Bulimia Nervosa

Bulimia (boo-LEE-me-uh) nervosa, commonly called bulimia, is a serious, potentially life-threatening eating disorder characterized by a cycle of secrete bingeing — eating large amounts of food — and compensatory purging, which involves self-induced vomiting to get rid of the extra calories in an unhealthy way.

Sometimes, people may purge even after eating only a small snack or a normal meal. Bulimia is categorized into two types:

 Purging bulimia

In this type, people regularly self-induce vomiting or misuse laxatives, diuretics or enemas after bingeing.

Nonpurging bulimia

People use other methods such as fasting, strict diet or vigorous exercising to get rid of extra calories and prevent weight gain.

These behaviors usually overlap, and irrespective of the method used, the attempt to get rid of extra calories is referred to as purging.

People with bulimia will be preoccupied thinking about their weight and body shape. They may judge themselves severely and harshly for self-perceived flaws. As it is related to self-image, and not just about food, it can be difficult to overcome this problem on your own.

Effective treatment may help you

• feel better about yourself,
• adopt healthy eating patterns,
• and reverse serious complications.

Symptoms

The signs and symptoms of bulimia nervosa may include:

• Being preoccupied with the thought of your body shape and weight
• Living with a fear of gaining weight
• Having a distorted body image (believing that you are overweight even if you have a healthy weight for your age and height)
• Feeling that your eating behavior is out of control
• Eating execssively until the point of discomfort or pain
• Eating large amounts of food in a binge episode than your normal meal or snack
• Forceful vomiting or exercising rigorously to prevent weight gain after bingeing
• Misusing laxatives, diuretics or enemas after eating excessively
• Strictly dieting by restricting calories or avoiding certain foods between epsiodes of bingeing
• Excessive use of dietary supplements or herbal products for weight loss

Physical signs

• Frequent loss or gain in body weight
• Signs of damage caused by vomiting include swelling around the cheeks or jaw, calluses on knuckles, damage to teeth, and bad breath
• Feeling of bloating, constipation or developing an intolerance towrads food
• Loss of or disturbance in menstrual periods in girls and women
• Dizziness
• Fatigue and sleeplessness

When to see a doctor

If you tend to have symptoms of bulimia nervosa, seek help from your doctor as early as possible. Bulimia can severely affect your health if it remains untreated. Discuss with your primary care provider or a mental health provider about your symptoms and feelings.

The exact cause of bulimia nervosa is unknown, and may differ from one person to another.

Some of the known factors that could play an important role in the development of eating disorders include

• genetic predisposition,
• biology,
• emotional health,
• combination of environmental, social and cultural factors.

Making a diagnosis of bulimia nervosa is done by performing several tests.

Here is some information to that can help you get ready for your appointment, and know what to expect from your doctor or other health care provider.

What you can do

Before your appointment, make a list of

• Your symptoms, even those that may seem unrelated to bulimia
• Key personal information, including any major stresses or recent life changes
• All medications, herbal supplemets, vitamins or other supplements that you take regularly and their doses

Questions to ask your doctor

Ask a family member or friend to accompany you, if possible. Someone who comes with you may remember something that you may have missed or forgotten to ask. A family member may also be able to give your doctor a complete picture of your home life.

For bulimia nervosa, some basic questions to ask your doctor include:

• What kind of tests do I need? Do these require any special preparation?
• What treatments are available, and which one do you recommend?
• Is a generic alternative available to the medicine you have prescribed?
• Does treatment affect my weight?
• Will I have normal, regular periods again?
• Are there any brochures or other printed material that I can take home? What websites do you recommend?

What to expect from your doctor

• Your doctor may ask you several questions, such as:
• For how long have you been worried about your weight?
• How often do you exercise?
• Have you tried other ways to lose weight?
• Do you have any physical symptoms?
• Did you ever vomit after being uncomfortably full?
• Have you taken any medications for weight loss?
• Do you think about food frequently?
• Do you have the habit of eating secretly?
• Do you have a family history of an eating disorder?

Your doctor is likely to ask additional questions based on your responses, symptoms, and needs.

