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Eating Disorder

Bulimia Nervosa


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Bulimia nervosa is an eating disorder. It affects about 2 to 3% of adolescent and young adult females. Its occurrence among the male population is rare. The female to male ratio of bulimia nervosa is about 10 to 1.

Bulimia nervosa is characterized by:

  1. Recurrent episodes of binge eating. Binge eating may be defined as eating an excessive amount of food within a short period of time in a manner that is out of control.
  2. Recurrent inappropriate behaviour to prevent weight gain using such measures as self-induced vomiting, fasting, excessive exercise, misuse of laxatives, diuretics (chemicals that cause excessive urination), enemas or other medications.
  3. Disturbance in the perception of one’s body shape and weight.

There are two subtypes of bulimia nervosa. They are:

  1. Bulimia nervosa, purging type which is characterized by regular activity in self-induced vomiting or misuse of laxatives, diuretics and enemas.
  2. Bulimia nervosa, nonpurging type which is characterized by inappropriate behaviour of excessive fasting or exercise.

The typical profile of a bulimia nervosa sufferer

Young people with bulimia nervosa are usually females. Even though those people who have suffered from anorexia nervosa previously are not exempt from the disorder, bulimia nervosa is a different disorder from anorexia nervosa. Sufferers of bulimia nervosa tend to be older than those with anorexia nervosa and they are not emaciated. In fact, their weights are either normal, or only a little over or under.

They go on a diet, skip meals or eat only parsimoniously. Then they become very hungry with a voracious appetite. They eat a very large amount of food usually within a short time. They do not stop until they become physically sick or uncomfortable. To relief the discomfort and reduce the absorption of the food, they may induce vomiting by sticking a finger down the throat. With practice, they may be so good at vomiting that they can do it at will. They may also exercise excessively the next day or resort to using laxatives, diuretics and other medications to lose weight. They fast and starve themselves and get into another cycle of hunger, overeating and purging.

Bulimia nervosa sufferers usually binge and vomit in secret. Some of them may be so good at hiding their behaviour that they can keep it away from their loved ones or the family for a long time. This is despite the fact that they can be indiscriminate in the choice of food during a binge episode, eating all types of food including frozen and uncooked food.

The abnormal psychology of the binge-purge cycle

The binge-purge behaviour of bulimia nervosa is driven by a host of abnormal emotions that are mutually reinforcing. To begin with, the person experiences an inner void and emptiness which she attempts to overcome by eating an excessive amount of food. Her overeating, however, does not get rid of the empty and void feelings. Instead, she feels really bad about herself. She then resorts to purging as a self-imposed punishment. Unfortunately, she continues to feel guilty about her loss of control. She overcompensates by fasting or dieting which then heightens her sense of emptiness and void, thus setting up another cycle of binge-purge behaviour.

Other conditions associated with bulimia nervosa

People with bulimia nervosa tend to suffer from depression. The dominant feeling associated with the depression, however, is usually a sense of emptiness than sadness. They also have a strong feeling of self-hatred or self-loathing.

They frequently experience the feeling of unreality. They do not feel themselves as real people. Consequently, they resort to self-mutilation in order to feel the sense of liveliness in themselves. It is as though they need to see the sight of blood and to feel its warmth to confirm to themselves that they are alive.

They also suffer from other forms of addictive behaviour such as drug and alcohol abuse. In fact, as many as one third of bulimia nervosa sufferers also have drug and alcohol problems. The drug and alcohol problems may have started as a form of self-medication to overcome the feelings of inner void or depression.

Their interpersonal relationships tend to be tumultuous due to the wild fluctuation in their emotions. They can be quite nice and docile one moment and become hostile and angry the next. As a result, their life is riddled with broken relationships.

Treatments of bulimia nervosa

People with bulimia nervosa rarely need hospitalization unless they have serious medical complications such as gastric bleeding and electrolyte imbalance due to vomiting. The treatments of bulimia nervosa are similar to those of anorexia nervosa.

Family therapy. This is particularly important, as the family dynamic is either contributing to or affected by the bulimia nervosa. Initially, the family needs to be educated about the illness. Later, the issues of boundary, control and autonomy can be addressed. Family therapy should also focus on helping the person to maintain the gains made through treatment.

Individual therapy. This is important because the issues of identity, self-esteem, self-worth and self-image can be addressed through this forum. Most people do not benefit much from individual therapy until they can resolve those personal problems which contribute to the disorder.

Medication. Medication can be helpful in the treatment of bulimia nervosa. Antidepressant medications, which increase the amount of chemical called serotonin in the brain, help to reduce the binge behaviour.  Medication may also be useful if other psychiatric illnesses such as depression and obsessive-compulsive disorders are present.

Stress management. This is particularly helpful since the sufferers of bulimia nervosa are usually highly stressed. Learning to deal with stress will help to reduce the chance of future relapse.

Overall, sufferers of bulimia nervosa usually do not maintain their therapeutic gains until and unless they have made a significant improvement in their lifestyle.

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