Bulimia Nervosa

Bulimia nervosa, commonly known as bulimia, is an eating disorder and psychological condition in which the subject engages in recurrent binge eating followed by feelings of guilt, depression, and self-condemnation and intentional purging to compensate for the excessive eating, usually to prevent weight gain (see anorexia nervosa). Purging can take the form of vomiting, fasting, inappropriate use of laxatives, enemas, diuretics or other medication, or excessive physical exercise. The cycle damages bodily organs. Bulimia nervosa is common especially among young women of normal or nearly normal weight.

The word bulimia comes from the Latin (būlīmia) from the Greek βουλῑμια (boulīmia), ravenous hunger, compounded from βους (bous), ox + λῑμος (līmos), hunger.

Bulimia Nervosa Diagnosis

The criteria for diagnosing a patient with bulimia nervosa are as follows: 

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a fixed period of time (e.g., within any two-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics or other medications; fasting; or excessive exercise.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of anorexia nervosa.
See the Diagnostic and Statistical Manual of Mental Disorders. If any of these symptoms are noticed, a doctor or psychologist should be contacted. However, these symptoms are often difficult to spot. Unlike anorexia nervosa, the person must be of normal or higher weight and is less likely to drop a significant amount of weight on a continual basis. Because bulimia carries a great deal of shame, the bulimic desperately tries to hide the symptoms from family and friends. Bulimia is more likely to span over a lifetime unnoticed, causing a great deal of isolation and stress for the suffering individual. Despite the frequent lack of obvious physical symptoms, bulimia has proven to be fatal, as malnutrition takes a serious toll on every bodily organ.

Bulimia yclic patterns

Bulimics go through cycles of over-eating and purging, that may be severe and devastating to the body. They sometimes involve rapid and out-of-control feeding that stops when the bulimic is interrupted by another person or when his/her stomach hurts from over-extension. This cycle may be repeated several times a week or, in serious cases, several times a day.

Some bulimics eat secretly, others eat socially but are bulimic in private. They also differ in "how much" they purge. Some can vomit without gagging themselves after eating. Often when the urge hits, they go to great lengths to purge, as if an uncontrollable urge is making them do so. Medical evidence shows that the chemicals released when purging may make a person feel "high".[citation needed] This can also lead to extreme dehydration and electrolyte imbalances.

Some bulimics do not regard their cycles as a problem, while others despise and fear the vicious and uncontrollable cycle. Bulimics may appear underweight, normal weight or overweight.

Bulimia Types

Two subtypes of bulimia are distinguished by the way the bulimic relieves themselves of the binge.

Purging Type is the more common type of bulimia, and involves any of self-induced vomiting, laxatives, diuretics, tapeworms, enemas, or ipecac, to rapidly extricate the contents from their body.

Non-Purging Type occurs in only approximately 6%-8% of bulimia cases, as it is a less effective means of ridding the body of such a large number of calories. It involves doing excessive exercise or fasting after a binge, to counteract the large amount of calories previously ingested. This often occurs in purging-type bulimics but is a secondary form of weight control.

Bulimia Causes

Bulimia is related to deep psychological issues and feelings of lack of control. Sufferers often use the destructive eating pattern to feel in control over their lives. They may hide or hoard food and overeat when stressed or upset. They may feel a loss of control during a binge, and consume great quantities of food (over 20,000 calories.) After a length of time, the sufferer of Bulimia will find that they no longer have control over their binging and purging. The binging becomes an addiction that seems impossible to break. Recovery is very hard and often in the early stages of recovery the patient will gain weight as they are still binging but no longer purging, causing anxiety which will in turn cause the patient to revert back to bulimia.

There are higher rates of eating disorders in groups involved in activities that emphasize thinness and body type, such as gymnastics, dance and cheerleading, figure skating. Bulimia is more prevalent among Caucasians, In one study, diagnosis of bulimia was correlated with high testosterone and low estrogen levels, and normalizing these levels with combined oral contraceptive pills reduced cravings for fat and sugar.[12]

Bulimia Consequences

Bulimia can cause following health problems:

