What is bulimia?
Over 85% of reported cases of bulimia occur in girls in their late teens and early twenties. On average, Bulimia occurs slightly later than Anorexia Nervosa. Approximately 10% of people with the condition are men.
Bulimia, medically known as bulimia nervosa, is marked by cycles of binge eating of excessive quantities of food, followed by purging using vomiting, laxatives or diuretics and/or excessive exercising.
If you have bulimia nervosa you are likely to be preoccupied with food. You may have episodes of craving food and eat vast amounts of food in secret. The common foods to binge on are sweet, high-calorie foods often though of as ‘treats’ such as ice cream, cakes, chocolate and biscuits.
The frequency of these bulimic cycles will vary. Some will binge and purge occasionally whilst others will binge and purge several times a day. Some cases of bulimia nervosa are short-lived. However often the symptoms will be present for some months or years before help is sought. Sometimes bulimia persists for many years and in some people symptoms may be present all their lives.
It is difficult to find accurate statistics about bulimia nervosa as it so often goes undiagnosed and untreated. The incidence is usually put at 2-3% of young women but the true incidence may be higher.
Symptoms of bulimia
Physical symptoms of bulimia are:
- Fluctuations in weight
- Sore throat, heartburn and tooth decay caused by excessive vomiting
- Puffiness of the face caused by swollen salivary glands
- Spots and poor skin condition
- Scarred knuckles due to attempts to force fingers down the throat to induce vomiting
- Irregular periods
- Lethargy and tiredness
- Depression, anxiety, low self esteem and mood swings
- Constipation and intestinal damage.
- Fear of obesity and distorted perception of body weight
- Obsession with eating and episodes of irresistible craving for food and secret bingeing
- Excessive exercise
- Fasting for periods of time
- Using laxatives, diuretics or enemas to counteract the bingeing.
- Tendency to leave the table immediately after a meal and disappearing to the toilet in order to vomit food eaten.
What causes bulimia?
The causes of Bulimia nervosa remain largely unknown but possibilities include:
- Some people who develop this condition have been physically or sexually abused as children.
- Some people have been in difficult family or sexual relationships.
- Others appear not to have experienced these problems but still lack self-worth and need an outlet for their emotions.
- Research suggests there may be a genetic link.
- Social pressures to be thin to be sexually attractive may be a factor.
It is thought that bulimia nervosa is a physical way of dealing with depression, stress, or issues of self-esteem. It may protect you from experiencing feelings and emotions that have become distressing and intolerable.
It enables feelings of short-lived control and calmness but the strategy soon becomes destructive as you begin to feel guilty, disgusted and out of control.
This cycle of bingeing and purging maintains and increases the severity of the condition, which can come to dominate all your emotional experience.
Sometimes in association with bulimia, other problems may be present, including drug abuse, alcohol abuse, self-harm, shoplifting and promiscuity. Also bulimia may be preceded by a brief period of Anorexia Nervosa and weight may remain low.
How to diagnose bulimia?
People with bulimia are often of normal weight, so the condition is not easy to recognize by friends or family.
Common indications are erosion of teeth enamel and scarring on the back of the hands.
Is it possible to treat bulimia?
Severity of bulimia varies considerably. It is likely that there are large numbers of girls with mild symptoms who never seek medical help and do recover on their own. However, there is a risk that the bulimia will slowly get worse with time. A common time for women to seek help is when they are planning to start a family.
Guidelines for the treatment published by the National Institute for Clinical Excellence (NICE) in January 2004 sets the standard for NHS treatment in of eating disorders in England and Wales.
The main guidelines for Bulimia nervosa:
- GP’s should make an early diagnosis of an eating disorder so those seeking help should be assessed and receive treatment at the earliest opportunity.
- Your assessment should be comprehensive and include physical, psychological and social needs.
- Your G.P. should initially offer you an evidence-based self-help programme. As an alternative or additional, adults with bulimia nervosa should be offered the antidepressant medication – fluoxetine (Selective serotonin re-uptake inhibitor /SSRI).
Self help does not work you should be offered Cognitive Behavioral Therapy, especially developed for bulimia (CBT- BN) The course should normally be 16-20 individual sessions over 4 to 5 months.
If you are a teenager with Bulimia you should be offered CBT-BN adapted as needed to suit your age, circumstances and level of development.
Family members (including other children in the family) should be involved as appropriate. The course should normally be 16-20 individual sessions over 4 to 5 months.
If you not respond or do not want CBT, other psychological treatment should be considered.
You will normally be treated in an out- patient setting, however a very small minority of people with bulimia may need inpatient treatment, when the condition is linked to a suicide risk or severe self- harm.
Advice can also be sought from specialist eating disorder help lines. You may be encouraged to keep a diary of eating habits. Success often depends on you wanting to recover, if this is the case, the outcome of treatment is very good.
Complications of bulimia
In extreme circumstances even if you are of normal weight, you can severely damage your body by frequent binging and purging. Electrolyte imbalance, dangerously low levels of the essential minerals and dehydration can cause heart problems and, occasionally, sudden death due to a heart attack.
They may also cause severe problems to other vital internal organs of the body. In rare instances, binging can cause the stomach to rupture.