Bulimia Nervosa: Symptoms, Causes, and Treatments

Classified as an Avoidant/Restrictive Food Intake Disorder, bulimia nervosa is an eating disorder that is common among young women and adolescents. While the causes for the disorder vary, most are emotionally based issues that relate to low self-esteem, poor body image, and a history of previous trauma. The most telltale sign of bulimia is the binge and purge cycle, where the affected will engage in a binge session of around 3,000 to 5,000 calories, then go to extreme measures to erase the binge by purging their body of the consumed food. This dangerous purging cycle is engaged in through the use of laxatives, forced vomiting, or the use of ipecac, which is a medicine used to induce vomiting. The treatment for bulimia begins with breaking the cycle of binge-and-purge and continues to delve deeper into the person’s psyche by targeting the emotional issues that caused the disorder in the first place.

While bulimia is a physical eating disorder, the psychological root of the disorder is undeniable in its affected persons. Bulimia is classified as an ARFID, or an Avoidant/Restrictive Food Intake Disorder, which is “characterized by a disturbance of feeding or eating that is associated with inadequate food intake” (Bryant-Waugh, 2012). While this covers an array of insufficiencies that could be caloric or nutritional, bulimia is direct ARFID, where its victim voluntarily and forcibly engages in these avoidant and restrictive dietary behaviors. The continual disturbance of eating can be caused by social and psychological rifts or problems that the victim has experienced over, usually, a long-standing period that has to drive them to engage in these restrictive behaviors. These behaviors negatively affect the victim and in addition to low energy intake, the victims also experience “weight loss, low weight, or reduction in the growth velocity” (Bryant-Waugh, 2012). These are considered desired results for people with bulimia nervosa, as their end goal in beginning the restrictive food behaviors is to reduce their body weight in drastic ways.

As for the demographics of bulimia nervosa, the disorder typically occurs in industrialized, specifically westernized nations, where there is an abundance of food and a slender appearance is considered more aesthetically pleasing. “The rate of bulimia has been increasing since the 1950s and it is the most common eating disorder in the United States” (Fundukian, 2011). In The Gale Encyclopedia of Medicine published in 2011, it was estimated that about three percent of Americans are bulimic and of this, eighty-five to ninety percent are female. However, “some experts believe that the number of diagnosed bulimics represents only the most severe cases,” (Fundukian, 2011) and that most people with the disorder successfully hide their symptoms. While it affects both men and women, the disorder is most often diagnosed in homosexual men as opposed to heterosexual men, and they begin their cycle at an older age than women. While anorexia is the counterpart to bulimia, this disorder is typically more common than anorexia because its participants can engage in eating behaviors in public, allowing them to better mask their disorder from their loved ones.

The binge-and-purge cycle is the most prevalent sign of the disorder’s presence in an individual. The disorder “involves three behavioral and cognitive components: binge eating, inappropriate compensatory measures, and body image disturbance” (Ertelt, 2012). Binge eating is classified as eating a copious amount of food, therefore intaking a large number of calories, at one time in a discrete or secretive way. This binging process is psychologically linked to a failure to abide by dietary restrictions the individual has created for himself or herself, such as engaging in an all-or-nothing attitude about the failure. When these forbidden foods are consumed, the diet is broken so the individual secretly consumes food “usually high in calories and often has fat content” (Ertelt, 2012). Binge sessions are usually followed by a highly negative emotional state of failure and disgust with oneself, combined with guilt and self-loathing. This negative emotional state then leads to the individual needing an immediate fix for the binge as they work to rid their body of what was just consumed.

The purge cycle of bulimia is the most dangerous part of the disorder. A purge after a binge is considered a compensatory method driven by self-loathing in what the individual perceives as a weakness in their psyche that caused them to break the rigid diet set out for themselves. “Vomiting, laxative misuse, and over-exercising” (Ertlelt, 2012) are the three most common forms of compensatory behaviors in the cycle, as vomiting and laxative use are classified as purging behavior and fasting and over-exercise are classified as nonpurging behavior. The cycle generally continues “in combination and at least twice weekly for three months” (Ertlelt, 2012) to be classified as a chronic disorder that defines a loss of control for the individual. The loss of control is the psychological root of the purge portion of the disorder, while the failure to engage in control classifies the binge cycle of the disorder.

