Bulimia Nervosa

Bulimia Nervosa

Bulimia Nervosa

Bulimia nervosa, also called bulimia, is an extreme and potentially fatal eating disorder characterized by separate episodes of binge eating followed by “makeup” measures taken to avoid gaining weight and/or to induce weight loss, such as purging.

Binge eating in the context of bulimia nervosa refers to the uncontrollable and ravenous consumption of a large quantity of food in a short period of time.

Purging vs Non-purging

The two categories of bulimia are purging and non-purging. Although there can be an overlap in the methods used, roughly 90% of people with bulimia fall into the category of purging bulimia, which involves self-induced vomiting and/or the use of diuretics and laxatives.

With non-purging bulimia, the individual will engage in extreme exercise or diets, use of diet pills or stimulants, as well as fasting — as alternative methods to purging — to shed the excess calories and to prevent weight gain.

Prevalence

Bulimia nervosa tends to develop during adolescence and early adulthood, and the male to female ratio is 1:10. People who have a family history of bulimia nervosa are more likely to develop this condition.

Bulimia Nervosa vs Anorexia Nervosa

Anorexia nervosa is a syndrome of self-starvation involving significant weight loss, whereas patients with bulimia nervosa are, by definition, at normal weight or above.

Symptoms of Bulimia Nervosa:

Compared to binge eating, which normally is not accompanied by purging, bulimia can be more difficult to spot or diagnose because the person may not exhibit weight changes.

Common symptoms may include some of the following:


Physical symptoms

  • Ongoing changes in weight
  • Ongoing excessive tiredness
  • Feeling dizzy or faint
  • Stomach ulcers, and/or acid reflux
  • Intestinal problems from repeated use of laxatives
  • Hemorrhoids
  • Visible blood vessels in the eyes
  • Severe throat pain and/or problems from repeated vomiting
  • Extreme dehydration because of vomiting
  • Oral skin issues from vomiting
  • Severe dental issues because of vomiting
  • Swollen saliva glands
  • Sleep issues
  • Irregular heartbeat
  • Dry skin
  • Stroke or heart attack because of electrolyte imbalance
  • Loss of, or interruption to menstrual period
  • Infertility
  • Reduced sex drive

Psychological symptoms

  • Uncommon fixation with weight and/or body shape
  • Inability to be happy with body appearance
  • Not feeling in control of one’s eating habits
  • A controlling fear about gaining weight
  • Mood swings
  • Reduced concentration
  • Stress and anxiety because of the condition and having to keep secrets

Behavioral symptoms

  • Religiously avoiding certain foods
  • Spending more than most people on food
  • Strictly controlling caloric intake between binges
  • Not stopping eating after reaching a feeling of being full
  • Eating more than most people at one time
  • Eating in private
  • Shedding excess calories using laxatives, diuretics, enemas, or self-induced vomiting
  • Obsessive, secret, and controlling behaviors in relation to preparing and eating food
  • Habitually making more than one visit to the restroom after eating
  • Abusing diet pills to prevent weight gain or to lose weight
  • Suicidal ideations or attempts

Those with bulimia routinely judge themselves very harshly in relation to what they see as flaws in their appearance; and in attempts to minimize that internal narrative, individuals can engage in behaviors that impact their reproductive, digestive, circulatory, and central nervous systems.

Causes of Bulimia Nervosa:

Factors that render an individual more vulnerable to developing bulimia nervosa can be psychological, emotional, social, genetic, and biological, and can include:

  • Emotional or psychological problems, low levels of serotonin and dopamine, impaired effective functioning
  • Cultural pressure to attain a certain body type, careers that have a focus on weight or appearance
  • Low self-esteem, negative thoughts or emotion related to body image
  • Obesity
  • Siblings or parents with the disorder
  • History of dieting
  • Trauma and or abuse
  • The stress of moving, changing schools, career changes, or other difficult transitions
  • Irregular levels of gut hormones and those related to gender

While there is no direct genetic link to the disorder, there might be a genetic link between inheriting traits like perfectionism, obsessiveness, anxiety, and inhibition and their potential to leave someone predisposed to developing the disorder.

