Dec 13, 2017 in Medicine


Bulimia is a disorder in which a person is obsessed with food and weight. The person regularly overeats, feels a loss of control and, as the result, uses different drastic methods to prevent a weight gain that is to prevent caloric/fat absorption. The methods vary with each individual. This eating disorder is often linked to stress, self- esteem and emotional problems. People constantly think about their weight, eaten calories, dieting and ways of getting rid of the eaten stuff. Bulimia is considered to be more common than anorexia. However, it is a hidden illness as people remain at an average or over average body weight. The disorder can be unnoticed for rather long time, but the person feels very unhappy and ill.

Bulimia can affect a variety of different people, but generally the victims tend to fall under certain categories. However, bulimia affects, in most cases, women rather than men. The disorder is especially common among young women and adolescent girls. The most vulnerable are the young females aged 12-18. One to three percent of adolescent and young women in the US are affected by the disorder. However, the disease may start at elementary school or much later. Some people (gymnasts, divers, ice-skaters and other athletes) are usually pressurized into starting bulimic habits. At high risk for the disease development are also males who perform in athletics sports, such wrestling. Bulimia victims are often linked to being exposed to physical, verbal, and/or sexual abuse. The disorder may also contain ties to manic or clinical depression. People with bulimia often start out with anorexia (excessive exercising and starvation), or may turn to develop anorexia disorders. Bulimic behaviors are seen in ten to twenty percent of population. As a rule, the affected person is aware of her or his abnormal eating pattern and feels guilt or fear with the binge-purge episodes. The evidence is that people with bulimia have no problems with weight, but they see themselves as being overweight (The Physiology and Psychology of Bulimia, n.d.).

There have been continuing debates concerning the physiological and psychological cause of the disease. There are a lot of factors (trauma, society, family; cultural, genetic, or psychological factors) which may play a vital role in bulimia development. However, the exact cause of the disorder is unknown. Studies, carried out in this sphere, show convincing results for both theories. The physiological aspect bases on the assumption that eating is controlled by the brain. Disturbances may occur in several places: the brain tryptophan level increase leads to inadequate effect of carbohydrate-rich meal on serotonin-mediated neurotransmission; the brain disability to respond appropriately to changes induced by food; the serotoninergic neurons functional activity might be disturbed by pathological processes in the brain (Stunkard, 1984, p. 84).

It is also believed that bulimia is the behavioral manifestation of the serotonin underactivity. Serotonin is a hormone that regulates vital functions in the central nervous system. The hormone is also responsible for the consciousness and mood control. It is considered to be special due to the fact that its own release and synthesis is enhanced by some types of food while it might be suppressed or unaffected by others. The brain effects depend on the content of nutrition. Absence of food affects transmitters and leads to the activation of serotonin-releasing neurons. These neurons make food consumption influence other behaviors linked with serotonin functions (environmental stimuli, sleepiness and others). They also allow mood disturbances to override the mechanisms of appetite control and result in excessive food consumption (Winik, 1988, p. 27-34).

Food produces certain chemical changes in the brain which should be caused by the neurochemical responses needed to carry instructions from one neuron to another. The consumption of rich in carbohydrate meal causes the serotonin neurotransmitter release; this signal reduces the possibility that a person will eat large amounts of carbohydrates having a meal next time. Instead, the next food to be consumed should be rich in protein. The amino acid that is responsible for the serotonin synthesis and release is called tryptophan (Winik, 1988, p. 82-83). Tryptophan is not made in the brain and is consumed as part of dietary protein. It is the only precursor source for the synthesis of brain serotonin. Being absorbed from the stomach, tryptophan is circulated in the blood where it is distributed (Wurtman, 1979, p. 121).

The carbohydrate-serotonin interaction is described as synthesis acceleration of carbohydrate-rich meal and serotonin secretion from neurons; the carbohydrates elicit insulin secretion reducing plasma levels of most large neutral amino acids (LNAA) and increasing the tryptophan hydroxylase saturation. As a result, less serotonin is synthesized leading to the lack of craving for carbohydrate rich foods. Patients with bulimia, often have a severely altered ratio of carbohydrate to protein consumption. The obstacle of understanding the relationship of appetite, mood and serotonin is the failure to measure actual patterns of nutrition in eating disorders.

Bulimia is characterized by eating binges which may occur several times a day for many months. People with the disorder usually eat large amounts of foods rich in calories. People may feel that they lose control over their eating habits. As a rule, binges lead to the feeling of self-disgust which causes purging to prevent gain of weight. Purging may include such methods as excessive exercise, urges to vomit, use of enemas, laxatives, or diuretics. Purging often results in a sense of relief.

