Bulimia Nervosa: Types, Symptoms, Causes, Risks, and Treatment

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.

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What Is Bulimia Nervosa?

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.

What Are the Two Different Types of Bulimia Nervosa?

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.

What Are the Causes of Bulimia Nervosa?

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

What Are the Signs and Symptoms of Bulimia Nervosa?

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.

What Are the Risk Factors of Bulimia Nervosa?

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.

What Are the Complications Associated With Bulimia Nervosa?

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.

How to Diagnose Bulimia?

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

How to Treat Bulimia Nervosa?

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.

When to See a Doctor?

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

How to Manage and Prevent Bulimia Nervosa?

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.

What Is the Prognosis of Bulimia Nervosa?

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.

FAQs About Bulimia Nervosa

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Does compulsive eating always indicate bulimia nervosa?

As per the National Institutes of Health, compulsive eating followed by purging at least twice a week for three months indicates bulimia nervosa.

Does bulimia nervosa cause hair fall?

Bulimia impacts the integumentary system comprising nails, skin, and hair. Therefore, frequent purging episodes may lead to dehydration and hair loss.

Does bulimia nervosa cause panic attacks?

Yes, panic attacks co-occur with bulimia.