What is bulimia nervosa?
It is an eating disorder characterized by excessive food intake combined with compensatory behavior to avoid weight gain. It is a more common disorder than anorexia, as it appears to affect 3-7% of women aged 15-25.
The most common compensatory behaviors are:
- Purging type of bulimia, such as self-induced vomiting or use of laxatives/diuretics.
- Non-purging type of bulimia, such as intense physical exercise, fasting.
Vomiting
Self-induced vomiting is the most common compensatory behavior technique. By using a finger to help or drinking too much water with the meal, the person is led to induce vomiting in order to eliminate the calories they have just consumed from the meal.
Use of Laxatives/Diuretics
The use of laxatives and diuretics is another method to eliminate the food that has been consumed. The person takes more than the acceptable limit for using laxatives, usually giving constipation as an excuse and not the real reason for taking them. The feeling of emptying therefore gives the person a sense of cleanliness, freeing them from guilt.
Excessive Exercise
A way of compensatory behavior in people with non-purging type of bulimia is excessive exercise. There are no specific limits regarding exercise, but the characteristic of these people is that they usually go to exercise within 2 hours of eating and this can be repeated up to 5 times a day depending on their meals.
Fasting
People after a bulimic episode, in an attempt to punish themselves, follow long periods of fasting and abstaining from food. The psychopathology of this behavior has something in common with anorexia nervosa. In this case, the intense food deprivation triggers the next bulimic episode, which in turn leads to the vicious cycle of bulimia, as shown in the figure below.
How is the diagnosis made?
The diagnostic criteria for bulimia include the following characteristics that must occur for 3 months or more:
- Repeated episodes of binge eating (bulimia) sudden or planned for which it is true that:
- The amount of food consumed in a specific period of time of up to 2 hours is much greater than what the average person would consume
- During this period there is a feeling of loss of control over food intake
- Repeated compensatory behaviors (may be one or more):
- Fasting
- Excessive exercise
- Provocation vomiting
- Taking laxatives or diuretics
- The person tends to evaluate themselves primarily based on their body shape and weight.
- Both binge eating and compensatory behavior must occur on average at least 2 times/week for 3 months
Categorisation of bulimia
Mild
1-3 episodes per week
Moderate
4-7 episodes per week
Severe
8-13 episodes per week
Extreme
More than 14 per week
Consequences of psychogenic bulimia
The main complications of psychogenic bulimia come from purging behaviors (self-induced vomiting, use of laxatives and diuretics) and their consequences.
- Dehydration and electrolyte disturbances, which damage the body in many ways and can cause cardiac arrhythmias.
- Gastroesophageal reflux
- Oral lesions. In the oral cavity, swelling of the salivary glands (especially the parotid glands), caries and erosion of the tooth surface due to the effect of gastric juices may be observed. The use of fingers to activate the vomiting reflex may result in scars on the dorsal surface of the hand (Russell’s sign).
- Muscle fatigue (due to excessive exercise and at the same time severe food restriction)
- Dry skin & hair loss
- Stomach ulcer
- Constipation
- Menstrual cycle disorders
In addition, psychogenic bulimia is a risk factor for depression, alcoholism and self-destructive behavior. As we have mentioned in our previous article on Emotional Binge Eating , the reasons that can lead a person to this type of anxiety disorder vary.
Management Tips
- Try eating in front of people, so that we get used to the exposure and realize that food is not our only companion.
- Filling out a food diary to see if we ate too much or too little. In addition, we can record the amount of food and the periods we vomit in order to recognize and avoid the emotional fluctuations that cause episodes of bulimia on a daily basis.
- We try to eat slowly, chew better in order to train ourselves in taste and the feeling of satiety.
- Regular consumption of meals (5-6 meals a day) at fixed times, favors the metabolism and limits the feeling of hunger and the effects that this has on mood and food choice.
- The use of diuretics and laxatives does not prevent the absorption of calories or energy as many believe, as absorption is almost complete before it reaches the large intestine. This is an important part that we need to understand.
Psychogenic bulimia, unlike psychogenic anorexia, is less obvious since the person is usually of normal weight. A person with bulimia prefers to leave the company to eat alone with whatever behavior they want. Socially, these people do not eat, so they do not show signs to their friends and family. Therefore, it is important to be vigilant if any of the characteristics mentioned above are present.
The participation of the entire family and not just the patient in the treatment of the disorder is considered essential. Simultaneous monitoring by a psychologist and nutritionist is also considered essential. The main goal of the treatment of all eating disorders is to address the dysfunctional perception that the person has about food, their body and themselves in general, as well as an attempt to find an alternative expression of negative emotions. Cognitive behavioral therapy is the appropriate method of managing psychogenic bulimia.
