Bulimia nervosa – causes, symptoms, diagnosis, treatment & pathology


Bulimia nervosa, often just called bulimia,
is a disorder that is characterized by rapid, out-of-control binge eating past the point
of fullness or comfort, followed by purging either by self-induced vomiting done manually
or sometimes with ipecac syrup, by taking laxatives, or by using diuretics. To fit the diagnosis, these cycles of binging
and purging must repeat consistently at least once a week for a period of 3 months, but
can happen as often as multiple times per day. The onset of bulimia typically happens around
adolescence, usually in individuals with low self-esteem who have a strong desire to have
control over key aspects of their life including their weight. They are often fixated on food, which includes
the amount that they consume as well as the calorie and fat content. The pattern of bulimia is often cyclical with
someone setting unrealistic goals for themselves (like getting a 100 percent on every exam
they take), and when they don’t reach those goals, they binge, and then they purge to
try to ‘fix’ the binging. Individuals with bulimia will also try to
control their weight in other ways—by taking stimulants, by going on extreme diets such
as “water fasts” where they consume only water, and by exercising excessively. These symptoms of binging and purging with
bulimia nervosa can be confused with another eating disorder—anorexia nervosa, where
they might also binge and purge, but the main distinction between these two disorders doesn’t
have to do with this act of binging and purging, but actually has to do with an individual’s
weight. People with bulimia are usually normal weight
or overweight, whereas people with anorexia are underweight. Because of this, people can more easily hide
the fact that they suffer from bulimia, and can also potentially start out with bulimia,
and then develop to anorexia over time. The binging and purging cycles associated
with bulimia can result in a number of serious side effects. Repeated vomiting can lead to erosion of dental
enamel, sialadenosis, which is swelling of the parotid gland, and halitosis, or very
bad breath. The back of the knuckles can get calloused
from using the hand to induce vomiting, which is called Russell’s sign, and if the vomiting
is forceful enough it can lead to tears of the distal esophagus and stomach itself, which
is called Mallory Weiss syndrome, which can cause abdominal pain and blood to come up
in the vomit, called hematemesis. Over time, vomiting can cause dehydration
and lead to hypotension—a blood pressure below 90/50, as well as tachycardia or a fast
heart rate over 100 heart beats per minute. The purging involved in bulimia can also cause
a depletion of electrolytes which leads to a low level of sodium, chloride, magnesium,
phosphate, and potassium, as well as a general metabolic alkalosis. The low potassium or hypokalemia is particularly
worrisome because it can lead to muscle weakness and even cardiac arrhythmias, the latter of
which can lead to death. Bulimia can also lead to endocrine changes,
the most common of which is menstrual irregularities in women, who might even develop amenorrhea,
where either the normal menstrual cycle stops or menstruation doesn’t start by age 15. In addition, individuals with bulimia are
at higher risk of developing diabetes mellitus, which makes for a particularly dangerous combination. And that’s because the purging part of the
bulimia cycle is a form of food restriction that causes a starvation state for the body’s
cells, and on top of that diabetes makes it more difficult for glucose to enter the body’s
cells at a cellular level, which worsens that starvation state. As far as causes of bulimia go, it’s been
shown to have a genetic component, based on twin and adoption studies. In addition, though, there is also evidence
for a strong social component. Bulimia typically begins in teen years or
in young adulthood, which is a time when individuals usually start to pay attention to the media,
and rates of bulimia are higher for individuals and in societies that have higher exposure
to media. Also, although bulimia is more common in women,
it’s worth mentioning that men suffer from bulimia as well, and in both genders it can
often be seen among athletes and professionals who are keenly focused on their body weight
and percent body fat, like with dancers, models, and wrestlers. Finally, bulimia is also commonly associated
with other conditions like obsessive-compulsive disorder, depression, and anxiety, all of
which have overlapping symptoms and risk factors. Medical treatment with careful nutrition and
weight management is important. But it’s also important to use tools like
psychotherapy and cognitive behavioral therapy to help the individual and his or her family
structure a new relationship around food. For example, teaching a person to eat just
a small amount of a ‘forbidden food’ and then consciously noticing the absence of severe
consequences. Bulimia is sometimes also treated with antidepressant
medications, like SSRIs or selective serotonin reuptake inhibitors, and typically a combination
of therapy with the medication works best for severe cases. Alright so as a quick recap, bulimia is when
somebody goes through cycles of binging and purging at least once a week for 3 months,
but are typically still normal weight or overweight. Thanks for watching, you can help support
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