Understanding Bulimia Nervosa: Symptoms, Causes, and Treatment

17-year-old Riya struggles with issues related to her body image. She is insecure about her appearance and constantly thinks about her weight. She frequently goes through phases where she eats unusually huge meals quickly. She eats in private because she feels guilty and embarrassed about it. After eating, Riya forcefully vomits so she does not gain weight because she feels guilty.  

Riya misses meals to compensate for her binge eating because her entire sense of worth is based on how she looks. After observing her behaviour, her friend Shreya urged Riya to see a medical professional.  Following a meeting with the doctor, Riya was diagnosed with an eating disorder called Bulimia Nervosa.  

This is an example of what happens in Bulimia Nervosa. Bulimia nervosa or bulimia is a serious eating disorder in which the person experiences episodes of uncontrollable binge eating following unhealthy ways to forcefully remove the food from the body such as throwing up or skipping meals to prevent weight gain. Bulimia is a serious disorder and can prove fatal if the treatment is delayed.

Symptoms of Bulimia 

1. Feeling guilt and shame for binge eating: after the episode of binge eating the person feels extreme guilt.
2. Eating too much in one sitting: someone who has bulimia experiences episodes of eating too much food in little time.  
3. Feeling helpless: someone who is dealing with this condition might feel they have no control over how much they are eating and start feeling helpless. 
4. Feeling insecure about physical appearance: they are very insecure about their appearance, they might feel dissatisfied with their body shape and weight. 
5. Having mood swings: bulimia affects both the psychological and physiological health of a person. Individuals who might have this condition may experience frequent changes in the mood.  
6. Constantly being afraid of weight gain: people who are dealing with bulimia have their entire self-worth tied to their body shape. They are in constant worry that they will gain weight and think about it for an unhealthy amount of time.  
7. Unhealthy ways to lose weight like: people having bulimia, after episodes of binge eating resort to unhealthy and often harmful ways to compensate for the excess food they have consumed. They might turn to forcefully vomiting excessive fasting or exercising too much to make up for binge eating.  

Some of the physical symptoms of bulimia are- irregular periods in girls, acid reflux,  feeling constipated, fainting, dehydration, scars on knuckles due to forceful vomiting,  etc. 

Complication 

Bulimia is a serious eating disorder and can lead to many complications:

• Swollen Esophagus: recurrent, forceful vomiting can damage the oesophagus
• Sore throat: repetitive episodes of self-induced vomiting can lead to a sore throat. 
• Dental cavity: vomiting too many times, leads to constant contact of stomach acid and teeth, causing dental cavities.  
• Heart problems: bulimia can also give rise to many heart problems like abnormal heartbeats pounding heart or even heart failure. 
• Stomach problems: reoccurring episodes of binge eating and purging can cause many stomach problems like diarrhoea, bloating, constipation, etc.  
• Suicidal thoughts: bulimia, even though it is an eating disorder is connected with other mental health issues like anxiety and depression which can often lead to suicidal thoughts. 

Causes 

Researchers have not been able to pinpoint the exact cause of bulimia Nervosa.  However certain factors are said to play a role in causing Bulimia.  

1. Genetics: if you have a relative or someone in the family who is diagnosed with an eating disorder, you are at higher risk of developing bulimia.  
2. A traumatic event: sometimes even a traumatic event like a big accident or losing a loved one can lead to the development of bulimia nervosa.  
3. Societal pressure: our society favours a certain body type more, and this creates pressure among people to change them. This societal pressure can also be a cause of developing bulimia.  
4. Cultural influence: popular culture and media play a role in setting standards for society. Media can influence people and make them believe that a certain body shape is ideal. These things can influence young minds and affect their self-confidence. To fit in they might indulge in certain behaviours that can blow  up and lead to eating disorders like bulimia

Diagnosis 

According to the Diagnostic and Statistical Manual for Mental Disorders, the criteria for the diagnosis of Bulimia Nervosa is:

• Repeated episodes of binge eating  
• Feeling one has no control over how much food he is consuming and what he is eating.
• Generally, binge eating episodes and compensatory behaviour happen once every  week for 3 months on average 
• Eating more than what a normal individual would eat under the same situation in a similar time frame within any 2 hours.  
• Reoccurring, detrimental compensatory behaviour to avoid weight gain like forcibly vomiting or unhealthy, excessive fasting or exercising too much.  
• Self-worth is completely dependent on the body shape and weight  ∙ The behaviour does not occur only during the episodes of Anorexia Nervosa.  ∙ No other medical condition is playing a role in binge eating.  

