The term “Bulimia” is derived from the Greek words “ox hunger,” while “nervosa” was added to signify its nervous nature. Bulimia nervosa is a psychiatric condition where individuals engage in binge eating and employ compensatory techniques to prevent weight gain, which may result in detrimental consequences. It is crucial to swiftly identify and diagnose this psychiatric disorder, provide sufficient treatment, and observe progress and any medical issues likely to occur.
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Criteria and Symptoms of Bulimia
Bulimia typically appears in late adolescence or early adulthood. The majority of those affected are women. However, it is believed that more boys and men suffer from the disorder than statistics indicate. Their cases often go unreported, as men are less likely than women to seek medical help for psychological issues.
Binge Eating in Bulimia
Typical for bulimia are binge-eating episodes, usually followed by self-induced vomiting. During such episodes, individuals eat far more than most people would in a similar situation. They feel unable to stop eating and lose control over what and how much to consume. Bulimic patients often feel they can’t stop eating or control what or how much they eat.
Those affected by bulimia distinguish between “forbidden” foods, which are mostly very high in calories, and “permitted” foods with fewer calories and fat. Binge eating involves devouring foods that are readily available, quick to eat, high in calories, and actually “forbidden.” Binge-eating episodes usually happen in secret, followed by self-induced vomiting.
Purging in Bulimia
During the binge eating episodes of bulimia nervosa, the food is poorly chewed, and little attention is paid to taste. Above all, it is essential to be able to choke out what has been ingested later. Eating continues until an uncomfortable feeling of fullness arises, food runs out, or external disturbances occur. The excessive hastily eaten food leads finally to vomiting or use of laxatives.
Fear of Weight Gain in Bulimia
Fear of weight gain leads to inappropriate compensatory behaviors.To prevent weight gain, people with bulimia resort to inappropriate measures. They often induce vomiting, eat irregularly, or fast. Many also exercise excessively or use medications like appetite suppressants, laxatives, or diuretics.
Strict dieting rules, which many patients impose on themselves, often lead to a vicious cycle. Fasting leads to intense hunger, which triggers more binge eating. This reinforces the need to take countermeasures to avoid weight gain.
Distorted Body image in Bulimia
The self-esteem in Bulimia is heavily tied to body image. Body image has a strong impact on self-esteem in people with bulimia. They are often dissatisfied with their body weight and shape. Their target weight is often far below what is healthy.
Vicious Cycle in Bulimia
Typical for bulimia is a cycle of strict dieting and binge eating. Many impose rigid dietary rules they can’t maintain long-term. Fasting often triggers intense hunger, leading to new binge episodes, which, in turn, heighten the urge to compensate to avoid weight gain.
Family Dynamics in Bulimia
Families often exhibit control, conflict avoidance, and enmeshment, limiting boundaries. Indirect blame, devaluation, and mixed messages dominate family interactions. Conflict avoidance prevents bulimic individuals from learning effective resolution strategies. Rigid family ideals on thinness and health emphasize appearance over individuality. Ignoring personal needs fosters disconnection from hunger and satiety signals. Food is used for distraction, reward, relaxation, or maintaining family traditions. Bulimia perpetuates a cycle of restriction, bingeing, and compensatory behaviors. Dieting and fasting cause deficiencies, leading to binge eating and subsequent discomfort. This discomfort is relieved by further fasting and vomiting, restarting the cycle.
Treatment for Bulimia in Dubai at CHMC
As with other eating disorders, the will and motivation of the patient are prerequisites for successful treatment of bulimia nervosa. The treatment is primarily outpatient. Psychotherapists and clinical counsellors plan their treatment based on different forms of psychotherapy. The effective treatment methods are family therapy, CBT (cognitive-behavioural therapy), person-centered counselling and psychoanalytic therapy.
Involving the family
The treatment takes place in individual and group therapies, if possible, with the involvement of the legal guardians and the family system. In the case of adolescent eating disorders, it is particularly important to involve the patient’s parents in the treatment. Family counselling and family therapy have proven to be particularly effective. In addition to psychotherapy, self-help groups can be helpful as an auxiliary feature to the main treatment.
Hospitalization
If the symptoms are very pronounced or there are severe personality disorders, self-harm behaviour, or risk of suicide, hospitalization and inpatient treatment may be necessary. In the case of metabolic or other physical disorders such as Crohn’s disease or diabetes, medical treatment is essential.
Treatment of bulimia may also include psychiatric medication. When co-morbid psychiatric disorders, such as anxiety or depression, are present, a psychiatrist may recommend a combination of pharmacological interventions (treatment with medication) in addition to psychotherapy.
Root Causes and Triggers of Bulimia
Bulimia arises from a combination of factors that interact and influence each other. These can be categorized into causes and triggers, though the distinction isn’t always clear.
Causes of Bulimia
are influences that determine an individual’s susceptibility to the disorder. The following factors increase the risk of developing bulimia:
• Biological and physical factors, like genetic predisposition or frequent dieting.
• Traumatic experiences, such as violence, abuse, or neglect in childhood.
• Certain personality traits are associated with low self-esteem, perfectionism, or excessive concern about appearance, body shape, and weight.
• Family risk factors, like disordered eating habits or a focus on thinness and appearance within the family.
• Societal influences, including the prevalent thin beauty ideal.
Triggers for Bulimia
are specific events or circumstances that can trigger bulimia. These include:
• High stress is caused by events such as separation, the loss of a loved one, a move, or bullying.
• The onset of puberty with its physical changes and growing challenges.
• Physical factors that make dieting more difficult, such as type 1 diabetes or pre-existing obesity.
Negative Health Implications Caused by Bulimia
Bulimia causes psychological and physical harm with mostly severe long-term consequences. Binge eating is frequently associated with other mental health disorders, especially depression and anxiety.
Excessive vomiting leads to stomach inflammation (gastritis) and, in extreme cases, even to stomach perforation. Other long-term effects of vomiting are dental damage, esophagitis (esophageal inflammation), and inflammation of salivary glands.
Patients suffering from bulimia are typically not underweight; nevertheless, they can suffer from malnutrition. The latter is caused by an imbalanced or deficient diet combined with purging and leads to loss of vitamins (vitamins B12 and D), microelements, electrolytes, and hormonal changes. In consequence, bulimic patients develop heart and kidney problems, hair loss, skin illnesses, and osteoporosis.
Treatment for Bulimia in Dubai. Summary
Bulimia nervosa features a cycle of food cravings and compensatory behaviours, such as self-induced vomiting or the use of diuretics or laxatives, sometimes repeated several times a day. People with bulimia nervosa are usually average weight. Although their weight might be within the normal range, they are dissatisfied with their body shape. As a result, they sometimes give up eating altogether; they go hungry or eat irregularly. They often go on diets or skip meals. Affected people get caught in a vicious circle of not eating, food cravings, binge eating, and self-induced vomiting.
The condition is strongly associated with feelings of guilt and shame. This is why this eating disorder is often kept secret and remains hidden for years.
Useful sources about bulimia:
National Eating Disorders Association (NEDA)
Association of Anorexia Nervosa and Associated Disorders (ANAD)