Today’s world, eating disorders have reached epidemic levels, leading to physical and psychosocial morbidity. One such condition is known as bulimia nervosa. Under such a potentially life-threatening disorder, individuals require the intervention of medical and psychological professionals to alter the course.

Read along to comprehend its types, prominent signs, causes, risk factors, ways to diagnose and treatments available.

Bulimia nervosa is generally characterised by uncontrollable eating episodes within a short period. During these binges, one has no sense of control over eating. As a result, it causes an inappropriate obsession to undo the impact of binge eating to control body weight.

Thus individuals suffering from this condition have self-esteem concerning closely with their body size or shape. Depending on how people try to subsume this behaviour, bulimia nervosa is categorised into two types.

Individuals suffering from this disorder follow two ways to restrict calories:

• Purging: In this type, individuals pick up purging behaviours, such as self-induced vomiting, misuse of diuretics, laxatives or enemas, or any other medicines to keep their intestines clean.
• Non-purging: In this type, people may go as far as fasting and indulging in excessive exercise to control body weight.

Though the particular reason behind this eating disorder is unknown, it is likely to be multifactorial. In addition, a recent review of 2019 and some research studies show that Bulimia Nervosa may develop due to a deficiency of serotonin in the brain.

Factors that lead to this condition can be classified into four categories, and these are as follows:

• Sociocultural
• Psychological
• Biological
• Developmental

The signs of bulimia vary from person to person and can be physical and behavioural. A few of them include the following:

Physical Symptoms of Bulimia Nervosa

• Dental concerns
• Irregular menstruation
• Gastrointestinal disorders such as bloating, acid reflux and constipation
• Sore throat
• Dizziness
• Swollen neck and face
• Muscle weakness
• Bloodshot eyes
• Calluses on knuckles or back of the hands due to forced vomiting
• Fainting
• Sleep disorders
• Dehydration
• Frequent weight gain/loss

Behavioural Symptoms of Bulimia Nervosa

• Eating only a particular item
• Over-chewing a food
• Not allowing anyone to touch the food
• Stealing food
• Skipping meals or eating in small portions
• Uncontrolled episodes of eating
• Self-induced vomiting
• Abusing diuretics, enemas, laxatives or any other medicine to reduce weight
• Using the washroom repeatedly after meals
• Depression
• Drinking excessive water or calorie-free beverages
• Feeling out of control.
• Avoiding social gatherings and activities one used to enjoy
• Frequently usage of mints, mouthwash or chewing gums
• Preoccupation with body weight and shape
• Feeling guilty about eating

These signs may seem similar to other medical or mental health conditions. Therefore, consult a professional for a diagnosis if you encounter any of the symptoms mentioned above.

Risk factors associated with any eating disorder revolve around sociocultural, biological and psychological issues. As the factors interact differently in people, individuals with bulimia nervosa go through diverse experiences and signs.

• Age: An eating disorder can occur to anyone, be it children or older adults. However, during adolescence and early adulthood, the occurrence of bulimia may take a peak.
• Gender: Though bulimia can occur in both men and women, studies show that females are more likely to develop binge eating disorders. The median age of onset is around 12 years for women.
• Emotional Disorders: Individuals undergoing psychological concerns such as anxiety, depression, obsessive-compulsive disorder, and low self-esteem are at risk of developing purging.
• Past Abuse: Individuals with a history of sexual abuse or trauma are more likely to develop eating disorders.
• Obesity: Bulimia may occur in adolescents and teenagers who are obsessed or have a history of obesity.
• Negative Body Image: People preoccupied with their body weight and have taken up crash diet plans are more susceptible to developing this eating disorder.
• Genetics: Individuals with family members with a history of eating disorders or other mental illnesses are at higher risk.
• Performing Certain Activities: A few sports and activities, such as gymnastics, running, wrestling, swimming and dancing, may encourage people to be thin and highly fit.
• Personality: People with a high drive to be perfect or struggle for perfection are likely to exhibit the symptoms of this eating disorder.
• Family Factors: Family conflicts, overprotective parenting, and parental indifference contribute to the development of bulimia. Nonetheless, any of these risk factors does not necessarily indicate bulimia nervosa. On the contrary, the more these conditions are present, the more the person is likely to develop an eating disorder.

