Bulimia nervosa or pathological anorexia nervosa, its symptoms, causes and treatment

We all sometimes overeat, especially during occasions like holidays and gatherings, and that’s completely normal if it happens occasionally. However, if overeating becomes frequent and a person feels unable to stop, it could be a sign of Binge Eating Disorder (BED). Learn more about this serious eating disorder on Dalili Medical, as it requires specialized medical care to manage it effectively and avoid severe health complications

How to Prevent Bulimia Nervosa?

Since the exact cause of bulimia nervosa is not known, preventing this disorder is still challenging. However, doctors and specialists agree that awareness and education play a significant role in preventing eating disorders. One of the most important ways to reduce the risk of bulimia is to encourage young people to accept their body shape as it is and to understand that the beauty standards promoted in the media are unrealistic. It is also crucial to recognize the early signs of bulimia in family and friends, encourage them to seek help, and talk about their feelings.

What is Bulimia Nervosa?

Bulimia nervosa is an eating disorder and a psychological condition where a person experiences episodes of consuming large amounts of food in a very short time, followed by attempts to get rid of it through methods such as self-induced vomiting, using laxatives, or excessive exercise to avoid weight gain. It is most commonly seen in teenagers aged between 13 and 18 years rather than in adults.

Types of Bulimia Nervosa

There are two types of bulimia nervosa:

Purging Type: In this type, the person eats excessively without control and then tries to eliminate the food through vomiting, laxatives, or diuretics.
Non-Purging Type: In this type, the person does not use purging methods like vomiting but compensates for overeating through excessive exercise or prolonged fasting.

When Should You Seek Medical Help?

Bulimia nervosa and the malnutrition associated with it can lead to severe health complications affecting all body organs, and in some cases, it can be life-threatening. Therefore, if you notice any signs of bulimia, it is essential to consult a doctor or specialist as soon as possible to get accurate information and start treatment. Here are some tips to help you make the most of your visit to the doctor.

What Causes Bulimia Nervosa?

There is no single, clear cause of bulimia nervosa, but several factors can increase the risk of developing the disorder.

Risk Factors That Increase the Chances of Bulimia Nervosa:

Family History: If someone in the family has had an eating disorder, the likelihood of developing bulimia increases.
Body Image-Related Bullying: Negative comments or ridicule about body shape can have a psychological impact and contribute to the disorder.
Obsession with Thinness Due to Social Pressure: Whether from family, friends, or media promoting unrealistic beauty standards.
Anxiety, Stress, and Constant Worry About Weight: People who are excessively concerned about their body shape and weight are more vulnerable to developing bulimia.

The Relationship Between Dieting and Bulimia Nervosa

Following strict or unbalanced diets can be a major cause of bulimia nervosa. Extreme hunger due to restrictive dieting often leads to binge eating, followed by unhealthy purging behaviors. Some key factors contributing to this cycle include:

Following extreme diets for long periods.
Being influenced by European beauty standards and the obsession with the "ideal body."
Participating in programs or courses that promote excessive weight loss in an unhealthy way.
Associating success and achievement with physical appearance, leading to frustration and despair when the "ideal body" is not achieved.

Biological Factors and Their Impact on Bulimia Nervosa

Recent brain imaging studies have shown differences in brain responses between men and women suffering from bulimia nervosa. Eating disorders often emerge during puberty, a time of significant hormonal changes.

Research from 2007 suggests that ovarian hormones may play a role in increasing the risk of bulimia nervosa in women.

What Are the Symptoms of Bulimia Nervosa?

Bulimia nervosa is difficult to detect because individuals suffering from it tend to hide their eating habits and purging behaviors. However, certain symptoms can help identify the disorder.

Symptoms of Bulimia Nervosa Can Be Divided into Four Categories:

1. Physical Symptoms:

Swollen cheeks due to frequent vomiting.
Yellowing of teeth caused by exposure to stomach acids during vomiting.
Constant fluctuations in weight, either gain or loss.
Throat inflammation due to repeated vomiting.
Persistent fatigue and exhaustion.
Digestive issues and frequent bloating.
Chronic bad breath due to frequent vomiting.
Irregular menstrual cycles in women.

2. Symptoms During Binge Episodes:

Inability to control food intake.
Consuming large amounts of food without noticeable weight gain.
Disappearance of food or finding empty food containers hidden in unusual places.
Avoiding eating with family and friends to hide eating habits.

3. Symptoms Related to Purging Behaviors:

Using laxatives to quickly eliminate food from the body.
Spending long periods in the bathroom after eating, often to induce vomiting.
Excessive and intense exercise.
Prolonged fasting to compensate for overeating.

4. Psychological Symptoms:

Severe mood swings.
Persistent feelings of anxiety and depression.
Social withdrawal and avoiding interactions with others.
Sleep disturbances, such as insomnia or excessive sleeping.

What Are the Risks of Bulimia Nervosa?

Bulimia nervosa can be extremely dangerous to a person’s health and even life-threatening. The methods used to purge food, such as frequent vomiting or laxative abuse, can cause severe damage to the digestive system and disrupt the body’s balance of essential minerals and fluids. Some of the major risks include:

Tears in the stomach and esophagus due to frequent vomiting.
Severe dehydration caused by excessive fluid loss from vomiting and diarrhea.
Irregular heartbeats due to dangerously low potassium levels.
Kidney failure as a result of severe potassium depletion.
Increased risk of heart attacks.
Reduced libido and negative effects on overall health.
Chronic anxiety and depression.
Self-harm tendencies.
Suicidal thoughts in severe cases.

