Introduction. What is Bulimia Nervosa?
The term “Bulimia” is derived from the Greek words “ox hunger,” while “nervosa” was added to signify its nervous nature. Bulimia nervosa is a psychiatric condition where individuals engage in binge eating and employ compensatory techniques to prevent weight gain, which may result in detrimental consequences. It is crucial to swiftly identify and diagnose this psychiatric disorder, provide sufficient treatment and observe progress and any medical issues likely to occur.
Symptoms of bulimia
Bulimia nervosa features a cycle of food cravings and compensatory behaviours, such as self-induced vomiting or the use of diuretics or laxatives, sometimes repeated several times a day. People with bulimia nervosa are usually of average weight. Although their weight might be within the normal range, they are dissatisfied with their body shape. As a result, they sometimes give up eating altogether: they go hungry or eat irregularly. They often go on diets or skip meals. Affected people get caught in a vicious circle of not eating, food cravings, binge eating and self-induced vomiting.
The condition is strongly associated with feelings of guilt and shame. This is why this eating disorder is often kept secret and remains hidden for years.
“Forbidden” and “permitted” foods
Those affected by bulimia distinguish between “forbidden” foods, which are mostly very high in calories, and “permitted” foods with fewer calories and fat. Typical for this condition is binge-eating episodes usually followed by self-induced vomiting. They hastily consume large amounts of food without seeming to stop. Binge eating involves devouring foods that are readily available, quick to eat, high in calories, and actually “forbidden.”
Binge eating and purging
During the binge eating episodes of bulimia nervosa, the food is poorly chewed, and little attention is paid to taste. Above all, it is essential to be able to choke out what has been ingested later. Eating continues until an uncomfortable feeling of fullness arises, food runs out or external disturbances occur. Binge-eating episodes usually happen in secret followed by self-induced vomiting.
Treatment for bulimia
As with other eating disorders, the will and motivation of the patient are prerequisites for successful treatment of bulimia nervosa. The treatment is primarily outpatient. Psychotherapists and clinical counsellors plan their treatment based on different forms of psychotherapy. The effective treatment methods are family therapy, CBT (cognitive-behavioural therapy), person-centred counselling and psychoanalytic therapy.
Involving the family
The treatment takes place in individual and group therapies, if possible, with the involvement of the legal guardians and the family system. In the case of adolescent eating disorders, it is particularly important to involve the patient’s parents in the treatment. Family counselling and family therapy have proven to be particularly effective. In addition to psychotherapy, self-help groups can be helpful as an auxiliary feature to the main treatment.
Hospitalization
If the symptoms are very pronounced or there are severe personality disorders, self-harm behaviour or risk of suicide, hospitalization and inpatient treatment may be necessary. In the case of metabolic or other physical disorders such as Crohn’s disease or diabetes, medical treatment is essential.
Treatment of bulimia may also include psychiatric medication. When co-morbid psychiatric disorders, such as anxiety or depression, are present, psychiatrist may recommend a combination of pharmacological interventions (treatment with medication) in addition to psychotherapy.
Risks
Bulimia causes psychological and physical harm with mostly severe long-term consequences. Excessive vomiting leads to stomach inflammation (gastritis) and in extreme cases even to stomach perforation. Other long-term effects of vomiting are dental damage, oesophagitis (oesophageal inflammation), and inflammation of salivary glands.
Patients suffering of bulimia are typically not underweight, nevertheless they can suffer of malnutrition. The latter is caused by imbalanced, or deficient diet combined with purging and leads to loss of vitamins (vitamins B 12, and D), microelements, electrolytes and to hormonal changes. In consequence bulimic patients develop heart and kidney problems, hair loss, skin illnesses and osteoporosis.
Useful sources about bulimia
National Eating Disorders Association (NEDA)
National Association of Anorexia Nervosa and Associated Disorders (ANAD)