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Bulimia

Introduction

What is bulimia nervosa?

Bulimia nervosa (usually referred to just as bulimia) is an eating disorder. The term bulimia nervosa means 'the nervous hunger of an ox'. The condition was first recognised as an eating disorder in 1979.

Who is affected by bulimia?

Bulimia can affect both men and women but, statistically, women are 10 times more likely to develop bulimia than men. However, bulimia is becoming more common in boys and men.

Recent studies suggest that around 8 in every 100 women will have bulimia at some point in their lives. The condition can occur at any age but it often starts around the age of 19. Bulimia can affect children, but this is extremely rare.

Bingeing and purging

Eating disorders can sometimes be difficult to understand. Everyone has their own eating habits - for example, people with a food intolerance need to avoid eating certain foods in order to stay healthy. However, the habits of people with eating disorders are motivated by an overwhelming fear of getting fat.

People with bulimia tend to alternate between eating excessive amounts of food (bingeing), and making themselves sick, or using laxatives (purging), in order to maintain a chosen weight. This is usually done in secret. People with bulimia purge themselves because they feel guilty about the binge eating, but the bingeing is a compulsive act that they feel they cannot control.

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Symptoms

The main symptoms of bulimia are bingeing and purging.

Bingeing

Bingeing is repeatedly eating vast quantities of high-calorie food, without necessarily feeling hungry, or needing to eat. The urge to eat can begin as an attempt to deal with emotional problems, but it can quickly become obsessive and out of control.

Bingeing is usually a very quick process and you may feel physically uncomfortable afterwards. Bingeing as a symptom of bulimia is something that happens on a regular basis, not just once or twice.

Sometimes, the binges are spontaneous, where you eat anything that you can find at that moment, but others may be planned with a shopping trip to buy foods specifically to binge on.

Purging

Purging is a response to the bingeing. After you have eaten lots of food in a short space of time, you may feel physically bloated and unattractive. You may also feel guilty, regretful, and full of self-hatred.

However, the main impulse to purge is a powerful, over-riding fear of putting on weight. The most common methods of purging involve making yourself sick, or using laxatives to encourage your body to pass the food quickly. Less common methods of purging include taking diet pills, over-exercising, extreme dieting, periods of starvation, or taking illegal drugs, such as amphetamines.

Bulimia is often a vicious circle. If you have the condition, it is likely that you have very low self-esteem. You may also think that you are over-weight, even though you maybe at, or near, a normal weight for your height and build.

This may encourage you to set yourself strict rules about dieting, eating, or exercising, which are very hard to maintain. If you fail to keep to these strict rules, you binge on the things that you have denied yourself. After feeling guilty about bingeing, you purge to get rid of the calories.

Other signs of bulimia

Other signs of bulimia can include:

  • regular changes in weight,
  • an obsessive attitude towards food and eating,
  • large amounts of money being spent on food,
  • disappearing soon after eating (usually visiting the toilet to vomit),
  • episodes of over-eating,
  • periods of starvation,
  • scarred knuckles (from forcing fingers down the throat to induce vomiting),
  • depression and anxiety,
  • distorted opinions about body weight and shape, and
  • isolation.
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Causes

There is no simple answer to explain what causes bulimia. Like other eating disorders, such as anorexia and binge eating, bulimia can be caused by a number of different factors. Some common factors that may lead to bulimia are outlined below.

Low self-esteem

If you have an eating disorder, you may have a low opinion of yourself and see losing weight as a way of gaining self-worth.

Depression

You may use bingeing as a way of coping with unhappiness. People with bulimia often feel depressed, and so they binge regularly. Unfortunately, purging does not relieve this depression and the cycle continues.

Mental health problems

Bulimia is often linked with some other psychological problems. Research shows that bulimia is more common in people who have anxiety disorders, obsessive compulsive disorder (OCD), post traumatic stress disorder (PTSD), and personality disorders.

Cultural and social pressure

Some people believe that the media and fashion create pressure for people to aspire to low body weights.

Emotional stress

Bulimia can sometimes occur following stressful situations, or life events. For example, it is possible for you to develop the condition after dealing with a traumatic experience, such as a death or divorce. Or during the course of important, life-changing events, such as getting married, or leaving home.

Bulimia can also occur in people who have experienced physical illness, or sexual abuse. Some people with bulimia have experienced difficult childhoods, with family problems, arguments, and criticism.

