BULIMIA NERVOSA

Bulimia nervosa(otherwise known as bulimia) is a serious, potentially life threatening eating disorder characterized by recurrent and frequent episodes of eating unusually large amounts of food ( binge-eating), and feeling a lack of control over the eating. The binge-eating is followed by a type of behavior that compensates for the binge, such as purging (e.g., self induced vomiting, excessive use of laxatives or diuretics), fasting and/or excessive exercise. Bulimia nervosa affects 1-2% of adolescent and young adult women. 80% of bulimia nervosa patients are females.

Usually, bulimic behavior is done secretly, because it is often accompanied by feelings of disgust or shame. Similar to anorexia, people with bulimia often have coexisting psychological illnesses, such as depression, anxiety and/or substance abuse problems. Risk of death from suicide or medical complications is markedly increased for eating disorders. When struggling with bulimia, life is a constant battle between the desires to lose weight or stay thin and the overwhelming compulsion to binge eat.
People with bulimia, are probably preoccupied with their weight and body shape, and may judge themselves severely and harshly for self-perceived flaws. Because it's related to self-image and not just about food bulimia can be difficult to overcome.                               

TYPES OF BULIMIA

• Purging bulimia –Here there’s regularly self-induced vomiting or misuse laxatives, diuretics or enemas after bingeing.
• Non-purging bulimia – Here other methods to get rid of calories and prevent weight gain, such as fasting, strict dieting or excessive exercise.

SYMPTOMS

Bulimia signs and symptoms may include:

·         Preoccupation  with  body shape and weight

·          Fear of gaining weight

·         Preoccupation with food

·         A feeling of being out of control during the binge-eating episodes

·         Eating until the point of discomfort or pain

·         Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.

·         Compulsive exercise

·         Abuse of laxatives, diuretics, diet pills

·         Using dietary supplements or herbal products for weight loss

·         Self-esteem overly related to body image.

·         Swollen salivary glands(cheeks)

RED FLAGS /WARNING SIGNS

The chance for recovery increases the earlier bulimia nervosa is detected. Therefore, it is important to be aware of some of the warning signs of bulimia nervosa.

·         Constantly worrying or complaining about being fat

·         Having a distorted, excessively negative body image

·         Repeatedly eating unusually large quantities of food in one sitting, especially high-fat or sweet foods

·         Not wanting to eat in public or in front of others

·         Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.

·         Calluses on the back of the hands and knuckles from self-induced vomiting.

·         Exercising too much to burn off calories taken in

·         Continued exercise despite injury

·         Having damaged teeth and gums

·         Discoloration of the teeth

·         Withdrawal from usual friends and activities

·         In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

CAUSES

The exact cause of bulimia is unknown. There are many possible factors that could play a role in the development of eating disorders - biology, emotional health, societal expectations and other factors increase your risk

RISK FACTORS

• Female sex - Girls and women are more likely to have bulimia than boys and men are.
• Age - Bulimia often begins in the late teens or early adulthood.
• Genetics - People with first-degree relatives (siblings or parents) with an eating disorder may be more likely to develop an eating disorder,
• Biology – in addition to the genetic linkage, it’s also possible that a deficiency in the brain chemical serotonin may play a role.
• Social Factors - Peer pressure and media influence may fuel a desire to be thin, particularly among young women. Professionals who are in the public eye, such as actors, dancers and models, are at higher risk of eating disorders. 
• Psychological and emotional issues - People with psychological and emotional problems may develop eating disorder. Examples include low self-esteem, impulsive behavior, anger management problems, perfectionism, depression, anxiety disorders or obsessive-compulsive disorder.
• Sports - Eating disorders are particularly common among athletes, such as gymnasts, runners etc                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  

·        COMPLICATIONS
         Dehydration, which can lead to

·          kidney failure

·         Severe tooth decay and gum disease

·         Absence of a period in females

·         Electrolyte imbalances

·         Heart problems -   irregular heartbeat and heart failure

·         Anxiety

·         Depression

·         Drug and alcohol abuse

·         Digestive problems, and possibly a dependence on laxatives to have bowel movements

TREATMENTS AND DRUGS

People with bulimia, may need several types of treatment; however combining psychotherapy with antidepressants may be the most effective for overcoming the disorder. Treatment involves a team approach that includes the patient, family, doctors, dietician, psychotherapist/ mental health provider amongst others.

Medications

Antidepressants when used with psychotherapy may help reduce the symptoms of bulimia. Approved antidepressants include fluoxetine an SSRI (selective serotonin reuptake inhibitor.)

Nutrition

 Dietitians and other health care providers can design an eating plan to achieve a healthy weight, normal eating habits and good nutrition.

Psychotherapy

There's evidence that these types of psychotherapy help improve symptoms of bulimia:

·         Cognitive behavioral therapy - identifies unhealthy, negative beliefs and behaviors and replaces them with healthy, positive ones.

·         Dialectical behavior therapy – helps to learn behavioral skills to tolerate stress regulate your emotions and improve your relationships with others.

·         Interpersonal psychotherapy -  addresses difficulties in close relationships, helping to improve  communication and problem-solving skills

·         Family-based treatment -   help parents intervene to stop their teenager's unhealthy eating behaviors; helps the teen regain control over his or her own eating, and helps the family deal with problems the bulimia can have on the teen's development and the family .

LIFESTYLE AND HOME REMEDIES

 In addition to professional treatment, follow these self-care tips:

Ø  Stick to the treatment plan. Don't skip therapy sessions

Ø  Get the right nutrition. Talk to the doctor about appropriate vitamin and mineral supplements especially when not eating well.

Ø  Learn about bulimia. Education about your condition can empower you and motivate you to stick to your treatment plan.

Ø  Be cautious with exercise.

Ø   Don't isolate yourself from caring family members and friends.

Ø  Resist urges to weigh yourself or check yourself in the mirror frequently..

ALTERNATIVE MEDICINE

Not extensively studied but may help to reduce symptoms-

Ø  Massage and therapeutic touch

Ø   Meditation,

Ø   Yoga,

Ø  Biofeedback

Ø   Hypnosis

Ø  Acupuncture

PREVENTION

There's no guaranteed way to prevent bulimia nervosa. If you notice a friend or family member with symptoms or warning signs of bulimia, consider talking to him or her about these issues.