Malnutrition
Dehydration
Electrolyte imbalance, which can cause cardiac arrest or brain damage by stroke
Hyponatremia
Damaging of the voice
Vitamin and mineral deficiencies
Teeth erosion and cavities, gum disease
Salivary gland swelling (sialadenosis)
Potential for gastric rupture during periods of binging
Esophageal reflux
Irritation, inflammation, and possible rupture of the esophagus
Laxative dependence
Peptic ulcers and pancreatitis
Emetic toxicity due to ipecac abuse
Swelling of the face and cheeks, especially the lower eyelids, due to the high pressure of blood in the face during vomiting; for the same reason Purpura can occur, a rash caused by burst blood vessels.
Callused or bruised fingers
Dry or brittle skin, hair, and nails, or hair loss
Lanugo
Edema
Muscle atrophy
Decreased or increased bowel activity
Digestive problems that may be triggered, including celiac, Crohn's Disease
Low blood pressure (hypotension)
Orthostatic hypotension
High blood pressure (hypertension)
Iron deficiency
Anemia
Hormonal imbalances
Hyperactivity
Depression
Insomnia
Amenorrhea
Infertility
High risk pregnancy, miscarriage, still-born babies
Diabetes
High blood sugar (hyperglycemia)
Ketoacidosis
Osteoporosis
Arthritis
Weakness and fatigue
Chronic Fatigue Syndrome
Cancer of the throat or voice box
Liver failure
Kidney infection and failure
Heart failure, heart arrhythmia, angina
Seizure
Paralysis
Death caused by heart attack or heart failure; lung collapse; internal bleeding, stroke, kidney failure, liver failure; pancreatitis, gastric rupture, perforated ulcer, depression and suicide.

Related psychological disorders

Many bulimics also have anxiety or mood disorders. One study found anxiety in 75% of bulimic patients. Prominent mood disorders include depression and substance abuse. Recent research suggests that depression is caused by the eating disorder. Bulimics are also more likely to attempt suicide and engage in impulsive behaviors.

Bulimic females typically have a less favorable opinion of themselves than control groups. They are more pessimistic, more ambivalent towards others, strive for less recognition in areas that are socially significant or require leadership. However, they also express a need to solicit sympathy, affection, and emotional support.

Bulimics are usually raised in dysfunctional families. Many also display alexithymia, the inability to consciously experience and express emotions.

Differences from anorexia nervosa

The main criteria differences involve weight: an anorexic must have a body mass index of less than 17.5. Typically an anorexic is defined by the refusal to maintain a normal weight by self-starvation.

Another criterion which must usually be met is amenorrhea, the loss of a female's menstrual cycle not caused by the normal cessation of menstruation during menopause for a period of three months. Generally the anorexic does not engage in regular binging and purging sessions. If binging and purging occurs but rarely, and the patient also fails to maintain a minimum weight, they are classified as a purging anorexic, due to the underweight criterion being met and cessation of menstruation.

Characteristically, bulimics feel more shame and out of control with their behaviors, as the anorexic meticulously controls their intake, a symptom that calms their anxiety around food as s/he feels s/he has control of it, naïve to the notion that it, in fact, controls her/him. For this reason, the bulimic is more likely to admit to having a problem, as they do not feel they are in control of their behavior. The anorexic is more likely to believe they are in control of their eating and much less likely to admit that a problem exists.

Anorexics and bulimics have an overpowering sense of self determined by their body and their perceptions of it. They trace all their achievements and successes to it, and so are often depressed as they feel they are consistently failing to achieve the perfect body. Bulimics feel that they are a failure because s/he cannot achieve a low weight, and this outlook infiltrates into all aspects of their lives. Anorexics cannot see that they are underweight and constantly work towards a goal that they cannot meet. They too allow this failure to define their self worth. As both the anorexic and bulimic never feel satisfaction in the more important part of their lives, depression often accompanies these disorders.

Bulimia At-risk groups

Risk factors for bulimia are similar to those of other eating disorders, such as anorexia.

The groups listed below are considered to be at the highest risk:

those of age 10 through to 25 (though typically bulimia tends to start in late teens or early 20s)
athletes 
those with/with a history of anorexia
students who are under heavy workloads
those who have suffered traumatic events in their lifetime such as child abuse and sexual abuse
people raised in dysfunctional families
those positioned higher on the socioeconomic scale
the highly intelligent and/or high-achievers
perfectionists
However, the disorder can occur in people of all ages and both sexes. There is a new rise of cases in men. In older patients, symptoms may have continued untreated for several years or decades, making the behaviors increasingly ingrained and difficult to confront. A popular assumption is that eating disorders are female diseases, but 2-8% of patients are male. Unfortunately, many men do not get the help they need for fear being thought of as homosexual or having a "Women's disease"[citation needed]

Bulimia Prevention

There is no known way to prevent the onset of bulimia. Less social and cultural emphasis on physical perfection may help, but it is difficult to make sweeping societal changes. The best way to stop the progression of bulimia is early intervention by contacting a medical health professional and receiving psychotherapy. Adults have an immeasurable impact on their children. Teaching children to adopt a healthy diet as a way of life and incorporating fun activities into their day allows this to become second nature to them. Children should be taught an emphasis on their internal characteristics and qualities rather than the external focus so much of society and the media tend to focus on. Action is the best way of teaching, and the adults' self-criticism and behavior reflects substantially on their children’s impressions of themselves.

Bulimia History

Bulimia was first described in 1977 by Boskind-Lodahl and Gerald Russell, who worked at the Royal Free Hospital, London. It has been recognized as an autonomous eating disorder by the American Psychiatric Association since 1980.