Bulimia nervosa disrupts the body from getting sufficient nutrients which may result in the following complications:

• Erosion of tooth enamel due to acid reflux
• Tooth cavities, decay and discolouration
• Gum infection
• Throat and stomach ulcers
• Disproportionate electrolyte level
• Cardiac failure
• Arrhythmia
• Throat soreness and inflammation
• Swollen and sore salivary glands due to frequent vomiting
• Esophagitis and tears
• Gastro paresis
• Increased self-harming or suicidal tendency
• Dehydration
• Substance abuse
• Damaged intestine and stomach
• Lower sex drive

Apart from these, in severe cases, one may undergo cardiac arrest.

During diagnosis, medical practitioners start with a medical history check and symptoms of this eating disorder. However, you may feel uncomfortable opening up completely, but it is essential, to be honest for effective results.

To diagnose bulimia nervosa, professionals conduct a psychological test. They often ask the following questions to understand the relationship between food and one’s body image such as:

• Do you indulge in any inappropriate purging behaviour? If yes, is it as often as once a week for three months?
• Does your body weight dictate your self-esteem?
• Do you experience uncontrollable urges to binge eat?
• Do you feel out of control while eating?

Nevertheless, there is no pathological test to diagnose bulimia. Experts may ask to get the following tests done to confirm how much this eating disorder has affected one's health:

• Full-body check
• Urine and blood tests
• Electrocardiogram (EKG)
• Kidney function test

Treatment for bulimia nervosa involves both physical and psychological aspects to restore mental health and healthy eating habits. The following are:

• Medical Treatments: Most eating disorder programmes include outpatient treatment. Doctors may prescribe an antidepressant to suppress the uncontrollable desire to binge eat. In severe cases, they may recommend admitting to a hospital for a short period.
• Nutritional Education: Individuals can seek medical assistance from a professional dietitian to understand the signs of hunger and fullness. This will significantly help stabilise weight and prevent unhealthy eating patterns.
• Psychotherapy: Besides counselling, mental health professionals may recommend the following therapies to treat bulimia nervosa effectively.
  • Interpersonal Psychotherapy (IPT): How one interacts with others can adversely impact emotional and mental health. Therefore, this therapy primarily addresses maladaptive thoughts to change relationship patterns.
  • Family-based Treatment (FBT): In this treatment, experts involve parents and other family members to re-establish the regular eating habits of the person who has bulimia.
  • Cognitive Behavioural Therapy (CBT): It helps to unlearn unhealthy eating patterns and keep a check on things that may result in a purge by challenging irrational thoughts and unusual behaviours.

Apart from these, individuals can take steps to do away with purging behaviours. For example, they can connect with their close ones or professionals to overcome such habits. Further, switching to a healthy diet plan can make a significant improvement.

Individuals must seek professional help on experiencing any of the following conditions:

• Dyspnea or shortness of breath
• Dizziness
• Acid reflux
• Extremely sore throat
• Chest pain
• Fainting
• Heart palpitations

Though there is no definite way to prevent bulimia, you can steer one toward healthier habits or opt for professional treatment. Here are a few tips to adequately manage and prevent the situation:

• Try to foster and reinforce healthy and realistic body image in children and help them build confidence in how they are.
• Have family mealtimes as frequently as possible.
• Refrain from discussing the adversities of unhealthy habits and encourage fad dieting. Instead, focus on the significance of healthy choices.
• Consult health care providers to identify the early indicators and prevent the development.

Once bulimia develops, it can be difficult to cure since one can secretly continue binge eating for a long time without any intervention. Thus, talking with the person and understanding the concerns is essential.

Most people with bulimia overcome the condition with proper treatment. However, the pace of improvement is indicative. At the same time, some may recover at first but may relapse and require treatment again.

That said, if left untreated, bulimia nervosa may result in severe complications and is associated with an increase in all-cause mortality.