Who Is at Higher Risk of Developing Bulimia Nervosa?

Anyone can develop bulimia nervosa, but certain groups are at a higher risk due to various factors, such as:

Females: While bulimia can affect both men and women, it is more common among females.
Teenagers: It often develops during adolescence, a period of significant physical, hormonal, and social changes, along with academic pressure.
Family history and genetics: A person is more likely to develop bulimia if there is a family history of eating disorders or mental health conditions.
Co-existing mental health conditions: Disorders like anxiety, depression, or substance abuse can contribute to the onset of bulimia.
Difficult life circumstances: Constant psychological stress, traumatic events, or extreme dieting can increase the risk of developing bulimia

How Is Bulimia Nervosa Diagnosed?

Doctors diagnose bulimia nervosa by assessing the patient’s medical and family history, along with a physical examination. Understanding the patient's lifestyle is crucial, including:

The amount of food consumed.
Weight monitoring and changes.
Living and working conditions.
Emotional and psychological state.

Tests and Evaluations for Diagnosis

The diagnostic process begins with a psychological and physical assessment, during which the doctor asks specific questions to rule out other mental health disorders, such as:

Do you eat large amounts of food in short periods?
Do you intentionally vomit after eating?
Do you use laxatives or weight-loss medications?
Do you engage in excessive exercise?
Are you satisfied with your body shape?

Severity Classification of Bulimia Episodes:

Mild: 1 to 3 episodes per week.
Moderate: 4 to 7 episodes per week.
Severe: 8 to 13 episodes per week.
Very Severe: More than 14 episodes per week.

Required Tests and Examinations for Diagnosis

Complete Blood Count (CBC):
- Monitors hemoglobin levels and red blood cell count to check for anemia caused by iron or folic acid deficiency.
Electrolyte and Mineral Tests:
- Measures sodium, potassium, and calcium levels, as imbalances can cause severe complications, especially heart irregularities.
Blood Sugar and Kidney Function Tests:
- Includes urea and creatinine tests to rule out kidney failure.
Liver Function Tests:
- Performed in rare cases to assess liver health.

Heart Examination

An electrocardiogram (ECG) is recommended to check for heartbeat irregularities and ensure normal heart function.

What’s the Difference Between Hunger and Craving?

Although both words describe a strong desire to eat, there is a subtle difference:

1. Hunger:

Represents a natural, regular feeling of needing food.
Usually results from the body’s physical need for nourishment.
Not linked to specific types of food—any available food can satisfy hunger.

2. Craving:

Refers to an intense urge to eat, whether or not the person is physically hungry.
Can be triggered by psychological or social factors rather than actual bodily needs.
Often involves a strong desire for specific types of food, regardless of real hunger.

Treatment of Bulimia Nervosa

Like other eating disorders, many people recover from bulimia, but treatment takes time, determination, and strong support to prevent relapses. Successful treatment typically involves a combination of approaches, including:

1. Psychological Therapy

Cognitive Behavioral Therapy (CBT): The most effective approach for modifying harmful eating behaviors and replacing them with healthy habits.
Family and Group Therapy: Provides strong social support, which has been proven to aid recovery.
Treatment of Coexisting Mental Disorders: Addresses underlying conditions like depression and anxiety that often accompany bulimia.

2. Nutritional Counseling

Helps develop a structured, healthy eating plan.
Supports the body in resisting binge-eating episodes and purging behaviors.

3. Medication

In some cases, medication is used alongside psychological therapy to prevent relapses.
The FDA has approved Fluoxetine (Prozac) for the treatment of bulimia nervosa.

4. Hospital Treatment (For Severe Cases)

If a patient experiences severe physical complications or suicidal thoughts, hospitalization may be necessary.

Treatment for Binge Eating Disorder (BED)

The treatment plan for BED depends on the cause and severity of the disorder and typically includes:

1. Psychological Therapy (The Most Important Approach)

Cognitive Behavioral Therapy (CBT): Helps patients manage negative thoughts about food, body image, and weight.
Interpersonal Therapy (IPT): Helps patients identify emotional and social issues contributing to binge eating, with gradual progress over 12–16 weeks.
Dialectical Behavior Therapy (DBT): Teaches patients how to manage negative emotions and cope with stress in a healthy way instead of resorting to binge eating.

2. Medication

Some medications can help reduce binge eating episodes in the short term, but they are not always as effective as behavioral therapy and may have side effects.

3. Weight Loss Treatment

Behavioral weight-loss therapy focuses on improving lifestyle habits through healthy eating and physical activity.
It enhances self-esteem and body image but is not as effective as psychological therapy in stopping binge-eating episodes.

Which Specialists Treat Bulimia Nervosa?

A doctor treating bulimia nervosa is typically an expert in one or more of the following fields:

Specialists Involved in Treating Bulimia Nervosa
Psychiatrist – Treats mental health disorders related to bulimia nervosa and prescribes medication if necessary.
Psychologist – Uses psychological therapies like Cognitive Behavioral Therapy (CBT) to help the patient control their eating behaviors.
Dietitian/Nutritionist – Develops a structured and healthy diet plan and educates the patient on how to develop a balanced relationship with food.
Internal Medicine Doctor / Gastroenterologist – Treats physical complications caused by bulimia, such as digestive disorders or the effects of frequent vomiting.
Comprehensive Treatment Approach
In severe cases, treatment involves a multidisciplinary team consisting of:

Psychiatric care
Psychotherapy
Nutritional counseling
Medical follow-up to monitor physical health