Bulimia nervosa

February 20, 2011

Bulimia is an eating disorder characterised by recurrent episodes of binge eating in which the patient eats a large amount of food in a short time, as if he is very hungry.

The patient loses control and then tries to vomit and/or evacuate what they ate through devices such as medication so they do not gain weight.

There is a popular tendency to think that bulimia is the opposite of anorexia. In fact, with the opposite, the patient would feel that he is too thin and needs to gain weight and then becomes obese but continues to eat too much.

However, this psychiatric condition does not exist. In bulimia, patients do not want to gain weight, but cannot contain the impulse to eat for more than a few days.

A bulimia patient is typically not obese because he uses extremes to eliminate excess ingested food. There are two types of patients with bulimia – those who try to eliminate excess ingested food by vomiting or using laxatives, and patients who do not do that end up gaining weight.

The latter may be classified as suffering from another eating disorder, the Binge. Patients with bulimia usually have two to three episodes of binge eating per week, but this does not mean that they are alright the rest of the time.

Actually, these episodes do not always occur daily, or even once a day, but the patient is constantly struggling against them.

As in anorexia, bulimia nervosa is a multifactorial syndrome caused by a mix of biological, psychological, familial and cultural factors. The emphasis on physical appearances can play an important role. Family problems, low self esteem and identity conflicts are also involved in triggering this condition.

How does it develop?

Often, it takes time to realise that someone has bulimia nervosa. The main symptom is episodes of binge eating, sometimes done secretly, accompanied by a lack of control over the act.

It can be recognised by behaviour directed at weight control, which includes fasting, self induced vomiting, use of laxatives, diuretics and strenuous exercise.

A diagnosis of bulimia nervosa is made when episodes have a minimum frequency of twice a week for at least three months. The phobia of becoming fat motivates behaviour.

These episodes of binge eating are followed by compensatory methods to lose weight, and can remain hidden from the patient's family for a long time.

Bulimia nervosa strikes teenagers a little older, around 17 years. People with bulimia are ashamed of their symptoms, avoid eating in public and going to places like beaches and pools, where they need to show their bodies.

As the disease progresses, these people are only interested in issues related to food, weight and body shape.

How can it be treated?

A multi-disciplinary approach is most suitable for the treatment of bulimia nervosa and includes individual psychotherapy, pharmacotherapy and nutritional counselling at outpatient clinics. Anti-depressant medication also has a proven efficacy in controlling bulimic episodes.

The nutritional approach is to establish healthier eating habits, eliminating the cycle of 'binge eating/purging/fasting.' Family orientation and therapy are necessary because the family plays a very important role in the patient's recovery.