Bulimia nervosa symptoms are more common in teenagers. Thus, anorexia nervosa prevention is essential to control the prevalence of this condition.

Bulimia Nervosa

Humza Khizer

Overview

Body image disturbances and unhealthy eating behaviors can give rise to eating disorders. Once considered to solely affect females, studies have shown that they affect both males and females of all age groups<a href="#accordion">[1]</a>. According to a Lancet study, eating disorders - bulimia nervosa and anorexia nervosa - have a global prevalence of less than 0.2% of the population<a href="#accordion">[2]</a>. Despite the low incidence, the risk is five times higher in adolescents and, hence, is a major cause of mortality among them<a href="#accordion">[1]</a>.

&nbsp;

A study conducted among medical students in Karachi found a higher risk of them developing eating disorders, with women being more prone than men<a href="#accordion">[3]</a>. Since eating disorders are considered psychiatric illnesses, they can have serious implications on a person&#39;s overall health and life. Therefore, researchers emphasize the need for the detection of factors that can contribute to the development of different eating disorders.&nbsp;

Bulimia nervosa, also called bulimia, is characterized by recurrent episodes of binging and purging. Up to 3% of women and more than 1% of men suffer from a life-threatening eating disorder during their lifetime<a href="#accordion">[1]</a>. Although its incidence has seen a decline, there has been a shift in cases occurring among a younger population, most commonly affecting people aged between 15 and 29 years<a href="#accordion">[1]</a>. In countries like Pakistan, India, and Bangladesh, 4-38% of young adolescents tend to develop eating disorders<a href="#accordion">[4]</a>.

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Signs And Symptoms

Individuals with bulimia nervosa go through cycles of binge eating and purging. During the binge episode, people consume large quantities of food at one time, with no control over what they&#39;re eating. This is immediately followed by purging behaviors to make up for the shame and guilt of eating as well as to prevent any weight gain. People may employ different purge methods, such as vomiting, using laxatives or diuretics, and excessive exercise. Moreover, individuals have an obsession with body weight and image and a constant fear of gaining weight.&nbsp;

Other common signs and symptoms of bulimia include:

<ul>
	<li>Feeling uncomfortable while eating in front of others</li>
	<li>Binge-eating foods a person might typically avoid</li>
	<li>Immediate trips to the bathroom after meals</li>
	<li>Excessive exercise</li>
	<li>Mental health problems, such as <a href="https://merisehat.pk/disease/anxiety">anxiety</a> and <a href="https://https://merisehat.pk/disease/depression">depression</a></li>
	<li>Weight changes</li>
	<li>Mood swings</li>
	<li>Self-harming behavior</li>
</ul>

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Forced vomiting often results in dental problems, such as gum disease, tooth decay, dental erosion, bad breath, and stained teeth. The eating disorder can also result in several physical, gastrointestinal, and reproductive symptoms.&nbsp; 
&nbsp;

<ul>
	<li>Physical Symptoms:&nbsp;Facial and cheek swelling due to parotid gland enlargement, dental problems, calluses on knuckles and back of hands (Russell&#39;s sign), dry skin, hair loss, and brittle nails</li>
	<li>General Symptoms:&nbsp;Weakness, fainting, and dizziness&nbsp;</li>
	<li>Gastrointestinal Symptoms:&nbsp;Heartburn, gastroesophageal reflux disease (GERD), chronic sore throat, constipation, indigestion, ulcers, esophageal tears from forceful vomiting, and abdominal pain</li>
	<li>Reproductive Symptoms:&nbsp;Amenorrhea, irregular periods, and infertility</li>
	<li>Cardiac Problems:&nbsp;Irregular heartbeat, heart failure, and palpitations</li>
	<li>Electrolyte Imbalance:&nbsp;Dehydration and kidney damage 
	&nbsp;</li>
</ul>

Complications can often become life-threatening in bulimia nervosa. 
&nbsp;

Causes

Bulimia nervosa typically begins with excessive dieting that causes people to enter starvation mode, leading to the urge to binge uncontrollably. This is followed by guilt that manifests itself as various purging behaviors. Moreover, people with bulimia are often concerned with maintaining a certain body weight, size, or shape. They may also have a fear of becoming overweight.

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There is no specific cause of bulimia nervosa; instead, it is thought to arise from a combination of genetic, environmental, emotional, and social factors.&nbsp;

Common risk factors of bulimia include: 
&nbsp;

<ul>
	<li>Genetic Factors:&nbsp;Having a family member with an eating disorder causes a 28-74% chance of developing an eating disorder<a href="#accordion">[5]</a>. Thus, having a parent or sibling with an eating disorder increases an individual&#39;s chance of developing it as well.&nbsp;</li>
	<li>Trauma:&nbsp;Experiencing any traumatic event, such as sexual or physical abuse, can often manifest itself as bulimia or other eating disorders.</li>
	<li>Psychological And Emotional Factors:&nbsp;Substance use disorders and psychological disorders, such as anxiety and depression, can also contribute to bulimia.</li>
	<li>Serotonin:&nbsp;The neurotransmitter serotonin not only plays a role in mood regulation but also in impulse control and appetite regulation. Altered levels and disruptions in its activity have been shown to cause the development of bulimia<a href="#accordion">[6]</a>.</li>
	<li>Societal Factors:&nbsp;The media&#39;s portrayal of unrealistic beauty standards plays a huge role in the development of eating disorders. This leads to feelings of unhappiness and body image issues among the population, especially young teens.&nbsp; 
	&nbsp;</li>
</ul>

Diagnosis

Unlike people with anorexia nervosa, individuals suffering from bulimia are not underweight or thin. They usually maintain an average weight or are overweight. Therefore, the disease often goes unnoticed. Moreover, most people are either unaware that they have an eating disorder or are reluctant to ask for help.&nbsp;

If your doctor suspects bulimia, they may conduct several tests including a psychological evaluation. During a psychological evaluation, individuals answer questions regarding their eating habits and body image. Moreover, a therapist or mental health professional relies on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for bulimia<a href="#accordion">[7]</a>.