Bulimia Nervosa complications:

The complications of bulimia nervosa include:

  • Thickened skin on the knuckles
  • Erosion and decay of teeth – as a result of excessive vomiting
  • Dehydration – which can lead to major medical problems such as kidney failure
  • Heart problems – such as irregular rhythm of the heart and heart failure
  • Gastrointestinal disturbances – diarrhea, constipation
  • Kidney damage and or failure
  • Obesity
  • The introduction or increase of low self-esteem
  • Alcohol or substance abuse or dependence
  • Suicidal ideation or actions
  • Absent periods in females

The complications of bulimia nervosa include:

  • Thickened skin on the knuckles
  • Erosion and decay of teeth – as a result of excessive vomiting
  • Dehydration – which can lead to major medical problems such as kidney failure
  • Heart problems – such as irregular rhythm of the heart and heart failure
  • Gastrointestinal disturbances – diarrhea, constipation
  • Kidney damage and or failure
  • Obesity
  • The introduction or increase of low self-esteem
  • Alcohol or substance abuse or dependence
  • Suicidal ideation or actions
  • Absent periods in females

Bulimia is frequently associated with other mental disorders such as depression, anxiety, and addiction problems like alcohol dependence syndrome.

The twofold complications of bulimia are a result of either the malnourished state and/or the compensatory efforts taken in order to feel better physically or emotionally, or both.

Diagnosing Bulimia Nervosa:

A doctor will usually do physical exams and lab work — to rule out any other illnesses and assess the damage usually caused by bulimia — and conduct a psychological evaluation through a set of questionnaires and conversations to determine the person’s thoughts and feelings about food or eating.

The criteria for a bulimia nervosa diagnosis from the American Psychiatric Association’s DSM-5 (Diagnostic and Statistical Manual of Mental Disorders – version 5), includes the following:

  • Eating an unusually large amount of food compared to other people and doing so on an ongoing basis
  • During a binge-eating episode, experiencing a feeling of not being in control of when to stop eating, or of how much is eaten
  • Using purging mechanisms like laxatives and/or diuretics, medications, diet pills, extreme exercise, fasting, or self-induced vomiting to avoid weight gain
  • Weekly binge eating and purge episodes for a minimum of 3 months
  • Weight and body shape influence the sense of value or self-worth more than they would for most people
  • Neither the symptoms nor a diagnosis for anorexia

Bulimia is rated in relation to its severity using the DSM-5 Severity Indicator and by the number of inappropriate purging or weight compensation behaviors in a weekly period.

  • Mild – 1 to 3 weekly episodes
  • Moderate – 4 to 7 weekly episodes
  • Severe – 8 to 13 weekly episodes
  • Extreme – more than 14 weekly episodes

Even if someone doesn’t qualify for a bulimia diagnosis, he/she may still have an eating disorder that could damage their body physically, as well as have a profound negative impact on their mental and emotional health. Professional help should be sought out.

Treatment of Bulimia Nervosa:

The primary treatment for bulimia is typically a combination of psychotherapy and medication. A case manager is usually assigned to coordinate care between the doctor, nutritionist or dietician, and mental health professionals.

If the bulimia has caused severe health problems, the person might initially be admitted to a hospital or attend a day center, and treatment options include:


  • Cognitive behavioral therapy (CBT) – the CBT format specifically designed in relation to eating disorders is CBT-E. The person explores his or her thoughts and feelings toward food and body image and examines the reasons behind the external actions of binging and purging before learning how to adopt new thinking patterns and strategies.
  • Interpersonal therapy – Examines relationships and/or experiences which may have led to the thought processes in the development of bulimia. Part of this treatment teaches social skills; enforcing boundaries; and how to deal with isolation and unresolved grief, difficult transitions in life, and/or relational conflict at home, at work, or at school.
  • Family-based therapy – For families with a child or teenager diagnosed with bulimia, supportive parents or guardians are taught how to be actively involved in helping the child establish healthy eating habits and return to an appropriate weight for their age and height.
  • Education – Educates about the importance of optimal physical health and the adoption of regular, healthy eating habits.

