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Eating disorders are on the rise, with approximately 2 in 100 women in the UK developing bulimia nervosa in their lifetime.
Bulimia is an eating disorder and part of a group that includes anorexia, though bulimia nervosa's symptoms are very different to those of anorexia nervosa.
It is important to remember that bulimia nervosa is treatable, and there are lots of places that people who suffer with it can go to for help.
What Is Bulimia Nervosa?
Bulimia is a condition where someone goes through phases of over-eating, or episodes of binge eating, and then tries to counter-act the “fattening” effect that this may have on their body image to prevent weight gain.
During the binge eating phase, a person may feel out of control and unable to stop eating. A person who has bulimia nervosa may eat until they feel physically uncomfortable, and often when they aren’t actually hungry.
Following this, a person may typically feel shame and will try to “purge” the calories that they have taken on in an attempt to change their body weight. Classically this is done by self-induced vomiting. People may also take laxatives, exercise excessively, or stop eating for a while.
As people can often feel ashamed, usually these behaviours are kept secret.
How Is Bulimia Nervosa Different From Anorexia?
Anorexia and bulimia are both eating disorders and people suffering with these conditions are concerned about their body shape. They more often than not develop due to a desire to be thin, though it can also be associated with other conditions, such as anxiety, or depression.
People may suffer from something called “body dysmorphia,” which is where they believe themselves to be much larger than they are in regards to body shape and weight. This leads to them obsessively dieting.
Anorexia is characterized by severe calorie restriction. There may be some overlap between the two conditions, as some people who suffer from anorexia will self-induced vomiting on occasion. In anorexia nervosa, however, people do not go through periods of binge-eating that is typical of bulimia.
Are Some People More Likely To Get Bulimia Than Others?
Eating disorders, in general, tend to affect women more than men, though men can develop them. This is also true of bulimia. The disorder tends to start when someone is a teenager. Those who have bulimia frequently will have improved by the time they are in their late 20s.
If you have a close relative who has suffered from bulimia nervosa, you may be more likely to develop it yourself. This suggests that there could be a genetic factor contributing to its development, though this isn’t known for sure.
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Bulimia symptoms focus around the bingeing and purging cycle. Whichever method is used for purging will contribute to a different set of symptoms of bulimia.
In general, people with bulimia are average weight, or overweight. They might lose weight during the illness, stay the same, or even gain weight, so this in itself is not a reliable symptom to monitor how severe the disease is.
Eating disorders tend to co-exist with other mental health conditions, including anxiety and depression. Someone who has bulimia nervosa may become withdrawn, avoid social situations and have low self esteem.
During the binge phase, it might be that a person becomes secretive about their eating. They may hide food wrappers, or tend to eat only in their bedroom, or car. Beyond this, you might not notice any symptoms.
Symptoms during the “purge” cycle will depend on the methods used.
With self-induced vomiting, there can be many complications, or symptoms like…
- Poor Teeth – constant erosion, (caused from acid in the stomach passing the teeth as someone vomits), causes a loss of enamel and a yellowing of the teeth. Acid also damages the gums and can cause bleeding, abscesses, and accelerate tooth loss.
- Heartburn – when you vomit, you force food from the stomach through the oesophagus and out through the mouth. Normally, there is a tough ring that sits between your stomach and oesophagus, which stops food from passing out this way. This ring is called your oesophageal sphincter. If you repeatedly force it open with intentional vomiting, it can become looser, which allows acid from your stomach to move up into your oesophagus and cause heartburn.
Barrett's Oesophagus – this is a condition where your oesophagus becomes irritated and scarred by the acid in your stomach. This condition is associated with an increased risk of oesophageal cancer.
- Loss of electrolytes – electrolytes are chemicals that you need in your body to perform a variety of functions. When you excessively vomit, you lose some of these. A good example is potassium. Your stomach acid is full of potassium, and if you vomit enough, this might cause the potassium levels in your body to drop. This can lead to tiredness, weakness, and even abnormal heart rhythms.
Overuse of Laxatives
The main symptom caused by laxative abuse is diarrhoea. Others include:
Abdominal pain – laxatives either cause your bowel to take on a lot of water, or cause it to move faster to push food out more quickly. Both of these can cause abdominal pain, as your bowel is either swollen and bloated, or is moving quickly and pushing on large amounts of solid food to try to move it.
Constipation – your body can become used to chronic use of laxatives. If you stop using them, you may become constipated.
