria must be met for a bulima nervosa diagnosis to be made:

1.  Repeated episodes of binge-eating.
2.  Inappropriate purging.
3.  Worries about body shape or weight.
4.  Inability to control your eating behavior during an episode.
5.  Experiencing bing-eating at least once per week for three months.

 

Several tests can be conducted to check how the condition has affected health. These are:

•  Urinalysis.
•  Kidney function test.
•  Electrocardiogram (ECG).
•  Blood tests.

 

Despite the availability of many tools for screening, only a few focus on diagnosing bulimia nervosa.

Some of these tests are:

• The Bulimic Investigatory Test, Edinburgh (BITE) questionnaire.
• The Eating Attitudes Test.
• Note that the above mentioned are not laboratory tests.

 

 Treatment and Management

How is bulimia nervosa treated?

Treatment strategies include:

•  Psychotherapy. Cognitive behavioral therapy(CBT), family-based therapy and dialectical behavioral therapy are some of the forms of therapy that can be employed.
• Nutritional counselling. Nutritional education is offered by dietitians.
• Medication. Fluoxetine, an SSRI (selective serotonin reuptake inhibitor) is the only anti-depressant approved by the Food and Drug Administration (FDA) to treat bulimia nervosa.
• Support groups. These act as a source of hope, encouragement and advice on how to cope with this condition.

 

 Complications

What are the complications of bulimia nervosa?

 

• Arrhythmia (irregular heart rhythms).
• Electrolyte imbalances. In lower-weight bulimic patients there electrolyte abnormalitie such as hypochloremia, metabolic alkalosis, hyperphosphatemia and hypokalemia.
• Tooth decay and cavities.
• Heart failure.
• Menstrual disturbances such as amenorrhea and oligomenorrhea. These occur in only 50% of patients with bulimia nervosa.
• Gastrointestinal (GI) problems. These occur due to purging. Mallory-Weiss tears and gastroesophageal reflux disease (GERD) may develop as a complication of vomiting excessively.

 

 

Prevention

How do we prevent bulimia nervosa?

Young individuals should be educated about health, good nutrition and lifestyle. They should be let to know that the so called “ideal” body type portrayed by the media and socialites is not realistic at all. They should not respond to the pressure of having certain body types that are advocated for by the popular culture.

Persons with other psychiatric conditions such as anxiety disorders and depression must be properly  treated in order to lower the risk of developing bulimia nervosa.

If it is familial, individuals must know the warning signs so that the problem can be caught early.