Bulimia (boulīmia; ravenous hunger) is an eating disorder. Bulimics feel the compulsion to binge (eat a large amount of food in a short time) and after that they start purging (do something to get rid of the food). They usually vomit, exercise excessively or use laxatives. The occurrence of both binge eating and compensatory behaviour is observed atleast twice a week on an average for 3 months. Females are said to be 10 times more likely affected than males.
It usually begins in late adolescence or early adulthood, during or after a diet and is often associated with a depressed mood. They are overconcerned with their body shape and weight. Dieting leads to increased hunger and overeating. Bulimic may present with a history of anorexic eating.
Symptoms of Bulimia Eating Disorder
Bulimics follow the “all-or-nothing” rule when it comes to eating i.e., either they are fasting or they are binging. They consume a large amount of food in a short period of time have a feel that eating is out of their control. Secretly they go to the kitchen after everyone in the family has slept and then eat in privacy.
If they have eaten a box of “ladus,” then they will try to replace it so that no one notices. The family members of the bulimic often complain of disappearance of food and find empty containers in garbage. When buying food, they shop at four separate shops to avoid questions.
They often rush to the washroom after a meal to get rid of the calories they have consumed. It is observed that a bulimic initially induces vomiting by manual stimulation of the gag reflex, but most of them develop the ability to vomit at will at the later stages. The wash room of a bulimic may smell of vomit.
They also use diuretics, laxatives or enemas after a binge which results in fluid loss leading to a feeling of emptiness and dehydration but has little influence on the caloric intake. They try to hide their behavior by turning on the tap water to hide the sound of vomiting or use air freshener to disguise the smell. They exercise avidly, especially after eating.
Scars or skin thickenings on the back of hands are present because of sticking fingers into the throat to induce vomiting. Cheeks appear full and puffy due to hypertrophy of salivary glands enlargement. Teeth discoloration is frequent due to exposure to stomach acid while purging. Bulimics usually have a normal body weight or may be slightly overweight. If underweight, it could be associated with a history of anorexia.
The non purging bulimics tries to get rid of the calories by fasting and exercising whereas the purging bulimic tries to vomit and uses laxatives. Some may have mild symptoms of depression while others may also exhibit serious mood and behavioral disturbance such as suicide attempt, drug and alcohol abuse. They often associate self esteem with their weight and shape.
An eclectic approach which consists of both psychological therapy and medications gives best results. Mostly bulimia nervosa can be treated on an outpatient basis.
Cognitive behavior therapy is a psychological treatment focusing on the patients concern with body shape, weight, dieting, binging and purging which are central to the disorder. The bulimic is asked to monitor the precipitating factors like the situation, thought, emotions associated with their behaviors (binging /purging etc). Next they are asked to challenge the above realized precipitating factors and also their assumption of linking their body image to their self esteem and achievements.
US Food and drug administration approves Prozac as an effective drug for the treatment of bulimia nervosa. However, antidepressant medications are not as effective as Cognitive behavior therapy in the management of bulimia nervosa. Family support not only makes the entire process easier and quicker but also helps in preventing prolapse.
Bulimics resistant to Cognitive behavior therapy and or medications may require a more intensive treatment like hospitalization. Mortality rate is low and full recovery occurs in almost 50% of Bulimia Nervosa patients. Prognosis is better than Anorexia Nervosa.