Medications for Bulimia Nervosa can include:

Medication alone is rarely considered effective, but antidepressants are often prescribed in combination with psychotherapy.

Antidepressants

  • Fluoxetine – a selective serotonin reuptake inhibitor that helps reduce symptoms of depression, OCD, and anxiety
  • Venlafaxine – a serotonin-norepinephrine reuptake inhibitor that helps reduce symptoms of depression and anxiety

Sometimes younger people react badly to antidepressants, experiencing suicidal thoughts and severe mood symptoms. For this reason, they should be closely monitored for any possible reaction to the medication over the first few weeks.

Certain antidepressants can react badly to other medications the person is on, and to alcohol, so be sure to check for any listed drug combination warnings.

 

Symptoms of Bulimia Nervosa:

Compared to binge eating, which normally is not accompanied by purging, bulimia can be more difficult to spot or diagnose because the person may not exhibit weight changes.

Common symptoms may include some of the following:


Physical symptoms

  • Ongoing changes in weight
  • Ongoing excessive tiredness
  • Feeling dizzy or faint
  • Stomach ulcers, and/or acid reflux
  • Intestinal problems from repeated use of laxatives
  • Hemorrhoids
  • Visible blood vessels in the eyes
  • Severe throat pain and/or problems from repeated vomiting
  • Extreme dehydration because of vomiting
  • Oral skin issues from vomiting
  • Severe dental issues because of vomiting
  • Swollen saliva glands
  • Sleep issues
  • Irregular heartbeat
  • Dry skin
  • Stroke or heart attack because of electrolyte imbalance
  • Loss of, or interruption to menstrual period
  • Infertility
  • Reduced sex drive

Psychological symptoms

  • Uncommon fixation with weight and/or body shape
  • Inability to be happy with body appearance
  • Not feeling in control of one’s eating habits
  • A controlling fear about gaining weight
  • Mood swings
  • Reduced concentration
  • Stress and anxiety because of the condition and having to keep secrets

Behavioral symptoms

  • Religiously avoiding certain foods
  • Spending more than most people on food
  • Strictly controlling caloric intake between binges
  • Not stopping eating after reaching a feeling of being full
  • Eating more than most people at one time
  • Eating in private
  • Shedding excess calories using laxatives, diuretics, enemas, or self-induced vomiting
  • Obsessive, secret, and controlling behaviors in relation to preparing and eating food
  • Habitually making more than one visit to the restroom after eating
  • Abusing diet pills to prevent weight gain or to lose weight
  • Suicidal ideations or attempts

Those with bulimia routinely judge themselves very harshly in relation to what they see as flaws in their appearance; and in attempts to minimize that internal narrative, individuals can engage in behaviors that impact their reproductive, digestive, circulatory, and central nervous systems.

 

Causes of Bulimia Nervosa:

Factors that render an individual more vulnerable to developing bulimia nervosa can be psychological, emotional, social, genetic, and biological, and can include:

  • Emotional or psychological problems, low levels of serotonin and dopamine, impaired effective functioning
  • Cultural pressure to attain a certain body type, careers that have a focus on weight or appearance
  • Low self-esteem, negative thoughts or emotion related to body image
  • Obesity
  • Siblings or parents with the disorder
  • History of dieting
  • Trauma and or abuse
  • The stress of moving, changing schools, career changes, or other difficult transitions
  • Irregular levels of gut hormones and those related to gender

While there is no direct genetic link to the disorder, there might be a genetic link between inheriting traits like perfectionism, obsessiveness, anxiety, and inhibition and their potential to leave someone predisposed to developing the disorder.

