Bulimia Nervosa

Bulimia nervosa is an eating disorder characterized by frequent episodes of binge eating, followed by frantic efforts to avoid gaining weight. It affects women and men of all ages.

What is binge eating?
Binge eating involves two key features:
• Eating a very large amount of food within a relatively short period of time (e.g. within two hours)
• Feeling a sense of loss of control while eating (e.g. feeling unable to stop yourself from eating). 

The binge and purge cycle
Binge eating signs and symptoms
Lack of control over eating – Inability to stop eating. Eating until the point of physical discomfort and pain.
Secrecy surrounding eating – Going to the kitchen after everyone else has gone to bed. Going out alone on unexpected food runs. Wanting to eat in privacy.
Eating unusually large amounts of food with no obvious change in weight.
Disappearance of food, numerous empty wrappers or food containers in the garbage, or hidden stashes of junk food.
Alternating between overeating and fasting – Rarely eats normal meals. It’s all-or-nothing when it comes to food.
Purging signs and symptoms
Going to the bathroom after meals – Frequently disappears after meals or takes a trip to the bathroom to throw up. May run the water to disguise sounds of vomiting.
Using laxatives, diuretics, or enemas after eating. May also take diet pills to curb appetite or use the sauna to “sweat out” water weight.
Smell of vomit – The bathroom or the person may smell like vomit. They may try to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.
Excessive exercising – Works out strenuously, especially after eating. Typical activities include high-intensity calorie burners such as running or aerobics.
Physical signs and symptoms of bulimia
Calluses or scars on the knuckles or hands from sticking fingers down the throat to induce vomiting.
Puffy “chipmunk” cheeks caused by repeated vomiting.
Discolored teeth from exposure to stomach acid when throwing up. May look yellow, ragged, or clear.
Not underweight – Men and women with bulimia are usually normal weight or slightly overweight. Being underweight while purging might indicate a purging type of anorexia.
Frequent fluctuations in weight – Weight may fluctuate by 10 pounds or more due to alternating episodes of bingeing and purging.

Symptoms of Bulimia
In a man or woman with signs of bulimia, symptoms of increasing physical damage from the disease may include:
• Abnormal bowel functioning
• Bloating
• Dehydration
• Fainting
• Seizure
• Fatigue
• Dry skin
• Irregular heartbeat
• Menstrual irregularities or loss of menstruation (amenorrhea)
• Tingling in the hands or feet
• Muscle cramps

Effects of bulimia
When you are living with bulimia, you are putting your body—and even your life—at risk. The most dangerous side effect of bulimia is dehydration due to purging. Vomiting, laxatives, and diuretics can cause electrolyte imbalances in the body, most commonly in the form of low potassium levels. Low potassium levels trigger a wide range of symptoms ranging from lethargy and cloudy thinking to irregular heartbeat and death. Chronically low levels of potassium can also result in kidney failure.
Other common medical complications and adverse effects of bulimia include:
Weight gain
Abdominal pain, bloating
Swelling of the hands and feet
Chronic sore throat, hoarseness
Broken blood vessels in the eyes
Swollen cheeks and salivary glands Weakness and dizziness
Tooth decay and mouth sores
Acid reflux or ulcers
Ruptured stomach or esophagus
Loss of menstrual periods
Chronic constipation from laxative abuse