Loss of electrolytes – as with vomiting, excessive laxative use can lead to the loss of essential chemicals in the body.
If people do excessive exercise, they will be more prone to injury. They may develop joint problems, or pain, and take pain killers to help with this. Pain killers that can irritate the stomach lining are best avoided, such as ibuprofen, as this can increase the risk of stomach ulcers.
How Do You Treat Bulimia Nervosa?
Treatment for bulimia nervosa is focused on ways to change behaviours, and ways to break up the binge/purge cycle and to get rid of the low self esteem. This could include psychological therapies, biological treatments, or even social treatments. What is offered will depend on patient preference, and the severity of the illness.
The most common psychological treatment for bulimia is cognitive behavioural therapy. This aims to identify triggers that may cause overeating, or bingeing, and then find ways to combat that. Treatment may take a long time, with improvements expected over months, or years, rather than straight away.
Family therapy can also be used. This is where (usually young) patients and their families, or carers, attend regular sessions with a therapist. As previously mentioned, this should not be seen as a quick fix, and treatment is usually prolonged over months, or years.
There are very few medications licensed for the treatment of bulimia nervosa. If you are suffering from other conditions that are contributing, such as depression, this may be treated with medications to try to improve symptoms.
Fluoxetine is a drug that is used occasionally to help. It is an anti-depressant, and there is some evidence that it may help to reduce the frequency of binge eating and vomiting.
Some people may find monitored support groups helpful. It is crucial if considering attending a support group, especially online, that you ensure that an accredited charity provides it, or that you have been referred to it by your GP. Some groups have been developed to encourage negative behaviours and can worsen symptoms.
Is Bulimia Dangerous?
It is very unusual to die from bulimia. It can, however, affect the body in many different ways.
Beyond the danger to physical health, it can have a profound effect on a person’s wellbeing. People can struggle to function socially, with food being an ever-present issue. Dining out with friends, for example, may be something that a person can no longer do. Social circles restrict as someone suffering from bulimia is no longer comfortable going out. The isolation can feed into depression, which can make things worse.
It is important to recognise bulimia as a disease that affects the mind and body. Patients can also suffer from decreased productivity, and have their life prospects affected negatively by their ongoing symptoms.
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If you think you or someone you know might have bulimia nervosa, it is essential to visit your GP, or encourage them to. There will be plenty of treatments and available support networks in your local area that they will be able to refer you to. They may also decide to do investigations, such as blood tests, to make sure that your body is coping well with the condition.
The charity beat eating disorders is a UK based charity aiming to provide help to people suffering from all types of eating disorders, including bulimia nervosa. They run a helpline every day from 12 pm-8 pm, and 4 pm-8 pm on weekends and bank holidays. They also run online support groups, webchats, and can direct people to other services local to them.
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Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.
- Abdominal – the section of the body that contains all of the structures between the chest area and the pelvis
- Abscesses – a collection of bacteria, or pus
- Anorexia – an eating disorder which leads to severe calorie restriction
- Anti-depressant – a type of medication used to treat depression
- Anxiety – the body’s natural response to stress
- Bingeing – in the context of bulimia, a process whereby a person eats large amounts of food
- Body dysmorphia – a condition where someone feels that their body is different to how it actually is. For example, believing that they are obese when they are in fact underweight.
- Bowel – the lower part of the digestive system
- Cognitive behavioural therapy – a type of psychotherapy where negative patterns of thought are challenged through talking to help treat mood disorders
- Constipation – a condition where there is difficulty regularly emptying the bowels
- Depression – a constant feeling of sadness and loss of interest in the world around you, preventing you from carrying out your usual activities
- Diarrhoea – a condition of having at least three loose, liquid, or watery bowel movements each day
- Electrolytes – minerals that carry an electrical charge. They are vital for health and survival and help maintain fluid balances within the body
- Fluoxetine – a type of antidepressant known as an SSRI (selective serotonin reuptake inhibitor), used to treat depression, compulsive disorders and bulimia
- Oesophagus – a long tube connecting your throat and stomach. It is responsible for moving things that you swallow down to your stomach
- Purge/purging – in the context of bulimia nervosa, the process where after eating, a patient tries to counteract the calories which they have taken on board. This could be by starving themselves for a period of time, or by vomiting, or by abusing laxatives
- Trigger – something that sets off a disease, or flare-up
- Vomit – a discharge of the stomach’s contents through the mouth (also called being sick, throwing up)