Bulimia

Bulimia nervosa: symptoms, causes and treatment

Bulimia can manifest through a variety of different bingeing and purging patterns. Individuals may have powerful urges to overeat and this is then followed by periods of starvation or food restriction. They may fast, skip meals, follow strict diets or eliminate certain food groups from their diet. Some people may then purge or vomit as a strategy for managing their weight.

Some people suffering from bulimia never force vomiting at all. That’s because the concept of bulimia nervosa has to do with a pattern of bingeing and purging or starving, not just vomiting specifically.

There are two types of bingeing behaviours:

Subjective Bingeing

Subjective bingeing refers to eating more than your diet rules will allow. So for example, you may think that you’ve binged because you’ve had an extra slice of toast or a larger meal than you usually have.

Objective Bingeing

Objective bingeing refers to eating a large amount of food in a relatively short space of time. This is often in excess of 1500 calories and generally accompanied by feelings of loss of control.

The difference between Bulimia and Binge-eating disorder is:

Binge-eating involves eating a large amount of food, but without the compensatory strategies of those suffering from bulimia.

The difference between Bulimia (non-purging) and Binge-eating disorder is the behaviour that happens after a binge.

• Bulimia (non-purging)

After a binge, the individual will try to compensate for all the calories they consumed by either fasting or engaging in excessive exercise.

• Binge-eating disorder

After a binge, the individual does nothing to compensate for the amount of calories they consumed.

Types of Bulimia

Essentially, bulimia nervosa can be broken into two different categories or types called purging and non-purging. In both cases, the individual will binge, which can involve consuming in excess of 1500 calories during a binge episode. In the purging type, the person will engage in behaviours to compensate for the food they just consumed. They may use any of the following individually, in combination, or all together:

The non-purging type of bulimia is still equally problematic and dangerous. In this case, the patient will go to other excessive measures in the wake of their binge. They may:

Either way, the individual will not have control of their erratic urges to participate in this behaviour, often accompanied by a distorted body image. This will be reflected in their constant need to try to lose or maintain their weight.

What causes of bulimia?

Bulimia is likely to develop in late adolescence or early adulthood. Research suggests that a number of factors involving personality traits, thinking styles, moods as well as biological and environmental are likely to contribute. Often, people who develop bulimia believe they are using the problem as a way to have more control over their lives and bodies. Research indicates that bulimia begins when sufferers display a deep dissatisfaction with their body size and shape. This would often be accompanied by low self esteem and an intense fear of weight gain. However, the eating disorder actually creates a vicious cycle that leaves the sufferer completely out of control. If you think you have bulimia, then consider this cycle. Do you feel like you are stuck in it?

These diagrams illustrate the vicious circle of bulimia and show how these eating patterns become reinforced. Thus, strict dieting often leads to food cravings, following by eating something, then feeling like a failure, leading to a binge, after which feelings of guilt and self-loathing emerge. Purging would then occur to relieve these feelings, however, following a purge, even further uncomfortable feelings develop. And so the cycle continues.
The following example is of a non-purging bulimic cycle, following similar patterns.

The fact that bulimia tends to run in families also suggests that a susceptibility to the disorder might be inherited.

Impact of Bulimia on Individuals

Physical Impact of Bulimia

Physically, bulimia can be hard to recognize. This is because the majority of people suffering from this condition maintain a normal weight or even a slightly above average weight. Depending on the type of bulimia that you or your loved one could be suffering from, some of the physical damage includes:

Fatigue, muscle weakness, dizziness, and fainting due to an imbalance in electrolytes.
For women, missed menstruation and even long-term or permanent infertility
Loss of blood flow leading to anaemia and starvation of organs.
Cardiovascular (heart) damage including arrhythmias, heart disease, and high cholesterol.
Loss of vitamins and minerals leading to a compromised immune system.
Tooth decay and oesophageal tears and bleeding from vomiting
Dehydration and gastrointestinal distress from chronic use of laxatives.
Kidney damage or failure.
Loss of bone leading to long term osteoporosis.
Retarded growth and thyroid malfunction in youths.
Long-term bulimia could lead to organ failure, including heart failure, and can be fatal.

