What is bulimia nervosa?
Bulimia nervosa is an eating disorder (ED) characterized by frequent binges where the person usually eats significant amounts of food in a short period of time. Anyone can have bulimia, but it is widespread in women during adolescence or early adulthood.
People with bulimia restrict their food intake to lose weight. However, this creates a state of physical hunger and impulsivity that led to binge eating, followed by feelings of guilt and food restrictions and other ways of compensation or purging, such as excessive exercise, vomiting, taking laxatives or diuretics, or fasting.
People with bulimia have forbidden food, but those are the ones they tend to eat during a binge. For example, sweets, chocolate, cheese, bread, etc.
Behaviours like vomiting cause the loss of sodium and potassium which can increase the risk of hypotension, cardiac abnormalities, and other serious physical problems that put their lives in danger.
There are many reasons why someone can develop bulimia, including biological, psychological, and social factors. Some people have low self-esteem, social relationship problems, low mood, traumas, and difficulties regulating emotions. These issues can lead them to mistakenly try to improve their emotions and self-esteem by losing weight, following the society that nowadays dictates that thinness is good whereas fatness is terrible. Nevertheless, diets, more often than not, can induce an eating disorder.
Our culture presents thinness as a way to achieve success, suggesting that not being thin is a sign of failure, which puts much pressure on these patients, who try hard to lose weight.
By dieting, fasting, and restricting food, the person creates a state of anxiety and the physical need to eat. The brain enters the “starvation mode”, and the moment the person starts eating, it will prompt the person to eat significant amounts.
It isn’t known how much impact the biological factors have on the development of bulimia nervosa, the social pressure and diets are the main known factor. Bulimia and anorexia share some causes, such as drug abuse, obesity, diabetes, certain personality traits, and distorted ideas about the body.
In any case, bulimia develops due to a mix of causes, not one only factor is the cause of the condition.
The main symptom of bulimia is the circle of restricting food, binge eating and purging. People with bulimia don’t tend to lose weight like people with anorexia, so the condition can be better hidden.
The main symptoms of bulimia include:
- Binge eating: the person eats great amounts of food, usually in a short amount of time, but the loss of control can be spread in one day.
- Compensatory behaviours: to prevent weight gain after a binge, people with bulimia use a range of measures like laxatives, excessive exercise, medication, fasting or vomiting. In order to be diagnosed with bulimia, you don’t need to use vomiting or using laxatives as compensatory measures, it is enough with working out excessively, or taking any action with the purpose of compensating.
These circles can lead to other problems such as:
- Low self-esteem and recurrent feelings of guilt.
- Mood changes.
- Depression and anxiety.
- Drug and alcohol abuse.
If not treated, other physical problems can develop due to bulimia:
- Headaches, dizziness and weakness.
- Problems with the teeth and hair.
- Irregular menstruation.
- Big changes in the person’s weight.
In more extreme cases, these symptoms can develop:
- Loss of bone mass.
- Arrhythmias and heart attacks.
- Oesophagus perforation.
National Eating Disorders has an extensive checklist of possible symptoms and signs of bulimia.
How can families recognize signs of bulimia?
Families can be alert to certain behaviours that might suggest the person is struggling with this condition. Some of the signs include:
- Going to the bathroom frequently.
- Food disappearing quickly from the house.
- Avoid eating with the family and try to eat later on their own, in an impulsive way.
- Avoid social events if there is food involved.
- Damage to the teeth: sometimes, dentists can detect such damages.
- Unusual alterations in mood.
- Purging: the person uses vomiting and other purgative methods like laxatives to avoid weight gain.
- Non-purging: the person uses fasting and excessive exercise as compensatory behaviour but doesn’t vomit or use laxatives.
Bulimia nervosa can be treated with medication and psychotherapy or a combination of both. The medication can reduce the urges to binge and purging behaviours, allowing the patient to engage better in the therapy.
Cognitive-behavioural therapy (CBT) is one of the types of therapies that have shown success to treat bulimia. The purpose of the therapy is for the person to understand the need to stop restricting food and engaging in compensatory behaviours. The critical element is to develop healthy eating habits, where the person eats a variety of food in the appropriate quantity, without having any food restrictions or any other food rules. By doing this, the physical hunger that was leading the person to eat will stop. In the second stage, therapy can focus on reducing the binges produced by emotions. CBT teaches the patient to deal with emotions more healthily rather than using food to escape unpleasant feelings.
It is also vital to tackle body dissatisfaction, challenging the social messages that make us think that we are worth what our bodies are worth, instead of focusing on our values, compassion, empathy and personality.
- What is cognitive behavioural therapy (CBT)?
- More information about bulimia – NHS
- Food factsheet – The Association of UK Dieticians
- Support and services – Beat eating disorders
- Support and services – Anorexia and Bulimia Care