What are the warning signs of Bulimia?
Physical signs:
• Frequent changes in weight (loss or gains)
• Signs of damage due to vomiting including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath
• Feeling bloated, constipated or developing intolerances to food
• Loss of or disturbance of menstrual periods in girls and women
• Fainting or dizziness
• Feeling tired and not sleeping well
Psychological Signs:
• Preoccupation with eating, food, body shape and weight
• Sensitivity to comments relating to food, weight, body shape or exercise
• Low self esteem and feelings of shame, self loathing or guilt, particularly after eating
• Having a distorted body image (e.g. seeing themselves as overweight even if they are in a healthy weight range for their age and height)
• Obsession with food and need for control
• Depression, anxiety or irritability
• Extreme body dissatisfaction
Behavioural Signs:
• Evidence of binge eating (e.g. disappearance or hoarding of food)
• Vomiting or using laxatives, enemas, appetite suppressants or diuretics
• Eating in private and avoiding meals with other people
• Anti social behaviour, spending more and more time alone
• Repetitive or obsessive behaviours relating to body shape and weight (e.g. weighing themselves repeatedly, looking in the mirror obsessively and pinching waist or wrists)
• Secretive behaviour around food (e.g. saying they have eaten when they haven’t, hiding uneaten food in their rooms)
• Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)
• Dieting behaviour (e.g. fasting, counting calories/kilojoules, avoiding food groups such as fats and carbohydrates)
• Frequent trips to the bathroom during or shortly after meals which could be evidence of vomiting or laxative use
• Erratic behaviour (e.g. spending large amounts of money on food)
• Self harm, substance abuse or suicide attempts

What are the risks associated with Bulimia?
The risks associated with Bulimia are severe. People with Bulimia may experience:
• Chronic sore throat, indigestion, heartburn and reflux
• Inflammation and rupture of the oesophagus and stomach from frequent vomiting
• Stomach and intestinal ulcers
• Chronic irregular bowel movements, constipation and/or diarrhoea due to deliberate misuse of laxatives
• Osteoporosis– a condition that leads to bones becoming fragile and easily fractured
• Loss of or disturbance of menstrual periods in girls and women
• Increased risk of infertility in men and women
Irregular or slow heart beat which can lead to an increased risk of heart failure

What are the Effects of Bulimia Nervosa?
• Extreme social isolation
• Inability to sleep
• Fractured relationships with family and friends
• Loss of spiritual connection to one’s faith, religion, or higher power
• Forced withdrawal from school or college
• Job loss
• Bankruptcy, often resulting from excessive spending on binge foods
• Infertility
• Internal bleeding
• Drug and alcohol addiction, especially if these substances are used to self-medicate for uncontrolled emotions or deal with physical complications
• Suicide
• Self-injury behavior
• Heart attack
• Death

What Causes Bulimia?
As with anorexia and other eating disorders, the causes of bulimia nervosa are impossible to determine in any individual case.
Some women may be genetically predisposed to developing bulimia. Young women with a biological sister or mother with an eating disorder are at higher risk, for example, suggesting a possible genetic link. There is some evidence that serotonin, a naturally occurring brain chemical, may influence eating behaviors because of its connection to the regulation of food intake.
People with symptoms of bulimia may have other psychological and emotional characteristics that contribute to the onset and progression of the disease. They may have low self-worth, for instance, or struggle with perfectionism. They may have trouble controlling impulsive behaviors, managing moods or expressing anger. The families of people with bulimia may tend to have more conflicts, higher rates of alcoholism, along with more criticism and unpredictability. There may be a history of emotional, physical and/or sexual abuse at the center of feelings of worthlessness and self-loathing.
In addition, popular culture cultivates and reinforces a desire for thinness that may contribute to bulimia in both men and women. Success and worth are often equated with being thin, especially for women. Pressure from a peer group at school, work, or social circles can also fuel this desire to be thin, particularly among young girls and teens. For other people, bulimia symptoms may begin later in life, particularly during times of transition, if they experience trauma or stress that overwhelms their ability to cope.
Additionally, bulimia nervosa is also frequently accompanied by other co-occurring disorders or addictions. This may make it challenging for a woman or man to achieve emotional recovery and develop a healthy relationship with food and body. Bulimia nervosa takes a toll on a person's life very quickly, and so it's common for sufferers to develop alcoholism or drug addiction, or begin to abuse prescription drugs, in an attempt to cope with their symptoms. Co-occurring mood disorders, anxiety disorders, PTSD, self-injury and personality disorders are also frequently recognized in people with symptoms of bulimia.

