Bulimia Nervosa: Decoding the Intricacies of Binge and Purge

Ever wondered if you’re experiencing the urge to eat and constantly eating the food secretly, then unearthing unhealthy ways to prevent weight gain or to cut down the calories? You may have contracted the disorder known as Bulimia nervosa.

The term “Bulimia nervosa” was coined and explained by Gerald Rusell in 1979. Bulimia has its origin from the Greek word ‘Boulimia’ meaning ravengous hunger and nervosa means behavioral disorder. It is one of many eating disorders. Bulimia nervosa is characterized by episodes of binge eating combined with inappropriate reviews of preventing weight gain. In simpler words, eating excess food with loss of control over eating and also purging upon them, constitutes Bulimia nervosa. Purge here means the person will be dissatisfied with his/her body and try to get rid of extra calories in unhealthy ways such as forceful vomiting, excessive fasting, use of laxatives (drugs) & Diuretics or compulsive exercising. Patients with Bulimia nervosa usually maintain a normal body weight or are slightly higher-weight as they have fear of gaining weight or feel dissatisfied with their body. It’s more prevalent than Anorexia.

Also Read: Deconstructing Pop Culture’s Impact on Eating Disorders

Theory related to Bulimia nervosa

A predominant theory of Bulimia nervosa shows binge-eating and purging developing as a consequence of attempts at dieting or food restrictions which then can intensify the guilt feelings of binge eating as it’s in direct contrast with the individuals goals for dieting this often leads to more dieting or compensatory behaviors prompting even more binge eating and guilt & shame creating an endless cycle that’s difficult to disrupt.

Onset and Prevalence:

Through the figures emerged it has been seen that onset of Bulimia nervosa is during the Adolescence generally between 13-20 years of age. It is also considered as one of the developmental disorders.(Eliot and Baker, 2001).

Prevalence of the disorder is mostly seen on Females than Males. It develops in 1.5% of women and 0.5% of men. These percentages converted into 4.7 million females and 1.5 million males. The reason behind this can be the societal pressure faced by females more in modeling and TV industries as they are perceived by the society to be fit and to have a slim figure.

Criteria as per described by DSM-5-TR.

• A) Frequent episodes of eating excessively. Binge eating episodes are distinguished by the presence of both of the following:-

1. Consuming a quantity of food in a discrete time period (such as within a 2-hour period) that is unquestionably greater than what most people would consume in a comparable amount of time under comparable conditions.
2. Having no control over one’s eating during the episode (i.e believing that one cannot control what or how much one eats or stop eating).

• B) Consistently engaging the unsuitable compensatory behaviors to avoid gaining weight, like forcing onself to vomit, abusing laxatives, Diuretics or other drugs, fasting or engaging in excessive physical activity.
• C) During the course of three months, binge eating and inappropriate compensatory behaviors have both occurred, on average, at least once a week.
• D) Body type and weight have an undue influence on one’s assessment of oneself.
• E) The disturbance doesn’t always happen during anorexia nervosa episodes.

Also Read: Breaking the Silence on Eating Disorders

Indicate if:

• In partial remission: Some, but not all, of the diagnostic criteria for bulimia nervosa have been satisfied for an extended length of time after they were first fulfilled.

• In complete remission: All requirements for bulimia nervosa have previously been satisfied, but none have been for an extended length of time.

Indicate the severity as of right now:

The frequency of incorrect compensatory behaviors determines the minimum severity level (see below). In order to account for additional symptoms and the extent of functional impairment, the severity level may be raised.

• Mild: 1-3 instances of improper compensatory behavior on average each week.
• Moderate: Four to seven instances of incorrect compensatory behavior per week on average.
• Severe: 8–13 instances of incorrect compensatory behavior on average per week.
• Extreme: 14 or more instances of incorrect compensatory behavior each week on average.

Signs and Symptoms

Physical symptoms:

• Frequent variations in weight (loss or gain).
• Dental problems, sore throat, swelling around the jaws due to the forceful vomiting.
• Developing intolerances to food.
• Having sleep disturbances.
• Forceful vomiting.
• Dehydration, fainting.

Also Read: The Psychology Behind Cheating

Psychological symptoms

• Preoccupied with body shape and weight.
• Feeling of guilt and shame after eating.
• Depression, anxiety or Irritability.
• Low self esteem.

Behavioral symptoms:

• Secretly eating.
• Doing excessive exercise.
• Frequent use of the bathroom after meals.
• Strict dieting behavior.
• Substance abuse.

Causes

Bulimia nervosa is considered to be a complex disorder with numerous factors contributing to the development.

Biological Factors:

• Genetic Predisposition: Having a close relative, who has Bulimia, increases the susceptibility of the disorder. (Ploog & Walter, 2004).
• Some disordered eating behaviors have been shown to be attributed to abnormal levels of many hormones, notably serotonin. According to the research by Ploog and Walter, neurotransmitters endorphins and encephalin are responsive to binges (2004).

Psychological Factors:

• Environmental issues or traumatic stressful life events (divorce, death) can also elicit Bulimia.
• It can also be triggered when one has low self esteem.

Social Factors

• Constant comparison to societal standards can exacerbate feelings of inadequacy and low self esteem.
• Effect of media.

Also Read: Conduct Disorder: Signs and Diagnosis

Treatment:

• Psychotherapy: Psychotherapy is an approach which can be used to treat Bulimia nervosa, aimed at changing the way you think or behave and to develop a positive attitude towards food and weight.
• Nutritional Counseling: involves learning healthier ways to eat.
• Medications: Antidepressants majorly help to reduce the symptoms of Bulimia. The only Antidepressant approved by FDA (Food and Drug Association) is Fluoxetine , which is a type of selective serotonin reuptake inhibitor (SSRI).

Prevention:

If left untreated, people with Bulimia nervosa may develop serious complications. Thus, one should keep measures to treat.

• Doctor’s advice: You should seek medical advice if necessary to reduce the symptoms of bulimia.
• Build Self Confidence: One should not be influenced by the unrealistic ideal body type or the social media. It can be unhealthy and unsafe.