BULIMIA NERVOSA (BN)

We humans have a strong connection with the food we eat as it helps in our growth and development. But there are people suffering from different types of eating disorders. These eating disorders are considered as consequential psychiatric sickness which is commonly seen in adolescence or in young adults. Moreover, some people anticipate that eating disorders are associated with lifestyle choices. It is not true as eating disorders may show some catastrophic effect that may lead to an imbalance in a person’s whole eating pattern. There are certain indicators of eating disorders like passion towards food, body weight, and shape. Frequently occurring eating disorders involve anorexia nervosa, bulimia nervosa, and binge-eating disorder. In this article, we will discuss bulimia nervosa in detail.

Bulimia nervosa is a sort of eating disorder because of which an individual ingests food in an immense amount within a short duration followed by purging what was consumed to abstain any kind of weight gain. Purging methods may include self-induced vomiting, extravagant use of diuretics or laxatives and intense exercise. Bulimic individuals are often able to mask their disorder from others for a prolonged period as they carry out bingeing or purging episodes secretly. People suffering from bulimia nervosa adapt to these behaviors in order to avoid weight gain.

• TYPES OF BULIMIA NERVOSA

There are basically two major types of bulimia nervosa:-

Purging type: In this type, people compensate the overeating behavior by self- induced vomiting or excessive use of laxatives, diuretics or related substances. Majority of the population suffers from this type of eating disorder.

Non-Purging type: Conversely, here individual approach for alternative options (like intense exercise) to compensate the binge episodes.

• PREVALENCE

Hsu LK.(1996) showed that the prevalence of bulimia nervosa is 2% to 3% in women and reached up to 10% in vulnerable population like in college-going females. Lee NF, Rush AJ and Mitchell JE(1985) indicated that most often bulimic patients are single, college educated or in their mid-20s. But, commonly patients start facing bulimic symptoms during adolescence. Upadhyah A et al.(2014) demonstrated in their study that eating disorders are also prevalent in Indian adolescent females that were strongly related to various behavioral, psychological and socio-environmental zone.

• CAUSES OF BULIMIA NERVOSA

The precise causes of this eating disorder are unknown but there are various factors responsible for its development. Some of the main causes of bulimia are outlined below:-

- Inferiority related to body shape
- Lifestyle changes
- Poor self-esteem
- Occupation where appearance plays a vital role e.g. modeling

• SIGNS AND SYMPTOMS

“Bulimia Nervosa: Causes, Symptoms, Signs & Treatment Help” 2018 mentioned some sign and symptoms such as:

Physical sign and symptoms of bulimia nervosa are:
-Constant weight fluctuation
- Imbalance of electrolytes that leads to cardiac arrhythmia, cardiac arrest , etc.
- Enlargement of glands in the neck and under the jawline
- Oral trauma like mouth laceration
- Chronic dehydration
- Weakness, exhaustion, and bloodshot eyes
- Indigestion, heartburn due to acid reflux and bloating

Signs and symptoms of purging and binge eating are:
- Recurrent use of washrooms after meals
- Consuming hidden food
- No self-control during eating
- Vomiting smell
- Alteration between a phase of overeating and fasting.

• HEALTH COMPLICATIONS RELATED TO BULIMIA

There are various medical complications related to the binge-purge cycle which get worse with time.“5 Medical Risks of Bulimia Nervosa” mentioned some of the health risks which are outlined below:

Electrolyte Imbalances and Dehydration: Imbalance of electrolytes are more common in bulimic individuals as a result of repeated episodes of vomiting. Sodium, potassium, calcium, and chloride are a few essential electrolytes which play an important role in maintaining body functions. Moreover, vomiting also causes dehydration in the body.

Digestive problems, peptic ulcers, and pancreatitis: Excessive use of laxatives and diuretics distort the gastrointestinal functioning of the body. This results in a decrease in muscle tone of intestine due to which dependence induces on laxatives to stimulate the bowel movement. Whenever the laxative use is halted it leads to stomach discomfort, constipation and bloating. The occurrence of peptic ulcer may be due to the production of excessive acid in the stomach or duodenum that causes partial erosion of lining in affected areas that results in painful and bleeding sores.


Dental caries: Frequent self-induced vomiting behavior, and acid reflux causes decaying of teeth due to the accumulation of acid in the mouth area. Dynesen A et al. (2008) showed in their research that dental erosion was associated with the duration of eating disorder.

Stomach rupture: Episodes of binge eating may increase the risk of gastric puncture or perforation.

Hoarseness: Acid reflux is associated with symptom of laryngopharyngeal reflux which is the hoarseness.

Eyes, ears, and nose: Brown CA, Mehler PS (2013) anticipated that self-induced vomiting may be responsible for causing red patches in the whites of the eye beneath the clear lining and recurrent epistaxis (bleeding from the nose).