Among the symptoms of this eating disorder are bloating, nausea, abdominal pain, flaky skin, dizziness, sleeping and concentrating problems, weakness, mouth sore, swollen feet, hands, or cheeks, hoarse voice, and sore throat. Bulimia causes a variety of long-term diseases including kidney damage, anemia, lack of menstrual periods, loss of teeth, cardiac failure, stomach ulcers, heart problems, risk of rupture of stomach and esophagus, type 2 diabetes, obesity and associated health problems, mouth infections, bad breath, stomach pains, constipation, fainting, bowel problems, and high blood pressure (Bulimia Nervosa, 2010).

The bulimic body often does not receive enough nutrients causing electrolyte imbalances and disruption of the bodily functions on an ionic level. In a few months of, the bulimic’s skin and hair will become dry, and the hair may even start to fall out. Nails will become brittle and break easily. Such people usually suffer from fatigue, nausea, dizziness and other injuries such as stress fractures. The stress of the food forcing out from the stomach puts strain on the heart of an individual and can cause palpitations. The bones of such people are usually weakened and are at risk of osteoporosis.

The symptoms that can be noticed by other people are as follows: sudden eating of large amounts of food, compulsive exercise, and regular visits to the bathroom after meals; throwing away packages of diet pills, laxatives, diuretics, or emetics. Such people over-eat, especially in the evenings, eat alone (even at night) and do not consume normal meals.

A dental exam of people with bulimia usually shows gum infections or cavities. The tooth enamel may be pitted or worn away due to the exposure to the acid in vomit. A physical exam often shows dry mouth, broken blood vessels in the eyes, pimples and rashes, pouch-like cheeks, calluses or small cuts across the finger joint tops, possibility of electrolyte imbalance or dehydration in blood.

The disorder may be dangerous and may lead to serious medical complications. The possible complications include dehydration, constipation, dental cavities, hemorrhoids, electrolyte imbalance, throat swelling, and others (Bulimia, 2013). People who suffer from bulimia usually suffer from a poor self-esteem and have an excessive focus on the need to be thin and attractive. They have negative emotions and usually feel shame, anxiety, guilt, low self-esteem, mood swings and dieting obsession.

People with bulimia rarely have the need to go to the hospital. Medical care is required in case of anorexia, drug addiction to help people top purging, major depression, and others. The treatment approach is usually stepped and depends on the disorder severity.

The discovery of the link between eating disorders and body chemistry has provided new developments in the disease treatment. In the past, there was an idea that the best solution to the eating disorders is gaining of self-control. Nowadays, it is evident that body’s hormones play a vital role in a variety of eating disorders and their treatment. It was proven that patients respond in a more positive manner to treatments when they realize that willpower or the lack of willpower is not a cure determinant. As a rule, patients choose the treatment program that they find to be the most suitable, in order to produce the most lasting results.

The method of psychotherapy that is used to treat people with bulimia is referred to as the therapeutic triad. The first and the second part of the triad are related to the psychological and withdrawal stage treatment. This stage of treatment includes learning about the bulimia addictive process and getting rid of the binge-purge behavior. The final part of the triad is related to the bulimic trait treatment. It includes individual therapy and the therapy of faulty family dynamics (Heubner, 1993, p. 145).

The first part of the triad combines cognitive, intellectual and experimental approaches to learn about the addictive process in bulimia. The patient is asked to note the number of binge-purge episodes, the nature and amount of fluid and food intake, states of mind and exercising. It helps the psychoanalyst trace the times at which bulimic activity is the highest, as well as the emotional state that caused this activity. This method provides an opportunity to see the progress and is considered to be very helpful in treating the disease. The problem is that many bulimics find it extremely difficult or even impossible to keep a log (Huebner, 1993, p. 146).

The second part of the triad experiments have been made with binge-purge behavior. The psychoanalyst observes the addictive and reinforcing nature of the disease. The patient feels cognitive control over own experiences, and it helps to see the first therapeutic results. The binge-purge behavior experimentation allows better understanding of the addictive qualities and a behavior change. The patient is taught to differentiate between a healthy and an addictive food. There is a strict limitation of calories intake (1,200 - 1,400), which constitute three small meals and one snack per day. In case, the bulimic feels the need to binge, he/she has to wait at least 1-1.5 hours after a meal. As soon as the patient is able to separate the consumption of healthy and addictive food, he/she can reduce the binge-purge episode frequency. This is the so called withdrawal stage which heightens the desire for the addictive behavior. Support and encouragement and are key factors of the stage as the bulimic experiences a heavy period of emotional stress while fighting between giving up the addictive behavior and returning to it. This stress usually requires antidepressants, which help to reduce the patient’s reactivity to stressful life situations. It also reduces the desire to control emotions through purging and binging.

The third part of the triad includes individual or family treatment. The patient learns to identify situations that resulted in bulimia. It provides an opportunity to apply an analytical approach to future situations in life that are able to trigger the desire to return to addictive behavior. Family therapy is a vital component of bulimia treatment as it is extremely necessary to understand the family dynamics to determine the place of pressure occurrence. The family has to know how to support a person with bulimia (Huebner, 1993, p. 148-150).

