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Bulimia Nervosa: Types, Symptoms, Causes, and, Treatment

Bulimia (a.k.a: Bulimia Nervosa) is a potentially life-threatening eating disorder which is characterised by excessive eating in one sitting. Individuals with bulimia desire unrealistic body weight and shape.  After excess eating, the individuals have a feeling of guilt and get anxious about weight gain. The feeling of guilt and fear of gaining weight forces the individual to purge.

Overeating followed by purging might cause serious health issues. Bulimia is more often seen in women than men. In India, approximately more than one million cases of bulimia nervosa are reported each year.


Types of Bulimia Nervosa:

Bulimia Nervosa is of two types based on the method adopted by the individual to get rid of excess calories consumed. They are as follows:

  • Purging Bulimia: In purging bulimia, the individual use laxatives, enemas or diuretics and might also self-induce vomiting to get rid of extra calories.
  • Non-purging Bulimia: In non-purging bulimia the individual tries to balance the extra calories by strict dieting, fasting or exercising.

However, any method used for getting of calories is refereed as purging because mostly these methods overlap.

Cause of Bulimia Nervosa:

The cause of bulimia is not known. Researchers believe that social, emotional, biological and genetic factors are involved in the development of bulimia nervosa.

Signs and Symptoms of Bulimia Nervosa:

An individual having bulimia nervosa has a normal BMI, but they still judge themselves severely. Individuals are obsessed with an unrealistic body image. The various signs and symptoms of bulimia nervosa are as discussed below:

  • Weakness
  • Exhaustion
  • Heartburn
  • Bloating
  • A sore throat
  • Mood swings
  • Irregular periods
  • Overeating in a single sitting
  • Always in distress due to weight again
  • Excessive exercising in between over eating period
  • Preoccupied with unrealistic body shape and weight
  • Overuse of supplements or herbal products for weight loss

Risk Factors for Bulimia Nervosa:

Many factors are involved in the development of Bulimia Nervosa. The presence of the following risk factors increases the risk of bulimia nervosa:

  • Gender: Being a female increase the risk of developing bulimia nervosa.
  • Age: Bulimia nervosa occurs more often in teenagers and adults.
  • Family History: People who have a family history of bulimia nervosa are at high risk of developing this condition.
  • Weight: The risk of developing bulimia nervosa is high in individuals who were overweight in childhood or adolescence.
  • Serotonin Levels: Low levels of serotonin can significantly contribute to the development of bulimia nervosa.
  • Social Pressure: The media showcase an unrealistic body image. This might cause social pressure to get accepted in the society.
  • Emotional and Psychological Factors: Psychological disorders such as anxiety and low self-esteem and environmental stress and trauma increase the probability of developing bulimia nervosa.
  • Professional Requirements: Certain professionals like actors, dancers, athletes and models are at high risk of developing bulimia as they are encouraged to look good for better appearance or better performance.

Complications of Bulimia Nervosa:

Bulimia nervosa has the potential to cause various life-threatening complications. The possible complications include:

  • Dental Problems: The individual might experience dental problems such as toothaches, tooth decay, gum diseases, swollen gums and erosion of tooth enamel due to acid present in vomiting
  • Damage to Endocrine Glands:  Endocrine glands are damaged due to purging which leads to osteoporosis due to inadequate absorption of calcium.
  • Dehydration: Dehydration is caused due to purging which causes weakness, dry skin, fainting and kidney damage.
  • Electrolyte Imbalance: Due to dehydration there is the possibility of electrolyte imbalance. Fatigue, weakness and various heart problems are caused due to electrolyte imbalance.
  • Bloody Vomit: Blood in vomit is due to the inflammation of the oesophagus.
  • Haemorrhoids: Laxative abuse strains the bowel movement leading to the development of haemorrhoids.
  • Swelling of Salivary Glands: The salivary glands are sore and swollen due to excessive vomiting. Swollen salivary gland makes the cheeks appear puffy.
  • Psychological Disorders: The individual might experience anxiety and depression. Anxiety and depression also increase the probability of suicide in the individual suffering from bulimia.
  • Childbirth: The female individuals might experience difficulty in conceiving and the might also have irregular periods or no periods.

Diagnosis of Bulimia Nervosa:

If an individual is suspected to have bulimia nervosa the physician might do the following test for the diagnosis of bulimia nervosa:

  • Physical Examination: Physical examination involved the determination of height and weight relative to age and vital signs. In physical examination, the patient is also examined for abdominal tenderness, dental check-up, jaundice, hair loss, dry skin, oedema etc.
  • Routine Laboratory Testing: Routine laboratory testing includes thyroid function test, urine test and complete blood picture with differential serum chemistry. Based on the outcome of physical examination and routine laboratory testing the physician might suggest other tests such as chest radiograph, electrocardiogram
  • Psychological Assessment: Psychological assessment is done to determine the eating habits, medical condition, body image and interpersonal relationship. This parameter helps in planning the treatment and identifying depression and treatment.

Treatment of Bulimia Nervosa:

Treatment of bulimia nervosa should be started as soon as possible to avoid complications. The best approach to treat bulimia is to combine medication and psychotherapy.

Medication: Anti-depressant medication can effectively treat bulimia nervosa. Fluoxetine is the only anti-depressant medication which is approved by the Food and Drug Administration (FDA) for treating bulimia.

Psychotherapy: Psychotherapy is commonly called as psychological counselling or talk therapy. The various approaches of psychotherapy include:

  1. Cognitive Behavioral Therapy: Low nutrient levels cause the individual to overeat. So, cognitive therapy is done with an objective to restore the nutrients to the required levels by reducing the obsession of an unrealistic weight.
  1. Family-based Therapy: The family of the individual with bulimia is trained so that they can handle the complications and help the individual in adopting healthy eating habits.
  1. Interpersonal Psychotherapy: Interpersonal psychotherapy assists indentifying a particular relationship which can be a cause of bulimia nervosa. The physicians determine how emotions of this particular relationship are causing symptoms of bulimia and correct it so that the individual does not overeat.


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