Reproduction: Crow SJ et al. (2002) suggests that while irregularities in menstrual cycles are common but bulimia nervosa has little impact in conceiving in latter stages.

Laxative abuse: Mehler PS and Rylander M (2015) revealed that laxative abuse is considered as the second most frequently used mode of purging in bulimic patients. Laxatives are categorized into five major classes based on their mechanism of action- bulk laxatives, osmotic, surfactants, emollients, and stimulants. Among all, stimulants laxatives are habitually misused by bulimic patients and are correlated with most of the medical complications. The medical complications linked to laxative abuse is classified into two categories:
- Those due to effects on the gastrointestinal system along with hypovolemia (decrease in blood volume).
- Those due to a disturbance in electrolyte balance. Electrolytes that are lost due to the use of laxatives are chloride, calcium, bicarbonate and potassium.

• TREATMENT FOR BULIMIA NERVOSA

The main aim in treating a bulimic individual is to stop the binge eating and purging episodes. Other objectives include:
- Fabricate a healthy attitude towards food
- Form a nutritional meal pattern.
- Prevent relapsing
- Acquire self-confidence

Medical treatment

“Medication for an eating disorder” 2017 mentioned some of the medications primarily to stabilize the patient both mentally and physically. Bulimia nervosa medication includes:

• Electrolytes (Potassium chloride, calcium gluconate and potassium phosphate) are commonly incorporated. As eating disorder may include severe restriction of some food, body’s electrolytes and chemicals that are necessary for proper functioning of the body, therefore, required for replenishment.

• Psychiatric medications involved the use of antidepressant or neuromodulator, they are needed because a bulimic individual may suffer from depression, anxiety and obsessive disorder.

Nutritional treatment

Nutrition also plays a major role in the treatment of eating disorders. Therefore, it is necessary to educate and assist the bulimic individual along with nutritional intervention. A balanced diet helps in the recovery as a person may be deficit in vitamin C & D. Nutritional education also helps overcome the eating disorder by switching to a healthier eating pattern. Add variety and inculcate food items in sufficient quantity to prevent bingeing. Moreover, family and friends support plays a primary role in the treatment.

Talk therapy

Talk therapy comprises one-on-one counseling between a counselor and the bulimic person.

Conclusion

Bulimia nervosa is a type of eating disorder which is commonly found in younger population. The distinguishing feature of bulimia nervosa is a distorted sight for food and eating. Bulimic may exhibit normal or above normal weight. It is most prevalent in women who are single, college-going or for whom appearance plays a major role. Like other eating disorders, bulimia nervosa is associated with various medical complications which are based on the method and frequency of purging. The bulimic individual uses different ways to get rid of overeating like self-induced vomiting. Laxatives are also frequently used to avoid weight gain but excess use ends in acid-base and electrolyte abnormalities. In case, bulimia remains untreated then it can result in an overall health damage. It is a treatable condition if diagnosed early. Different approaches are used for treatment like medical treatment, nutritional intervention, education, talk therapy and many other.This might seem as a social stigma but to the contrary is a medical condition. Keep an eye on people around you and if known always lend a helping hand to such patients.


REFERENCES

Crow SJ, Thuras P, Keel PK, Mitchell JE (2002). Long-term menstrual and reproductive function in patients with bulimia nervosa. Am J Psychiatry 159:1048–50

Brown CA, Mehler PS (2013). Medical complications of self-induced vomiting. Eat Disord 21:287–94

Dynesen A, Bardow A, Petersson B (2008). Salivary changes and dental erosion in bulimia nervosa. Oral Surg Ora Med Oral Pathol Oral Radiol Endod 106:696–707
Hsu LK. Epidemiology of the eating disorders (1996). Psychiatr Clin North Am 19:681–700

Lee NF, Rush AJ, Mitchell JE (1985). Bulimia and depression. J Affect Disord 9:231–238

Upadhyah A et al (2014). prevalence and risk factors for eating disorders in Indian adolescent females. NJPPP 4 (2):153-157

Mehler PS, Rylander M (2015). Bulimia nervosa-medical complications. Int J Eat Disord 3:12

https://www.dovepress.com/bulimia-nervosa-in-adolescents-prevalence-and-treatment-challenges-peer-reviewed-fulltext-article-AHMT#

https://www.ncbi.nlm.nih.gov/pubmed/8933602

https://www.ejmanager.com/mnstemps/28/28-1372740251.pdf

https://emedicine.medscape.com/article/912187-overview

https://www.waldeneatingdisorders.com/5-medical-risks-of-bulimia-nervosa/

https://www.ncbi.nlm.nih.gov/pubmed/12042197

https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-015-0044-4

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