 

Bulimia Nervosa complications:

The complications of bulimia nervosa include:

  • Thickened skin on the knuckles
  • Erosion and decay of teeth – as a result of excessive vomiting
  • Dehydration – which can lead to major medical problems such as kidney failure
  • Heart problems – such as irregular rhythm of the heart and heart failure
  • Gastrointestinal disturbances – diarrhea, constipation
  • Kidney damage and or failure
  • Obesity
  • The introduction or increase of low self-esteem
  • Alcohol or substance abuse or dependence
  • Suicidal ideation or actions
  • Absent periods in females

Bulimia is frequently associated with other mental disorders such as depression, anxiety, and addiction problems like alcohol dependence syndrome.

The twofold complications of bulimia are a result of either the malnourished state and/or the compensatory efforts taken in order to feel better physically or emotionally, or both.

 

Diagnosing Bulimia Nervosa:

A doctor will usually do physical exams and lab work — to rule out any other illnesses and assess the damage usually caused by bulimia — and conduct a psychological evaluation through a set of questionnaires and conversations to determine the person’s thoughts and feelings about food or eating.

The criteria for a bulimia nervosa diagnosis from the American Psychiatric Association’s DSM-5 (Diagnostic and Statistical Manual of Mental Disorders – version 5), includes the following:

  • Eating an unusually large amount of food compared to other people and doing so on an ongoing basis
  • During a binge-eating episode, experiencing a feeling of not being in control of when to stop eating, or of how much is eaten
  • Using purging mechanisms like laxatives and/or diuretics, medications, diet pills, extreme exercise, fasting, or self-induced vomiting to avoid weight gain
  • Weekly binge eating and purge episodes for a minimum of 3 months
  • Weight and body shape influence the sense of value or self-worth more than they would for most people
  • Neither the symptoms nor a diagnosis for anorexia

Bulimia is rated in relation to its severity using the DSM-5 Severity Indicator and by the number of inappropriate purging or weight compensation behaviors in a weekly period.

  • Mild – 1 to 3 weekly episodes
  • Moderate – 4 to 7 weekly episodes
  • Severe – 8 to 13 weekly episodes
  • Extreme – more than 14 weekly episodes

Even if someone doesn’t qualify for a bulimia diagnosis, he/she may still have an eating disorder that could damage their body physically, as well as have a profound negative impact on their mental and emotional health. Professional help should be sought out.

 

Treatment of Bulimia Nervosa:

The primary treatment for bulimia is typically a combination of psychotherapy and medication. A case manager is usually assigned to coordinate care between the doctor, nutritionist or dietician, and mental health professionals.

If the bulimia has caused severe health problems, the person might initially be admitted to a hospital or attend a day center, and treatment options include:


  • Cognitive behavioral therapy (CBT) – the CBT format specifically designed in relation to eating disorders is CBT-E. The person explores his or her thoughts and feelings toward food and body image and examines the reasons behind the external actions of binging and purging before learning how to adopt new thinking patterns and strategies.
  • Interpersonal therapy – Examines relationships and/or experiences which may have led to the thought processes in the development of bulimia. Part of this treatment teaches social skills; enforcing boundaries; and how to deal with isolation and unresolved grief, difficult transitions in life, and/or relational conflict at home, at work, or at school.
  • Family-based therapy – For families with a child or teenager diagnosed with bulimia, supportive parents or guardians are taught how to be actively involved in helping the child establish healthy eating habits and return to an appropriate weight for their age and height.
  • Education – Educates about the importance of optimal physical health and the adoption of regular, healthy eating habits.
 

Medications for Bulimia Nervosa can include:

Medication alone is rarely considered effective, but antidepressants are often prescribed in combination with psychotherapy.

Antidepressants

  • Fluoxetine – a selective serotonin reuptake inhibitor that helps reduce symptoms of depression, OCD, and anxiety
  • Venlafaxine – a serotonin-norepinephrine reuptake inhibitor that helps reduce symptoms of depression and anxiety

Sometimes younger people react badly to antidepressants, experiencing suicidal thoughts and severe mood symptoms. For this reason, they should be closely monitored for any possible reaction to the medication over the first few weeks.

Certain antidepressants can react badly to other medications the person is on, and to alcohol, so be sure to check for any listed drug combination warnings.