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The DSM-5 Defines Bulimia Nervosa As Presence Of:

<ul>
	<li>Recurrent binge eating episodes are characterized by both of the following:</li>
</ul>

a. Eating, within any 2-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.

b. A sense of lack of control over what or how much one is eating during the episode.

<ul>
	<li>Recurrent inappropriate compensatory behavior in order to prevent weight gains, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.</li>
	<li>Binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.</li>
	<li>Self-evaluation is unduly influenced by body shape and weight.</li>
	<li>The disturbance does not occur exclusively during episodes of <a href="https://merisehat.pk/disease/anorexia-nervosa">anorexia nervosa</a>.</li>
</ul>

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The Manual further categorizes bulimia on the basis of severity.

 
Mild: 1-3 weekly episodes

Moderate: 4-7 weekly episodes

Severe: 8-13 weekly episodes

Extreme: 14 or more weekly episodes.

Moreover, doctors also conduct physical examinations, blood and urine tests, echocardiograms, X-rays, and other tests. These help rule out other medical conditions and assesses for complications of bulimia.

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Treatment

Management of bulimia depends on the person&#39;s severity of illness and the presence of medical and mental co-morbidities. Treatment involves helping individuals form a healthy relationship with food and their body image. Therefore, a multidisciplinary team consisting of a nutritionist, mental health professional, primary care physician, and an occupational therapist is often required.

&nbsp;

Treatment options include: 
&nbsp;

<ul>
	<li>Psychotherapy:&nbsp;Cognitive behavioral therapy (CBT) is the first-line treatment for all eating disorders. In bulimia, patients are taught to identify unhealthy thinking patterns associated with their binging and purging episodes and replace them with healthy ones.</li>
	<li>Other Forms Of Therapy such as family-based therapy, interpersonal psychotherapy, and talk therapy may also be employed. In children and young adolescents, family-based therapy helps parents deal with their child&#39;s struggle with bulimia. Moreover, it helps teens develop healthier eating habits.</li>
	<li>Pharmacotherapy:&nbsp;Anti-depressants, such as selective serotonin reuptake inhibitors (SSRIs), are often employed. These work by preventing the reuptake of serotonin; thus, increasing its availability at the receptors. Since the neurotransmitter plays a role in mood, sleep, and appetitive regulation, it is often combined with psychotherapy. Moreover, the drug also helps with depression and anxiety. Currently, fluoxetine is the only FDA-approved SSRI for the treatment of bulimia.&nbsp;</li>
</ul>

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In severe cases or those not responding to psychotherapy and medications, doctors may advise in-hospital treatment. This allows the treatment of complications such as electrolyte imbalances, dehydration, kidney damage, and cardiac complications. Moreover, many treatment facilities offer live-in or day treatment programs.&nbsp;

Bulimia can often become life-threatening if left untreated. Although treatment is challenging, it is possible and requires a long-term commitment.&nbsp;

If you or someone you know is suffering from bulimia, reach out to a mental health professional or a physician. Seeking help not only prevents the development of life-threatening complications but also improves the overall quality of life.

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Key Points

<ul>
	<li>Bulimia Nervosa is an eating disorder characterized by episodes of binging followed by purging behaviors, such as vomiting, laxatives, or exercising.&nbsp;</li>
	<li>A combination of genetic, psychological, societal, and emotional factors is responsible for the development of bulimia. The media&#39;s portrayal of unhealthy beauty standards is considered pivotal in causing bulimia in teens.&nbsp;</li>
	<li>Bulimia often results in complications, such as tooth decay, kidney failure, cardiac problems, menstrual irregularities, and digestive issues.</li>
	<li>Treatment of bulimia focuses on helping individuals form healthy relationships with food and develop a kind and healthy view of themselves. Psychotherapy, antidepressants, and talking to a nutritionist can help manage the condition. 
	&nbsp;</li>
</ul>

[1] Eeden, A. E. v., Hoeken, D. v. & Hoek, H. W., 2021. Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current opinion in psychiatry, 34(6), pp. 515-524.

[2] GBD 2019 Diseases and Injuries Collaborators, 2020. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 396(10258), pp. 1204-1222.

[3] Memon, A. A. et al., 2012. Eating disorders in medical students of Karachi, Pakistan-a cross-sectional study. BMC research notes, 5(84).

[4] Din, Z. u. et al., 2019. Tendency Towards Eating Disorders and Associated Sex-specific Risk Factors Among University Students. Noro psikiyatri arsivi, 56(4), pp. 258-263.