Puberty

Sometimes, if teenagers feel that they have no say in their lives, bulimia can seem like the only way that they can take control.

Genetics

There may be a genetic factor related to developing bulimia. Research suggests that those who have a close relative who has, or has had bulimia, are four times more likely to develop it compared to those who do not have a relative who has had the condition.

The reasons for your bulimia may not be easy to explain. Although the condition is linked to a fear of getting fat, there are usually a more complex set of emotions and feelings that contribute to the problem. The act of bingeing and purging is often a way of dealing with these intense emotions.

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Diagnosis

If you have an eating disorder, such as bulimia, the first step is to recognise that you have a problem and visit your GP.

This may be a very difficult step for you to take, particularly considering that most people who have bulimia hide their situation for months, or years, before seeking help.

It can often take a change of situation, such as the start of a new relationship, or living with new people, to make a person with bulimia want to seek help.

Once you have explained your situation to your GP, they will be able to decide whether to refer you for help from a specialist mental health team. This team can include specialist counsellors, psychiatrists, psychologists, nurses, dieticians, and other healthcare professionals.

It is not always possible for you to be referred for treatment straight away. Depending on how serious your condition is, your GP may be able to treat you themselves. However, if your condition is serious, you may need specialist medical care.

 

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Treatment

You can recover from bulimia but it may be a long and difficult process. The types of treatment that can be offered to help with bulimia include psychological treatments and medication. Treatment usually begins with psychological treatments, aimed to help you to re-establish healthy attitudes towards eating. If medication for bulimia is suggested by your GP, it is usually taken in addition to psychological treatment.

Psychological treatments

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is the most common type of psychological treatment for bulimia, and involves talking with a therapist.

CBT will help you to look at your emotions in detail and to work out new ways of thinking about situations, feelings, and food. It may also involve keeping a food diary which will help to determine and assess the triggers for your binge-eating.

Interpersonal therapy (IPT)

As with CBT, interpersonal therapy (IPT) involves meeting with a therapist to discuss your condition. However, the focus is more on your personal relationships than your problems with food. You are more likely to be referred for this type of psychological treatment if you have recently lost a loved one, and have experienced a big change in your life. The aim of IPT is to help you to establish supportive relationships. This can help to draw your focus away from eating.

Medication

The medications used are known as selective serotonin reuptake inhibitors (SSRIs). SSRIs are a group of antidepressants that include:

  • fluoxetine (brand name Prozac)
  • paroxetine (brand name Seroxat)
  • citalopram (brand name Cipramil)
  • escitalopram (brand name Cipralex)
  • fluvoxamine (brand name Faverin)
  • sertraline (brand name Lustral)

SSRIs are mainly used to treat depression, but they are also used to treat eating disorders, obsessive compulsive disorder (OCD), anxiety, and social phobia.

These medicines can take two weeks or more to have an effect, so it important that they are taken regularly. It is best not to take SSRIs if you have epilepsy, or a family history of heart, liver or kidney disease.

Hospital treatment

Bulimia is not usually treated at hospital. However, if you have serious health complications and your life is at risk, you may be admitted to hospital. Hospital treatment is also considered if you are at risk of suicide or self-harm.

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Complications

There are a number of physical complications that are associated with bulimia. Some of these are outlined below.

Dental problems

Persistent vomiting can cause your stomach acids to damage the enamel on your teeth, which may lead to tooth decay. Excessive vomiting can also cause bad breath and a sore throat.

Irregular periods

Your menstrual cycle can become unpredictable, or even stop altogether. You may also find it difficult to conceive (become pregnant) in the future. See the 'related articles' section for more information.

Poor skin and hair

A lack of nutrients through persistent vomiting, or laxative use, can make your skin and hair unhealthy. Your skin and hair can become dry and your fingernails can become brittle.

Swollen glands

If you have bulimia, your saliva glands can become swollen from frequent vomiting. This makes your face appear rounder.

Chemical imbalance

Excessive vomiting and laxative use can cause body chemical imbalances. This can result in tiredness, weakness, abnormal heart rhythms, kidney damage, convulsions, and tetany (muscle spasms).

Bowel problems

Excessive use of laxatives can also damage your bowel muscles. This could result in permanent constipation.

Heart problems

Long-term complications of bulimia can include an increased risk of heart problems, and damage to other internal organs.

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