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What is bulimia nervosa?
Bulimia nervosa is an eating disorder and a serious mental illness. People who have bulimia often binge eat, meaning that they eat far more food than is normal in a short amount of time. They may feel like they have no control over how much food they eat and try to make up for their binge eating by making themselves vomit, using laxatives, fasting or excessively exercising.
People with bulimia are often in the normal weight range. It is common for people with the condition to try to hide their condition from others, so diagnosing it can be very difficult. Overcoming bulimia can be very challenging, but doctors, therapists and other healthcare professionals can help people with the condition to think more positively about themselves and their weight and develop a healthy attitude towards food.
Signs and symptoms
A person with bulimia has a regular behaviour of binge eating followed by deliberate vomiting (purging), using laxatives or diuretics, fasting or excessively exercising to counteract their initial overeating. Typically, the cycle of overeating and purging or fasting occurs once or twice a week.
It is common for a person with bulimia to try and hide their condition from others. Sometimes there may be several warning signs that a person is suffering from bulimia. These may be physical signs, changes in behaviour, or changes in the way a person thinks.
Physical signs of bulimia include:
- Weight loss or weight gain;
- Signs of frequent vomiting, including damage to teeth or bad breath;
- Fainting or dizziness, and;
Some of the behaviours that may be associated with bulimia include:
- Not eating food around others;
- Hoarding food;
- Frequent vomiting or use of laxatives;
- Lying about eating habits;
- Extreme dieting;
- Excessive exercising, and;
- Frequent use of the toilet during meals or after eating.
Psychological signs associated with bulimia include:
- Obsession with food and body shape;
- Low self-esteem;
- Having a distorted body image, and;
- Depression or anxiety.
Causes and risk factors
It is not known exactly what causes bulimia. Both men and women can develop the condition. It is thought to develop from a combination of genetic and environmental factors. A person may be more likely to develop the condition if they:
There are two main subtypes of bulimia, which are classified on the basis of how people compensate after binge eating.
Purging bulimia is when a person tries to get rid of the food they have eaten after a binge by making themselves vomit or by misusing laxatives, which are medicines usually used to relieve constipation. Purging may also include a person giving themselves an enema or taking diuretics, which are medications that help your body get rid of excess water and salt through the urine.
Non-purging bulimia occurs when a person compensates for their binge eating by going for long periods without eating (fasting), or by exercising excessively.
Methods for diagnosis
Bulimia can sometimes be difficult to diagnose. Many people with the condition are in the normal weight range and tend to hide their behaviour from others. To work out if a person has bulimia or another type of eating disorder, a doctor will ask them questions about their medical history, mental health and lifestyle.
Types of treatment
There are a number of different treatment options available for people with bulimia. Treatment can involve a combination of psychotherapy, which is sometimes called 'talking therapy' and medication to help improve the person's mental health.
If you have bulimia, meeting regularly with a therapist to discuss your thoughts and feelings may help you manage your condition. This is known as psychotherapy. A common type of therapy used to help treat bulimia is called cognitive behaviour therapy, which can help to teach people affected by an eating disorder healthy ways of thinking about food and how to think more positively about themselves and their weight.
Antidepressants generally need to be taken for at least two weeks before there is any improvement in symptoms. When stopping antidepressant medication, the dose usually needs to be reduced gradually over time to prevent any withdrawal responses.
As with many medications, some people may experience some side effects when taking antidepressants. Some common side effects include nausea, dizziness, tiredness and sexual dysfunction. Some antidepressants can have more serious side effects if they are taken with certain other medications or herbal remedies, or when combined with alcohol.
Very rarely, some antidepressants may increase suicidal thoughts and the risk of suicide. The risk is highest in the first weeks after starting antidepressant treatment, or when the dose of antidepressants is changed. If someone experiences suicidal thoughts, it is important to contact a doctor immediately.
Over time, bulimia can lead to several other medical complications. The frequent cycles of binge eating and purging can cause dehydration and result in low levels of essential salts and minerals, known as electrolytes, in your body. Bulimia can also lead to problems with the digestive system including irregular bowel movements and constipation.
Bulimia is a long-term condition that requires long-term management. It is possible to recover from an eating disorder, but recovery can be very challenging. If the warning signs are detected and treated early, there is a better chance of recovery. A team of doctors, therapists and other healthcare professionals can help people with the condition return to a healthy lifestyle.
There are several steps that can be taken to reduce the chance of developing an eating disorder such as bulimia. Promoting a positive body image, improving self-esteem and learning about nutrition and good general health may reduce your risk of developing an eating disorder.