However, due to the psychological struggles that lead to the disorder and emotional toll, psychotherapy is considered to be one of the most important steps on the way to recovery. With the help of therapy, patients have an opportunity to resolve their inner conflicts as well as learn to accept and love themselves irrespective of their bodies. Gaining a new self-awareness, bulimics may stop focusing on their feelings concerning their bodies and become engaged in a variety of things which surround them. 

The sessions of Cognitive Behavioral Therapy are treated as fact-finding missions, in which patients are asked to think about the things, places and people that tend to trigger their destructive behavior. As soon as those triggers are identified, patients are encouraged to develop plans they can put into place to remedy their destructive behavior.

Group therapy is another important type of psychotherapy that is widely used in the bulimia treatment. Group and individual psychotherapies are very similar as both of them employ the same methods of progress and self-realization. However, group psychotherapy is considered to be more effective than an individual one as it helps the patient to overcome the feelings of frustration and guilt. It also gives a sense of belonging to and acceptance from a group of people, who follow a common task. It is essential that the group success enjoys high participation levels, self-disclosure and risk-taking, coupled with low levels of tension and defensiveness (Harper-Giuffre, 1992, p. 37). Support groups are considered to be helpful for patients who have no problems with health and experience mild conditions of the illness. In other cases, nutrition and cognitive-behavioral therapy are the most effective treatments for bulimia. The disorder is also treated with antidepressants known as selective serotonin-reuptake inhibitors (SSRIs). Thus, the approaches of group therapy are often effective as they provide the opportunity to practice their skills with others, who have the same problems and are going through the same therapy. However, this form of treatment might not be equally appropriate for all people with bulimia.

Family relationships can sometimes be strained and frayed because of an eating disorder. A family trauma can cause intense stress and distress which results in disordered eating. Therapies can help families address changes which happen as a result of the bulimia issue. They even help families examine the trauma, which have caused the original development of the disorder. This approach makes families feel better and provide the person with bulimia with a supportive and safe place to grow and live (Bulimia Treatment, 2013).

Individual and group tension as well as medications are active parts in the bulimia treatment. The objectives for the bulimia treatment are to improve social emotional expression and competence, increase the ability to recognize feelings and signals, learn to attain tranquility and relax physically, as well as reduce excessive achievement orientation, change depressive thought patterns, organize appropriate leisure activities and take on responsibility (Fichter, 1990, p. 277).

Hospitalization is sometimes an effective method of bulimia treatment as the patient receives proper nutrients and his/her eating habits are scrupulously monitored. Bulimics may be retained on outpatient status receiving psychotherapy between weekly visits to the doctor for testing and weighing. In a variety of therapy sessions, people with bulimia get information about the way to control the destructive thoughts that can result in the need to purge and binge. Therapists often use he approaches of Cognitive Behavioral Therapy. They ask the patients to tackle the addiction problem as one unit and work in close partnerships with the therapist. It is important to have a good relationship between the patient and the therapist as an individual really needs to trust the therapist to share intimate details. The therapist can provide real help only in case he is aware of all the issues and details that lie beneath the addiction.

It may be concluded that bulimics are often perfectionists and feel they have severe standards, up to which they have to live. Those, who have the feeling of disability to control their lives, may turn to eating disorders. Such people tend to have an intense fear of letting others down and becoming a failure. In general, eating disorders are a lifelong battle, just like a drug, alcohol or any other addiction. People eat a very large amount of food, get thick and then cut down or starve to find the ways to make up for the food that has been eaten. Starving causes the feeling of hunger and leads to eating large amounts of food because the body needs nourishment. People, who think that bulimia is less dangerous than anorexia (as they do not have extreme loss of weight), are mistaken. The disorder is very harmful as its side effects and consequences pose a serious threat to health (Bulimia Nervosa, 2010).

It is worth knowing that eating disorders are not only conditions, but also complex diseases as they have a particular process of destruction for an individual displaying a set of characteristic symptoms. Eating disorders are mainly mental health diseases which are chronic with progression. People with bulimia often starve themselves due to restricting food, calories and fat intake for extended periods, before a massive binge develops, during which they consume abnormal amounts of food during a short period of time. These binges are usually followed by purging.

There is a widespread idea that media-fed images of perfection and beauty are responsible for the disease development. Modern society has made food a night-and-day obsession, causing people to withdraw from their families, schools and social lives. Bulimics often refuse to eat in front of other people and find a variety of excuses to avoid meals in groups.

Some bulimics will definitely agree that it is necessary to do something, but a great number of them do not agree that they have been sick with a serious disease. They sometimes drop out of therapy as they do not agree that they have a problem. In such a case, a therapeutic technique called motivational interviewing usually helps. Bulimia can be stopped in case the signs of warning are caught early enough. The road to recovery is long, hard and frequently plagued by relapses. The most important thing is that bulimia and other eating disorders may be prevented. However, the society should come to terms with the natural variety of human body shapes. People should also learn to be kind and tolerant to one another. In addition, it is essential to overcome the media-fed images of perfection and beauty.

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