Bulimia is an eating disorder which involves the habitual consumption of a large quantity of food (bingeing), followed by purging (usually by vomiting). It is closely related to anorexia nervosa because both involve problems with the individual’s self-image – the patient is in constant fear of gaining weight and is extremely dissatisfied with his or her shape and size.

Background

It has been the practice of cultures, even ancient ones, to employ fasting as a way to enhance beauty and health. It has been said to cleanse the system, and in the case of intellectuals of the early years, such as Pythagoras and Plato, it can even enhance the intellect. However, depriving one’s self of nutrients and exposure to dehydration can give rise to a host of complications in the long run.

Also known as bulimia nervosa or binge-purge behavior, it is more common in women than in men and affects adolescent girls the most. Unlike anorexia, however, those with bulimia may still have weights that fall within what is considered typical for people their age and height. Bulimic activities are almost always done in private because the patient is usually aware that his or her behavior is unnatural and is therefore embarrassed about it. However disgusted a person may feel about the bulimic behavior, however, he or she finds it difficult to control.

Causes

The exact causes of bulimia are unknown, but many factors – trauma, societal, familial, cultural, psychological, genetic – are attributed to it. Studies have shown that patients are more likely to have a relative with a similar condition. It is also possible that the patient comes from a family of overachievers or perfectionists and may be overcritical, pushing the patient to do anything to live up to their expectations. They usually have coexisting illnesses such as depression, anxiety disorders such as obsessive-compulsive disorder (OCD), other psychological disorders, and/or substance abuse.

Patients characteristically have low self-esteem, find it hard to express their anger, and are unable to manage impulsive behaviors. Some are even victims of sexual abuse. A significant percentage of bulimics come from disciplines that put a premium on physical appearance and fitness, such as athletics and show business.

Risk factors

Individuals most at risk of developing bulimia are middle-class white women, adolescents and college students, those with low self-esteem, and those whose families have histories of drug or alcohol abuse and mood disorders.

Symptoms

The bingeing may go on as frequent as several times a day and may last for months on end. This then triggers feelings of self-disgust at having eaten so much, and is followed by purging episodes. The patient may resort to inducing vomiting, which is the most common purging method, or may excessively take enemas, laxatives, or diuretics, to keep their weight down.

Patients also possess overachieving behavior and have a habit of constantly checking their weight. They may also exhibit the following symptoms: manic exercising, yo-yoing weight, diarrhea or constipation, gas, nausea, bad breath, and irregular menstrual periods or possibly, amenorrhoea.

Diagnosis

Apart from the obvious signs – bingeing and self induced vomiting – a dental exam could also confirm the presence of the disorder. Bulimics develop dental caries and gum infections due to the constant purging. Swollen glands below the jaw and in the neck may be palpated. And because vomit is extremely acidic, it erodes the tooth enamel and could cause the teeth to erode. In addition, a chem-20 test could be conducted to check for electrolyte imbalance due to dehydration.

Advanced stages of bulimia may present complications such as constipation, hemorrhoids, chronic throat soreness and inflammation, esophageal damage and/or gastroesophageal reflux disorder (GERD), kidney damage from abuse of diuretics, intestinal irritation from abuse of laxatives, and pancreatitis.

Treatments

Depending on the condition’s severity, a health professional may recommend treatment involving several stages. Not only should the doctor pay attention to returning the patient to physical health but the underlying psychological issues should be addressed as well.

However, before commencing treatment, it is important to orient the patient with the following:

• Treating bulimia is not an easy process, and it takes full cooperation from the patient and the patient’s friends and family members
• Several therapies may have to be tried before finally settling for the one most suited for the patient
• There is a high possibility for a relapse, but the patient should not be alarmed because intervention is always available

Approaches

• Support groups – practical and inexpensive, support groups give the opportunity for patients to share their experiences with others suffering from bulimia. This is ideal for those in the early stages of the disease.
• Cognitive-behavioral therapy (CBT), coupled with nutritional therapy – should be the treatment of choice for patients who would not do well with support groups.
• Medication – drugs such as SSRIs (antidepressants) are best combined with CBT. Prozac (fluoxetine) has been approved by the FDA for the treatment of bulimia. Aside from managing depression, it has also been found to lessen, if not eliminate, the frequency of the bingeing and purging cycle and modifies eating behaviors. Caregivers should note, though, that Prozac has been found to cause suicidal thoughts in children, making it necessary for them to be under constant monitoring.

Alternative treatments

Nutritional therapy:

Other than going through CBT, the patient must make a 180-degree turnaround in terms of diet to restore health and pay serious attention to the following pointers:

• Avoid refined sugars and sweets, including sodas and candy.
• Drink 6-8 glasses of water a day.
• Avoid tobacco, alcohol, and caffeine.
• Take Coenzyme Q to strengthen resistance and for muscular support.
• Focus on organic protein sources and always include them in your diet to rebuild body mass: vegetable protein shakes, whey, organic eggs and meat, to name a few.
• Take daily multivitamins – particularly containing vitamins A, C, and E (antioxidants), and the B-vitamins.
• Include trace minerals (copper, magnesium, zinc, selenium, and calcium) in the daily diet.
•  Take Omega-3 fatty acids to help lower inflammation and boost immunity. Halibut or salmon are good sources of fish oils. Have at least two servings weekly.
• Restore the health of your stomach and intestines by taking probiotics.
• Increase immunity and improve the health of your GI tract by taking L-glutamine thrice daily.

Herbs in dried extract form or as tinctures or glycerites can work wonders for the patient’s overall health. Examples are grapeseed, catnip, milk thistle, ashwagandha, and holy basil.

Therapeutic massages can help patients indirectly by giving them the opportunity to relax and let go of tensions that trigger bulimia. Acupuncture is another alternative therapy for bulimia and also helps ease the patient’s anxieties.
Bulimia is a disease that has developed over time and should be treated over a long period. The healthcare provider should regularly monitor the following: the patient’s mental and physical health, diet, eating and exercise habits, weight, and overall well-being.