The diagnosis process for bulimia will include a physical assessment in which urine and blood tests are included. A psychological examination will assist the healthcare professional in understanding your bond with food and if you have any body image issues. If the person fits the criteria given in the DSM for bulimia, then he is diagnosed with the disorder. There is a categorization for bulimia in the DSM from mild to extreme. It is of utmost importance to visit a medical professional as soon as you see the signs of bulimia nervosa to prevent complications later.

Treatment 

The treatment of bulimia consists of different treatments like medication, therapies and dietary consultation.  

1. Medication

Medications in addition to psychotherapy can be helpful for the treatment of bulimia. For instance, doctors may prescribe the antidepressant fluoxetine (Prozac) to adults who are struggling with bulimia. To stop binge eating and vomiting, several selective serotonin reuptake inhibitors are utilised. Medication is not only helpful in treating bulimia but also for managing anxiety and depression in people suffering from bulimia. Without first consulting a doctor and receiving the appropriate advice, do not use medication.  

2. Psychotherapy

Therapies like Cognitive Behavioural Therapy family-based therapy or interpersonal psychotherapy are used to help people with Bulimia nervosa. For example in Cognitive behaviour Therapy, the mental health professional will help you understand your thoughts and behaviour that is contributing to your disorder. They will also help you in setting healthy eating habits and assist you in adopting them long-term.  

Family therapy is usually recommended to young people, in which the child along with his family talks to a therapist. The therapist discusses how the condition has affected the child and his family and also suggests ways in which the family can support the person in getting better. The aim is to bring a change in harmful thoughts and behaviours that are adding fuel to the condition.  

3. Dietary consultant

Dietary consultation also plays an important role in the treatment and management of Bulimia. The dietary consultant helps in understanding the importance of healthy food habits and makes healthy, balanced meal plans. They might also lend a hand in changing your attitude towards food.

How to help a loved one 

If you see any of the warning signs of bulimia in people around you you must address the issue. It won’t be an easy conversation they might deny it and take it in the wrong way. Try talking to them, and tell them that you are concerned; sometimes the person might be afraid to ask for help, so encourage them to seek help from a professional. Support from loved ones during difficult times can benefit the person. Here are some strategies you can follow to help your loved one who is struggling with  bulimia:  

• Boost their self-confidence: the person having bulimia tends to have low self-esteem, so try encouraging them and giving them positive comments.  
• Include them in plans: try inviting them to plans, eating food with friends and family will help them in their journey of recovery. There are chances that initially they will refuse the invites and cancel plans, but keep including them.  
• Listen: sometimes people just need someone to listen to them without criticising or judging them or giving them advice. Listen to the person, and create a comfortable, safe space for them to vent out and talk about the issues they are going through.  
• Avoid criticizing: the person might not need someone to criticize them at the moment. Maybe you are concerned but try telling them about it calmly without upsetting them.  The last and most important thing is to keep reminding them that there is nothing to be ashamed of about their condition and it’s not their fault.  

Bulimia nervosa is a serious and life-threatening eating disorder that affects both the physiological and psychological health of a person. If you feel that someone you know or your loved one is going through this condition encourage them to seek medical treatment. Make them feel heard and help them in rebuilding their self-confidence. Recovery from bulimia is possible with proper treatment that involves dietary consultation, therapy sessions and proper medication.  

FAQs  

What is Bulimia Nervosa?  

Bulimia nervosa is a serious, potentially life-threatening eating disorder in which a person loses control over eating and eats an unusual amount of food in a short duration of time and then forces that food out of the body by throwing it out due to guilt.  

What are the symptoms of Bulimia?  

Eating enormous amounts of food in one sitting, spending an unhealthy amount of time being worried about your weight, resorting to inappropriate and harmful ways to lose weight such as forcefully vomiting or passing stools, missing meals, connecting self-worth to the way you look, experiencing mood swings, etc. are some of the signs seen in  Bulimia Nervosa.  

What other complications can arise due to bulimia?  

Bulimia is a serious eating disorder and can lead to many complications like  Stomach issues, swollen Esophagus, Heart failure, harm to intestines, suicidal thoughts, etc.  

How does Cognitive behaviour therapy help in the treatment of Bulimia?  

Cognitive behaviour aims to change a person’s thinking and behaviour. It will help in understanding the person’s harmful thoughts and behaviour that are contributing to the disorder. It will also assist in setting healthy eating habits and help you to adopt them in the long term.