If your doctor suspects that you have bulimia nervosa, he or she will typically perform:

• A complete physical examination
• Blood and urine tests
• A psychological evaluation that includes a discussion of your eating habits and attitude towards food

Your doctor may also order additional tests, if necessary to help pinpoint a diagnosis, rule out other physical causes for weight changes, and check for any other related complications.

Criteria for diagnosis

For a diagnosis of bulimia, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association has listed these points:

• Recurrent episodes of eating an abnormally large amount of food ― more than most people can eat in a similar amount of time and under similar circumstances, for example, in a two-hour time period.

• Lack of control while bingeing, such as how much you eat and whether you can stop eating.

• Getting rid of the extra calories gained from bingeing by induced vomiting, excessive exercise, fasting, or misuse of laxatives, diuretics or other medications to avoid weight gain.

• There has been binging and purging episodes at least once in a week for at least three months.

• Your body shape and weight have excessive influence on your feelings of self-worth.

• You do not have anorexia, an eating disorder with extremely restrictive eating behavior.

• The severity of bulimia depends on the number of times you purge in a week. You may have an eating disorder even if you do not meet all of the above criteria. Seek professional help if you have any symptoms of eating disorders, and do not try to diagnose yourself.

A combination of psychotherapy with antidepressant medications may be the most effective treatment for overcoming bulimia nervosa.

Treatment generally involves a multidisciplinary team approach that includes you, your family membres, your primary care doctor or other health care provider, as well as a mental health provider, and a dietitian experienced in treating eating disorders.

When you have bulimia, you may need several types of treatment options that include:

Psychotherapy

Psychotherapy, also called talk therapy or psychological counseling, involves discussion of your bulimia and related issues with your mental health provider. There are evidences that indicate that following types of psychotherapy help improve the symptoms of bulimia:

Cognitive behavioral therapy

It helps you identify unhealthy, negative beliefs and behaviors, and replace them with healthy, positive ones.

Family-based therapy

Helps parents intervene and stop their teenager's unhealthy eating behaviors, then to help your teen regain control over his or her own eating habits, and also helps the family deal with problems that bulimia can have on the teen's development and the family.

Interpersonal psychotherapy

Addresses difficulties that persist in your close relationships thus helping to improve your communication and problem-solving skills.

Ask your mental health provider which psychotherapy is beneficial in treating your bulimia.

Medications

Antidepressants, when used with psychotherapy helps in reducing the symptoms of bulimia. The only antidepressant specifically approved by the Food and Drug Administration to treat bulimia is fluoxetine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI).

Maintain a healthy weight by developing normal eating habits

Dietitians can design an individualized eating plan for you to help achieve a healthy weight, normal eating habits, and good nutrition. You may benefit from a medically supervised weight-loss program.

Hospitalization

If you have a severe form of bulimia, which results in serious health complications, you may need treatment in a hospital.

Challenges in treating Bulimia

Most people with bulimia recover completely, but in some symptoms may not go away entirely.

Periods of bingeing and purging may recur again and go depending on your life circumstances, such as recurrence may be seen during times of high stress.

If you find yourself back in the binge-purge cycle, "booster" sessions with your health care providers may help you manage the condition before your eating disorder goes out of control again.

Learn positive ways to cope, create healthy relationships and manage stress to prevent a relapse.

There are no sure ways to prevent bulimia nervosa. You can guide someone towards healthy eating habits or professional treatment before the situation becomes worse.

Here are some measures that can help to manage your condition:

• Help your children develop and reinforce a healthy body image, no matter what their size or shape is.

• Discuss with your pediatrician: Pediatricians can identify early signs of an eating disorder, and help you prevent its development.

• If you have a relative or friend with issues in eating food that could lead to or indicate an eating disorder, consider supportively talking to the person about these issues and ask how you can help.

A few alternative and homeopathic remedies exist for bulimia nervosa.

Dietary supplements and herbal remedies designed to suppress your appetite and aid in weight loss may be abused by people with eating disorders.

Weight-loss herbal supplements have serious side effects and can dangerously interact with other medications.

Discuss the potential risks with your doctor, if you want to use dietary supplements or herbs.

A few alternative and homeopathic remedies exist for bulimia nervosa.

