Bulimia Nervosa is an eating disorder with potentially life-threatening complications.
Sufferers of this condition experience repeated episodes of binge eating and purging.
A cycle that is difficult to break. Misconceptions of bulimia exist within
modern society. It is not uncommon for the general public to believe bulimia is
a lifestyle choice associated with vanity. In reality, individuals wishing to regain
control of symptoms must demonstrate commitment to medical intervention. Of further importance
is the support of loved ones. Improving our understanding can
help us identify the warning signs in ourselves or our loved ones, ensuring
rapid access to treatment and better outcomes. Want to learn more about this eating disorder?
Keep watching as we will break down here. So, let us talk about mental health.
My name is Dr Hart-Pinto. In this series,
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Ok so what is Bulimia Nervosa?
People with bulimia experience recurrent cycles of binge eating accompanied by purging,
aiming to counteract the fattening effects of their binge. Binge eating is driven by
a strong desire for food, resulting in impulsive eating of large quantities of high calory foods,
often several thousand calories in a sitting. Sufferers frequently control their weight
through extreme dieting, fasting, and prescription medication abuse. Commonly
misused drugs including appetite suppressants, diuretics, levothyroxine or laxatives.
Eating disorders are associated with some of the highest mortality rates
of any mental health conditions. So, we must take this condition seriously.
So what is the difference between Bulimia and Anorexia?
Cyclical binging and purging are features common to Bulimia and Anorexia.
We distinguish between these conditions through the assessment of body weight. Anorexic patients
will have low body weight, diagnostic with a BMI of <18.5. Contrarily, Bulimic
patients have a normal BMI or are overweight. A link between the two conditions does exist,
with up to 50% of Bulimic patients having a history of anorexia.
Who gets bulimia?
Bulimia affects around 15 in every 1000 women and 5 in every 1000 men. Women, much like anorexia,
are disproportionately affected by the condition. Bulimia is most common during adolescent years,
with the majority presenting to medical care in their early twenties. Researchers have proposed
an abnormality in brain chemistry propagates the bulimic cycle. An over-sensitivity to
the reward chemical serotonin, induced by high calory binging, is believed to be the trigger.
If you have a family history of affective disorder,
obesity, or substance misuse you are at increased risk of developing this eating disorder.
What do Bulimia patients experience?
People with bulimia often experience overvalued ideas around the ideal body shape and image.
They will report an insatiable craving for food, which results in episodes of binge eating.
Whilst individuals affected by bulimia gain satisfaction from their binging, they demonstrate
a fear of obesity. Often there are clear ideas on ideal body image, triggering a need to counter
the fattening effects of the foods they have consumed. Individuals may choose to self-induce
vomiting or misuse prescribed medications. Commonly abused are; Appetite suppressants,
diuretic, thyroid medications and laxatives. Purging, frequently performed in secret,
means the condition can go for some time unnoticed by loved ones, causing a delay
to diagnosis. Generalised weakness and fatigue are common symptoms associated with bulimia.
Recurrent purging leads to erosion of teeth enamel by the acidic stomach contents. Irritation
to the gullet and stomach can produce ulceration. Vomiting can result in abnormal blood salt levels,
exacerbated by misuse of laxative medications. Knock-on effect to the heart can also occur,
inducing irregular heartbeats, heart failure and even sudden death. The purging can also affect the
immune system reducing or over-activating infection-fighting white blood cells.
Patients who self-induce vomiting will develop calluses on their fingers and the back of their
hand, known as Russell's sign. Swelling of the cheeks may also be present, caused by swelling
of the saliva producing parotid glands. Amongst girls, half will report abnormal menstrual cycles.
Episodes of bloody vomit can indicate the development of a tear in the gullet,
known by doctors as a Mallory Weiss tear, which is considered a life-threatening medical emergency.
Episodes of fainting, severe abdominal pain or weakness should also prompt urgent medical review.
How does your doctor diagnose bulimia?
In the first instance, your general practitioner / primary care physician
may perform a screening test to assess for the presence of an eating disorder.
One such tool is the SCOFF questionnaire, which includes the following questions:
• Do you ever make yourself sick? • Do you worry that you have lost
control over how much you eat? • Have you recently lost more
than one stone in a 3-month period? • Do you believe yourself to be fat
when others say you are too thin? • Would you say that food dominates
your life? •
Recording positive results in two or more of the questions indicate a likely diagnosis of
an eating disorder. This outcome usually prompts a specialist referral or commencement of treatment.
To make a diagnosis of bulimia, your doctor must identify; the presence of recurrent uncontrolled
binging of an abnormally large amount of food in a short period. Calory controlling behaviours
such as self-induced vomiting, laxative abuse or excessive exercise must follow. These episodes
of binge eating must have been present at least weekly for three months. Your doctor will take
a detailed psychiatric history, assessing for any of the symptoms and signs discussed earlier.
Forming part of your examination, the doctor will measure your height and weight.
Your weight must be within normal limits or above weight. Your doctor will be keen to rule out any
life-threatening complications. Therefore, blood tests are helpful to assess for salt and hormonal
imbalances.
Treatment
The symptoms of bulimia are not going to improve on their own, but with the correct treatment,
you can regain control. Recovery can take time and will be different for everyone.
Most important is the commitment to therapy on the part of the affected individual.
Usually, patients can be managed at home using combination therapy.
Psychotherapy is usually the first line. Bulimia-nervosa self-help programmes are
run weekly over a 16-week course. This program can help you develop the skills to overcome your
eating disorders and establish healthy habits. You will develop strategies to challenge any
negative thoughts towards food, your body image and control your binge eating purge cycle.
Keeping a diary of your progress can help you see how far you have come in your treatment journey.
If the self-help approach is not suitable for you, your doctor can refer you for
cognitive behavioural therapy. Here you will work with your therapist to
challenge your negative thoughts and feelings and develop the tools to control your symptoms.
Medications such as SSRIs have an anti-Bulimic effect.
Fluoxetine is probably the most commonly prescribed SSRI. Most patients will remain
on medication long term, often greater than one year, ensuring symptoms remain well controlled.
Compulsory hospital admission is only for patients demonstrating suicidal ideas, signs
of life-threatening complications, and extreme cases previously unresponsive to treatment.
Prognosis & Complications With the correct treatment, around 60%
will make a complete recovery. Earlier diagnosis and treatment is associated with better outcomes.
Many patients also have co-existing mental health disorders such as depression.
Mortality rates for bulimia can be as high as 4%.
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