Psychological Impact of Bulimia

People who suffer from this condition are preoccupied by their eating patterns. This can damage interpersonal relationships and lead to depression or social withdrawal. Other psychological effects include:

Stress or difficulty in food related situations.
Self-imposed isolation and refusal to develop relationships.
Constant fear of disapproval from others.
Mood swings, strong emotions, and depression.
Suicidal thoughts, tendencies, or attempts.
Overwhelming feelings of guilt and self-loathing.
Development of anxiety disorders.

Often, people who suffer from bulimia find it easier to simply withdraw from anyone around them than to deal with constant fear of judgement or criticism.

Impact of Bulimia on Family and Friends

Bulimia does not just affect the individual, be that you or someone you love. It will have an effect on everyone associated with you or your loved one.

Family and friends will often feel helpless if they know their loved one is suffering from bulimia. They may know very little about the condition and they may have no idea what to do. That means they could become exasperated, losing patience with the individual and cause further emotional distress through arguments, demands, or criticisms.

Family and friends may be “cut off” by the individual who has chosen to withdraw from any social relationships or activities. This is extremely hard for family members who live in the same household. Essentially, bulimia is not an illness where the individual suffers in isolation, although it may very well feel this way for the individual involved. Everyone wholoves and cares for the person will go through a considerable amount of pain when they don’t know what to do to help.

What is the treatment for bulimia?

Psychological treatments for bulimia may involve individual, family or group psychotherapy. The National Institute for Health and Care Excellence (NICE, 2017) guidelines recommend Guided self-help and Cognitive Behaviour Therapy. Treatment recommended involves reducing physiological risks and enhancing psychological mental health.

Guided self-help

This involves engaging in a self-help programme either through a specified materials such as books or an online course. Sessions with a therapist help facilitate the programme and the recommendation is between 4 and 9 sessions, lasting approximately 20 minutes each.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy involves exploring underlying thoughts, feelings and emotional relationships leading to bingeing and purging behaviours. In conjunction, therapy would involve support in adopting regular eating habits, with approximately 20 sessions taking place over 20 weeks.

How is treatment designed for each individual?

In order to personalise treatment, the initial session involves an in depth clinical assessment, which takes into account the person’s current eating patterns, how these changed over time, their attitudes to food, their weight and body image, and a review of any interventions they might have tried in the past.

The client is encouraged to engage in self-monitoring in order to help understand and identify triggers and situations eliciting distressing thoughts and feelings related to eating. Therapist and client use this information to collaboratively formulate an understanding of their anorexic thoughts, feelings and behaviours. This formulation then informs an individualised treatment package meeting the specific needs of the individual.

Changes in relationships with food and body image change during treatment

Body weight is unlikely to change much during therapy as it is not designed to help you lose or gain weight. Discussions about weight loss, if desired by the individual, would happen in the longer term part of recovery.

During treatment, patients become more conscious of the reasons behind their eating patterns. Part of the function of an eating disorder is to block out or numb uncomfortable thoughts and feelings.

Treatment helps to identify some of the punitive rules and negative attitudes associated with food and body image as well as the behaviours which maintain them. The focus of treatment is largely on behaviour change through the application of regular tasks designed to challenge unhelpful thoughts and assumption about food, weight and body image. As individuals experiment with changing their eating patterns, learning to tolerate and process uncomfortable thoughts and feelings, their relationship to food and their body changes over time.

What would be the signs that someone has overcome bulimia?

Recovery is a process and continues well after treatment ends. The initial focus of treatment would be to eliminate bingeing and purging behaviours while facilitating a regular eating pattern. Individuals gradually feel more in control of their eating and a less preoccupied with food, weight and body image. Food is no longer categorised into ‘good’ and ‘bad’ groups and no longer elicit extreme distress. Individuals are able to identify, value and communicate their emotions effecting, thus, no longer using food as coping strategy. At this stage, individuals would have established a regular pattern of eating and learned how to manage and learn from lapses in order to maintain recovery.

References:

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