ANOREXIA NERVOSA AND BULIMIA NERVOSA
• Menstruation : In Anorexia Nervosa Absent, Bulimia Nervosa usually normal . Amenorrhea (absence of menstrual period) is usually present in patients with Anorexia Nervosa while it is usually normal in the other group of patients.
• Binge eating : 25-50% required for diagnosis
• Mortality : ~5% per decade low - often sudden due to arrythmias induced by electrolyte abnormalities
• Cardiovascular : low BP, decreased heart rate dehydration, imbalanced electrolytes (esp. potassium) & in Bulimia Nervosa low BP, orthostatic hypotension, arrythmias d/t electrolyte imbalance
• Skin / extremities : dry skin, lanugo hair & in Bulimia Nervosa dry skin, hair loss, brittle nails
• Glucose levels : Hypoglycemia & in Bulimia Nervosa usually normal
• Sex hormones level : Low estrogen or testosterone & in Bulimia Nervosa usually normal
• LH and FSH level : low & in Bulimia Nervosa usually normal
• Thyroxine levels : low normal & in Bulimia Nervosa usually normal
• Cortisol levels : increased & in Bulimia Nervosa usually normal
• Onset : mid adolescence & in Bulimia Nervosa late adolescence
• Prevalence in women : 0.5% & in Bulimia Nervosa 1-3%
• Weight : Markedly reduced & in Bulimia Nervosa usually normal

What causes eating disorders?
There is no simple answer, but these ideas have all been suggested as explanations:
• Social pressure: Our social surroundings powerfully influence our behaviour. Societies which don’t value thinness have fewer eating disorders. Places where thinness is valued, such as ballet schools, have more eating disorders. ‘Thin is beautiful’ in Western culture. Television, newspapers and magazines show pictures of idealised, artificially slim people. So, at some time or other, most of us try to diet. Some of us diet too much, and may develop anorexia.
• Lack of an “off” switch: Most of us can only diet so much before our
body tells us that it is time to start eating again. Some people with anorexia may not have this same body "switch" and can keep their body weight dangerously low for a long time.
• Control: It can be very satisfying to diet. Most of us know the feeling of achievement when the scales tell us that we have lost a couple of pounds. It is good to feel that we can control ourselves in a clear, visible way. It may be that your weight is the only part of your life over which you feel you do have any control.
• Puberty: Anorexia can reverse some of the physical changes of becoming an adult – pubic and facial hair in men, breasts and menstrual periods in women. This may help to put off the demands of getting older, particularly sexual ones.
• Family: Eating is an important part of our lives with other people. Accepting food gives pleasure and refusing it will often upset someone. This is particularly true within families. Saying “no” to food may be the only way you feel you can express your feelings, or have any say in family affairs. On the other hand, loving families often try to protect you from the consequences of an eating disorder, and this can mean that the eating disorder can go on longer.
• Genetics: There is a lot of evidence that eating disorders run in families even where the sufferers don't necessarily live together, and that certain genes make people more vulnerable, not only to eating disorders, but to related conditions.
• Depression: Most of us have eaten for comfort when we have been upset, or even just bored. People with bulimia are often depressed, and it may be that binges start off as a way of coping with feelings of unhappiness. Unfortunately, vomiting and using laxatives can leave you feeling just as bad.
• Low self-esteem: People with anorexia and bulimia often don’t think much of themselves, and compare themselves unfavourably to other people. Losing weight can be a way of trying to get a sense of respect and self-worth.
• Emotional distress: We all react differently when bad things happen, or when our lives change. Anorexia and bulimia have been related to:
• life difficulties
• sexual abuse
• physical illness
• upsetting events - a death or the break-up of a relationship
• important events - marriage or leaving home.
• The vicious circle : An eating disorder can continue even when the original stress or reason for it has passed. Once your stomach has shrunk, it can feel uncomfortable and frightening to eat.
• Physical causes: Some doctors think that there may be a physical cause that we don't yet understand.
• Certain illnesses and treatments: There is a relatively high incidence of anorexia in people who suffer from diabetes, Cystic Fibrosis or other illness where diet has to be monitored and without adequate treatment, weight is lost. It can be tempting to neglect your health in order to lose some weight, and this is particularly dangerous.