In addition to professional treatment, you can follow these self-care tips for bulimia:

Strictly adhere to your treatment plan

Do not miss your therapy sessions and try to follow your meal plans, even if they make you uncomfortable.

Learn about bulimia

Awareness about your condition empowers you and motivates you to follow your treatment plan.

Get proper nutrition

If you do not eat well or you purge frequently, it is likely that your body gets deprived of the essential nutrients. Eating at regular intervals and not restricting your food intake is the first step towards overcoming bulimia.

Your doctor will advise appropriate vitamin and mineral supplements.

Stay in touch

Do not isolate yourself from family members and friends who care for you. They have your best interests at heart and these nurturing, caring relationships are healthy for you.

Be kind to yourself

Resist frequent urges to weigh yourself or check yourself in the mirror. These may fuel your drive to maintain unhealthy habits.

Be cautious with exercise

Discuss with your doctor about what kind of physical activity is appropriate for you, especially if you exercise to burn off post-binge calories.

Coping and support

It may be difficult to cope with bulimia when you have to confront mixed reactions from the media, culture, coaches, family, and may be your own friends or peers.

So, how do you cope with a disease that can be fatal when you keep getting messages that being thin is a sign of success?

• Remember what a healthy weight is for your body.
• Resist the urge to diet or skip meals, which may trigger binge eating.
• Identify and avoid troublesome situations that can trigger thoughts or behaviors that may contribute to your bulimia.
• Have a plan made to cope with the emotional distress of setbacks.
• Follow positive role models who can help boost your self-esteem.
• Find pleasurable activities and hobbies that help you get distracted from thoughts about bingeing and purging.
• Boost your self-esteem by forgiving yourself and giving yourself credit

Get support

If you have bulimia, you and your family may find support groups helpful to provide encouragement, hope and advice on coping. Group members can understand what you are going through because they have been there with you. Ask your doctor if he or she knows of any support group near your area.

Coping advice for parents

If you are the parent of a child with bulimia, you may start blaming yourself for your child's eating disorder. Bulimia may have many causes, and parenting style solely is not a primary cause. It is good to focus on how you can help your child. Here are some suggestions that help support your child:

Ask your child what you can do to help. For example, ask if your teenager would like to plan some interesting family activities after meals so as to reduce the temptation to purge.

Listen to your child

Allow your children to express their feelings.

Schedule regular family mealtimes

Eating at routine times along with your family is important to help reduce binge eating.

Let your teenager know the concerns you have, but always do this without blaming.

Remember that eating disorders can affect the entire family, and you need to take care of yourself, too. You might benefit from professional counseling or ask your child's doctor about support groups for parents of children with eating disorders.

Factors that increase your risk of developing bulimia nervosa may include:

• Being female: Girls and women are more likely to develop this eating disorder than boys and men.
• Age: Bulimia is common in the late teens or early adulthood.
• Genetic factors and biology: Individuals with their first-degree relatives (siblings, parents or children) with an eating disorder may be more likely to develop an eating disorder, indicating a potential genetic link. A deficiency in the brain chemical- serotonin may also play a role. Being overweight as a child or teen may increase the risk.
• Psychological and emotional problems: Anxiety disorder, depression, perfectionism may contribute to low self-esteem which can further lead to eating disorders. Triggers for bingeing may include stress, poor body self-image, restrictive dieting or boredom. In some cases, traumatic events and environmental stress may also act as contributing factors.
• Media and societal pressures:The mass media, such as TV and fashion magazines often feature skinny models and actors that seem to correspond thinness with fame and success. Whether the media merely reflects social values or actually drives them is not clear.
• Sports, work or artistic pressures:Athletes, actors, dancers, and models are at a higher risk of developing bulimia nervosa. Parents or coaches may encourage young athletes to lose weight, maintain a low weight, restrict eating for better performance, which inadvertently increases the risk of bulimia.

Complications

Bulimia leads to serious, life-threatening complications such as:

• Dehydration, which causes major medical problems such as kidney failure
• Heart disorders such as an irregular heartbeat or heart failure
• Severe tooth decay and gum problems
• Absent or irregular menstual periods
• Digestive system disorders, and a dependence on laxatives to have bowel movements
• Anxiety and depression
• Alcohol and drug abuse
• Suicide