Bulimia Nervosa
Anorexics and bulimics, like those who are overweight, also have a poor body image, but use starvation and excess exercise as a means of punishment for looking and feeling this way. They typically report hating their bodies and seeing themselves as fat when they look in the mirror, even when they are average or below average in weight. Just like those who overeat, those who purge are looking for the control that this gives them over their bodies.
Overweight people may see the fat as protection against further assaults; those who binge and purge or starve themselves may feel they are punishing themselves for their attractiveness causing the assault in the first place.
Bulimia nervosa was first diagnosed in the 1980s and is marked by a binge cycle, where the person consumes large quantities of food, following by a purge cycle where they force themselves to throw up. Use of laxatives and diuretics, often accompanied by excess exercising, also marks the cycle.
If left untreated, bulimia can lead to tooth loss (from stomach acids eroding the tooth enamel during vomiting sessions), ulcers and ruptures of the digestive tract, electrolyte imbalance and cardiac issues including heart attacks, and dehydration. Bulimia affects both males and females, commonly during the high school and college age years.
All of these eating disorders can result in death if not addressed properly. At the roots of all of these is self-loathing. Feelings of being dirty, ashamed or embarrassed at what happened can ultimately manifest itself in these disorders.
Breaking the cycle is not as simple as putting down the fork, convincing someone that they are not fat or trying to stop someone from purging. Unless the root of the problem is resolved, the behaviors will continue. Often intervention is needed if the disorder is advanced. Even seemingly successful treatments will often result in relapse. That is because the problem is deeper than the actual eating and exercise habits.
For myself, I was grateful for the isolation and inattention that my being overweight provided. Hating myself went hand-in-hand with hating how I looked. Receiving confirmation of this from others who ignored me, looked at me in disgust or felt I lacked self-control just served to confirm my worst fears.
And changing these behaviors was more than just self-control, which is why most diets fail. In order to break the cycle of eating disorders, the person must begin to view themselves differently. They must begin to value themselves, see themselves as children of God – wanted, loved and created by Him – and that their bodies are a temple of God. This is not an easy process. Satan’s lies can be firmly entrenched in the minds of those abused. The reason for this is sin. Once sin (in this case, the sexual abuse that has victimized us) has impacted our lives, the far-reaching effects are devastating.
Causes, incidence, and risk factors
Many more women than men have bulimia, and the disorder is most common in adolescent girls and young women. The affected person is usually aware that her eating pattern is abnormal and may experience fear or guilt with the binge-purge episodes.
The exact cause of bulimia is unknown. Genetic, psychological, trauma, family, society, or cultural factors may play a role. Bulimia is likely due to more than one factor.
Symptoms
In bulimia, eating binges may occur as often as several times a day for many months.
People with bulimia typically eat large amounts of high-calorie foods, usually in secret. The person generally feels a loack of control over their eating during these episodes.
These binges cause a sense of self-disgust, which leads to what is called purging, in order to prevent gaining weight. Purging may include: making oneself vomit, excessive exercise, and use of laxatives, enemas, or diuretics (water pills). Purging often brings a sense of relief.
Body weight is often in the normal range, although people with bulimia often see themselves as being overweight. Because weight is often normal, this eating disorder may not be noticed by others.
Symptoms or behaviors that may be noticed include:
- Compulsive exercising
- Evidence of discarded packaging for laxatives, diet pills, emetics (drugs that induce vomiting), or diuretics (drugs that reduce fluids, also called water pills)
- Regularly going to the bathroom right after meals
- Suddenly eating large amounts of food or buying large quantities of food that disappear right away
Signs and tests
A dental exam may show dental cavities or gum infections (such as gingivitis). The enamel of the teeth may be eroded or pitted because of excessive exposure to the acid in vomit.
A physical examination may also reveal:
- Broken blood vessels in the eyes (from the strain of vomiting)
- Dry mouth
- Pouch-like appearance to the corners of the mouth due to swollen salivary glands
- Rashes and pimples
- Small cuts and calluses across the tops of the finger joints due to self-induced vomiting
A chem-20 test may show an electrolyte imbalance (such as hypokalemia) or dehydration.
Treatment
People with bulimia rarely need to be hospitalized, except under the following circumstances:
- Binge-purge cycles have led to anorexia
- Drugs are needed for withdrawal from purging
- Major depression is present
Most often, a stepped approach is taken for patients with bulimia. This treatment approach follows specific stages, depending on the severity of the bulimia, and the person’s response to treatments:
- Support groups may be helpful for patients with mild conditions who do not have any health problems.
- Cognitive-behavioral therapy (CBT) and nutritional therapy is the preferred first treatment for bulimia that does not respond to support groups.
- Drugs used for bulimia are typically antidepressants known as selective serotonin-reuptake inhibitors (SSRIs). A combination of CBT and SSRIs is very effective if CBT is not effective alone.
Patients may drop out of programs if they have unrealistic expectations of being “cured†by therapy alone. Before a program begins, the following should be made clear:
- A number of therapies are likely to be tried until the patient succeeds in overcoming this difficult disorder.
- It is common for bulimia to return (relapse), and this is no cause for despair.
- The process is painful and requires hard work on the part of the patient and the patient’s family.
Support Groups
Self-help groups like Overeaters Anonymous may help some people with bulimia. The American Anorexia/Bulimia Association is a source of information about this disorder.
Expectations (prognosis)
Bulimia is a chronic illness and many people continue to have some symptoms despite treatment. People with fewer medical complications of bulimia, and who are willing and able to engage in therapy, tend to have a better chance of recovery.
Complications
Bulimia can be dangerous and may lead to serious medical complications over time. For example, frequent vomiting puts stomach acid in the esophagus (the tube from the mouth to the stomach), which can permanently damage this area.
Possible complications include:
- Constipation
- Dehydration
- Dental cavities
- Electrolyte abnormalities
- Hemorrhoids
- Inflammation of the throat
- Pancreatitis
- Tears of the esophagus from excessive vomiting
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