The signs and symptoms of bulimia, apart from the binge-and-purge cycle are all very secretive measures done so by the individual to maintain control over the disorder’s presence in their life. The inability to stop eating in the binge process is classified as eating to the point of discomfort, while the secrecy surrounding the act involves consuming food alone in complete privacy. “Alternating between overeating and fasting” (Smith, 2014) is also a telltale sign of bulimia’s presence in an individual’s life, along with an individual eating an unusually large amount of food and not seeming to gain weight over an extended period. The physical symptoms of bulimia involve the appearance of calluses or scars on the knuckles where the teeth break the skin during the induction of vomiting. “Chipmunk cheeks caused by repeated vomiting” (Smith, 2014) along with discolored teeth are also physical symptoms from repeated vomiting.

The physical effects of bulimia are exhausting on the body. Dehydration due to purging is the most dangerous side effect. “Vomiting, laxatives, and diuretics can cause electrolyte imbalances in the body, most commonly in the form of low potassium levels” (Smith, 2014). This loss of electrolytes results in low potassium levels that trigger psychological and physical side effects, such as lethargy and irregular heartbeat.

Because bulimia is a complex emotional disorder, it does not have a single exact cause that can be traced directly to the source. “Research suggests that some people have a predisposition toward bulimia and some catalyst then triggers the behavior” (Fundukian, 2011). This predisposition is related directly to the hereditary factors that are apparent in the causes of the disorder. Having a close relative with the disorder slightly increases the likelihood of other female family members developing the disorder. Also related to hereditary are the biological factors of the disease, such as “low levels of serotonin in the brain. Serotonin is a neurotransmitter” (Fundukian, 2011) that regulates feelings of satiety in a person that signals them to stop consuming food, and is involved in causes of depression that is also related to eating disorders. A psychological factor in bulimia is related to insignificant impulse control, where the individual loses their battle in sticking to their dietary restrictions and continue to binge. The social causes in the disorder are prevalent in individuals who have family members or close friends “who have problems with alcoholism, depression, and obesity” (Fundukian, 2011). These relatives contribute to unpredictable lives for the individuals who suffer from bulimia, leading them to want to gain control over the only perceived aspect that they can control.

The treatment of bulimia involves different types of therapy approaches ranging from psychotherapy to pharmacotherapy. Typically, “cognitive behavioral therapy is generally considered the treatment of choice for patients with bulimia nervosa” (Ertlelt, 2012). This type of treatment focuses the individual to wean out bulimia-specific behaviors from a person’s psyche and the negative thoughts that enable the individual to engage in such destructive dietary behavior. Solving emotional issues is the most important factor in deterring an individual from engaging in the disorder again, as the root of the disorder is usually deeply psychological. “Relationship issues, underlying anxiety and depression, low self-esteem, and feelings of isolation and loneliness” (Smith, 2014) are all root causes that affect the individual’s perception of himself or herself. Personality disorders are mostly diagnosed in bulimics such as “borderline, narcissistic, histrionic, and antisocial” (Fundukian, 2011) disorders. The treatments range from hospital inpatient care to day treatment sessions where the individual is consistently monitored and supervised to ensure no destructive behaviors are taking place. The pharmacotherapy approach in treating bulimia involves the consumption of “selective serotonin reuptake inhibitors” (Fundukian, 2011) such as Prozac and Zoloft where the medications increase serotonin levels to affect the body’s sense of fullness.

Bulimia nervosa is not only the most common avoidant/restrictive food intake disorder in America but also one of the most bodily-damaging through dehydration and low potassium levels. At the core of the disorder is the individual’s need for a sense of control over an aspect of their life, be it by dieting to change their body shape and weight or fasting to prove their willpower to him or her in the process. The failure to do either of these things leads to a binge-and-purge cycle fueled by self-loathing, followed by drastic measures to compensate for an overeating session with drastic measures such as inducing vomiting. Psychological causes are the most deeply seeded emotional reasons linked with the disorder and psychotherapy combined with pharmacotherapy is the most utilized forms to combat the chronic eating disorder.

References

Bryant-Waugh, Rachel, B., & Keifer, Richard. (2012). Avoidant/Restrictive Food Intake Disorder in DSM-5. Psychiatric Annals, 42(11), 402-405. Retrieved April 12, 2014, from http://search.proquest.com.ezaccess.libraries.psu.edu/docview/1221966453/abstract?accountid=13158

Ertelt, T., Mitchell, J., Steffen, K., & Marino, J. (2012). Bulimia Nervosa. Encyclopedia of Human Behavior, 2 , 413-416.

Fundukian, L. (2011). Bulimia Nervosa. The Gale encyclopedia of medicine (4 ed., pp. 788-795). Detroit, MI: Gale Research.

Bulimia Nervosa. (n.d.). Signs, Symptoms, Treatment, and Help. Retrieved April 12, 2014, from http://www.helpguide.org/mental/bulimia_signs_symptoms_causes_treatment.htm.