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  • What is Bulimia Nervosa?

What is Bulimia Nervosa?

Bulimia nervosa is an eating disorder which is characterized by repeated episodes of eating food in a large quantity. The quantity of food is excessively large than would a person could eat in a given amount of time. Researches have shown that this quantity could be as much enormous then could eat the entire day. This excessive consumption of food is not limited to a specific setting (e.g. eating more than usually consumed on an event) rather the behavior is followed in all settings. The excess consumption of food in bulimics is followed by certain behaviors aimed at reducing the effects of binging or excessive eating. The distinguishing feature of anorexia nervosa and bulimia nervosa is that the terrific weight loss is not present in bulimia nervosa. But the fear of gaining weight or the desire to lose weight is common in both disorders. In the general population, the bulimia nervosa is found more to be prevalent in females than males with an approximate ratio of 10:1 respectively.

Core symptoms of Bulimia Nervosa

The symptoms of bulimia nervosa could be divided into two steps. These are as follows:

The individual loses control over oneself. He or she is compelled to binge and cannot refrain from eating. Once he starts eating it is unstoppable. The individual’s mind is preoccupied with the feeling of “cannot stop eating”.

Often times the individual describes this loss of control during binging as in a state of trance. This is a phase in which a person has no idea where he is heading up.

Binging often occurs in secrecy. This means that the individual is reluctant to eat excessively in the presence of his close ones.

In step 2 the individual makes attempts to overcome binging (excessive eating). This binging shame or disgust for the person.

Following is the range of behaviors that are usually being carried out by bulimics to overcome their disgust and the painful feeling caused by excessive eating.

The individuals induce vomiting himself; with the use of fingers. The bulimics vomit in order to get rid of the fear of weight gain and to get relief from the feeling of uncomfortable fullness.

Also, individuals do engage in binging to stipulate vomiting with the doctrine of getting oneself cleared of the excessive calories being ingested.

The excessive exercise being done by the bulimics often hinders their important chores.

  • The individual often used to evaluate themselves on the basis of their body shape and weight that does result in lowering their self-esteem. Let’s take a look at how this lowering of
  • self-esteem triggers the whole episode of bingeing followed by compensatory behaviors.

Common Precursors of Binging

Bulimia nervosa usually begins by adolescence. Following are certain precursors or antecedents of bingeing:

Physical Harms of Bulimia Nervosa

The use of various compensatory behaviors by bulimics results in several harmful physical consequences. Some of them are listed below:

  • The use of laxatives results in diarrhea that further causes the electrolyte disturbances in the body.

Repeated self-induced vomiting can cause serious problems such as tearing of stomach and throat tissues, acidity, electrolyte imbalance.

  • In most extreme cases death has also been associated with bulimia nervosa.

Factors Responsible for Bulimia Nervosa

The following factors are likely to play an important role in making the individual susceptible to this eating disorder:

In regard to genetic factors, the research has proven that some of the genes are inheritable. The first-degree relatives of women with bulimia nervosa are about four times more likely than average to have this disorder.

The neurobiological studies of this disorder have shown that bulimics have low levels of beta-endorphins. However, it is unclear whether this low-level of endorphins is the cause of bulimia nervosa or it is because of changes in food intake or compensatory behaviors. Also, the low level of serotonin has been found as responsible for making them binge. This results in making them incapable to achieve the feeling of satisfaction.

Another neurobiological factor includes the greater dopamine activity in the individual with eating disorders. This greater dopamine activity is thought to cause due to dietary restraints. This finding suggests that restrained eaters may be more sensitive to food cues as the increased levels of dopamine make the individual be more sensitive towards these cues thus compelling the bulimics to go after food.

Furthermore, in reference to the cognitive factors since bulimics evaluate themselves on the basis of body shape and weight results in the negative mood that motivates them to have strict dietary patterns. This restriction in food intake is inevitably broken thus the lapse escalating into bingeing. Thus bingeing in this way serves as a way of relieving the negative effect.  

Moreover, the sociocultural factors have also gained significant importance over the past few years. The special emphasis is directed nowadays towards the attainment of a perfect body image. This cultural influence of thinness serves as a vehicle to induce fear of getting or being fat in the individual with eating disorders. 

Modules for Treatment

Five Self-help tips for Bulimia Nervosa

These simple self-help tips are based on principles of advances therapeutic technique. These are much helpful.

  • Step 1. 

Keep the daily record of dietary intake and compensatory behaviors. How many binges (episodes of excessive food intake) occurred? When doses the binge start? Is there any stressor before binge? What is done to undo this excessive intake, like vomiting and diuretic intake?

  • Step 2. 

Take regular and planned meals. Fasting for longer period triggers binging and binging increases the desire for fasting. Regular meals break this vicious cycle.

  • Step 3. 

Now work on binges. Keep food out of reach and if possible, keep short stock of food. Take less money when going for a meal.

  • Step 4. 

Stop self-induced vomiting. Don’t use laxatives and diuretics drugs.

  • Step 5. 

To control to urge of excessive intake episode, try to distract yourself with other activities

Psychological Treatment

The main psychological treatment is Cognitive Behavior Therapy (CBT). The CBT is best known for its effectiveness for bulimia nervosa. The individuals report significant improvement in the reduction of binging episodes as well as harmful compensatory behaviors. The main aims of CBT are given as follows:

  • First of all, identify the events, thoughts, and feelings that trigger to urge to engage in excessive eating. Next is to learn more adaptive ways to cope with these situations.
  • The individual is desensitized to social evaluation. This technique encourages him to question society’s standards for ideal weight and the pressures to be thin.
  • The unrealistic standards of perfection and negative thinking patterns (e.g. I will not be accepted if I’ll gain weight, My husband would reject me if I hit 120 pounds) are firmly challenged by use of techniques e.g. questioning the evidence, identifying the logical errors in thinking, pie charting etc., and are then replaced with alternative positive thoughts.
  • Encouraging the individual to eat three meals regularly to avoid binging (episodes of excessive eating) and purging as this regular intake reduces hunger and also the urge of excessive eating. 
  • Reduction of self-induced vomiting behaviors by use of relaxation techniques. 

Medicines for Bulimia Nervosa

According to international guidelines, medicines are effective in the treatment of this disorder but they should be second-line treatment choice. Initially, we start with psychotherapy and self-help. If they are not working, then there will a need for medicines. Commonly used drugs are antidepressants. Their onset of action more rapid as compared to that of depression. 

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