What is bulimia nervosa?
- Bulimia nervosa is more common than anorexia nervosa.
- It is characterized by recurrent episodes of overeating and induced vomiting.
- Up to 3000 calories in 1 hour.
- It usually begins in adolescence. Often the cause of bulimia is a young girl’s failure to follow a restrictive diet. Reacts by eating too much which resolves in binge crises.
- Episodes of overeating characterized by consuming large quantities of food quickly in a short amount of time.
- The patient feels that he/she can not control the quantities of food he/she eats during the binge episode.
- A person with bulimia nervosa feels guilty about excessive food intake.
- The guilt resorts to induced vomiting, use of laxatives, diuretics and excessive exercise (cancellation behavior).
- Then the cycle is repeated with successive episodes of overeating and corrective or cancellation behavior (induced vomiting, use of laxatives and diuretics, excessive exercise).
- The bulimic individuals usually have normal or nearly normal body weight. If coexisting with anorexia then there is weight loss.
- People with bulimia nervosa are afraid of gaining weight, wish to lose weight and feel very badly about their bodies.
- They also feel shame and are embarrassed for having bulimic episodes. They are secretive about their behavior. After the cancellation behavior following the bulimic episode, they feel better.
- There are testimonials of patients with bulimia nervosa who had up to 14 binge episodes per week.
- For the diagnosis of bulimia nervosa the patient should have at least two binge episodes a week with cancellation behavior for three months.
- There are experts who believe that only one cycle of overeating and induced vomiting a week is sufficient for diagnosis.
The symptoms of bulimia nervosa
- Repetitive and uncontrollable episodes of overeating.
- Efforts of overturning the effects of overeating by self-induced vomiting, restrictive dieting, grueling exercise, licit or illicit appetite suppressants, use of laxatives or diuretic drugs.
- Often disappearing to the toilet after meals to vomit.
- Disorders in menstruation.
- History of large fluctuations in weight.
- Lesions of the enamel of the teeth and fingers ( Russels point)
- Lethargy.
- Feelings of guilt and self blame, lack of help and loneliness.
- Impulsive behavior disorder with loss of impulses and mood swings control.
- Behaviors masking, concealment and deception (secrecy, falsehood).
- Chronic stress, anxiety, depression.
- Acting out (sexual, self injury, alcohol and drugs overuse, theft).
Goals of treatment of bulimia nervosa
- Initiation of a normal diet program and prevention of the vicious cycle of overeating – vomiting
- Modification of thoughts, beliefs and feelings that sustain bulimic behavior based on cognitive model
- Treatment of medical complications of bulimia
- Treatment of coexisting psychiatric symptoms that are common in bulimia
- Psychological approach
- Individual or group psychotherapy:
- Cognitive - behavioral (treatment of choice)
- Interpersonal
- Psychodynamic
- Family Therapy
- Individual or group psychotherapy:
- Medicines
- Prevention of relapse
The Nutritional rehabilitation is to educate the patient with Bulimia Nervosa in order to:
- Adopt the principles of a balanced diet (eating regular meals, increasing the variety of food choices, reduce the speed of food intake and start eating the "forbidden" foods in a normal way).
- Understand the relationship between malnutrition and overeating.
- Understand the devastating effects of vomiting and laxatives use.
- Take balanced and regular meals.
- To increase his/her physical activity according to the dietary intake and to understand the relationship between balance of prevention and energy consumption.