What is bulimia?

The British psychiatrist Gerald Russell first spotted bulimia nervosa in the 1979. Bulimia in fact is a serious eating disorder where the patients go on binge eating, then decides to control their weight via dangerous methods. To illustrate,  the methods they use are self-induced vomiting, long fasting, excessive exercising or misusing laxatives, diuretics and enema. Indeed, this disorder mostly exists among young women (3% of women has bulimia) and it’s 10 times more common in females than in males. In short, having bulimia means you're obsessed with your weight and body shape. Because it's rooted in self-perception, it can be hard to beat. Nonetheless, treatment will help you improve your self-esteem, eat better, and prevent or recover from serious complications.

Causes of bulimia:

Finding the etiology of bulimia nervosa isn’t easy and it’s still not clear. But there might be an involvement of neurochemicals and genetic factors. Actually, a study demonstrated that bulimia nervosa as well as anorexia patients shows widespread structural abnormalities with diffuse structural and functional changes in the white matter, particularly in pathways associated with appetite and taste. According to other studies, an alteration in intrinsic brain architecture function is observed.

Bulimia symptoms:

• Binge eating of large quantities of food (known as eating episodes) and without self-control
• Sore throat
• Constipation
• Headache
• Unorganized menstruation
• Fatigue
• Lethargy
• Bloating
• Abdominal pain

Diagnosis:

Physical examination:

Episodes of binge eating must take place minimum 1 time per week for 3 months to diagnose as bulimia.

As a matter of fact, physical examination includes a height, weight, orthostatic blood pressure, and vital signs check. Moreover, the patients’ skin, abdomen and mouth should also go under check.

Above all, neurological examination is the building block for diagnosing this disorder, since weight loss and vomiting after eating might have another neurological etiologies.

Certainly, to know if the patient has bulimia nervosa through physical examination, you’ll notice:

• Dry skin
• Swelling of the parotid gland
• Russell’s sign (calluses on hands dorsal part)
• Hypotension
• Dental erosion
• Hair loss
• Edema (swelling caused by blood leakage into nearby tissues)
• Epistaxis (Bleeding from the nostrils, nasal cavity or nasopharynx)

Full evaluation:

• Metabolic panel: calcium, serum creatitine, electrolytes, liver tests, and blood urea nitrogen.
• Complete blood count with differential.
• Vitamin B12 level test.
• Urinalysis.
• Electrocardiogram as well as magesium and phosphorous test in case of severe bulimia.
• Pregnancy test for females; to assess for other possible causes of amenorrhea, women with secondary amenorrhea should have luteinizing hormone (LH), prolactin, beta-HCG, and follicle-stimulating hormone (FSH) tests.
• Testing for stool or urine laxatives such as bisacodyl, emodin, aloe-emodin, or rhein is available. However, finding a positive result does not make a diagnosis.
• Anemia, hyponatremia, and transaminitis are some of the laboratory abnormalities associated with bulimia nervosa.

Treatment of bulimia:

Treatment main focus is on ceasing excessive eating episodes, which is the main issue in bulimia.

Medication:

Bulimia nervosa symptoms can be reduced with fluoxetine, citalopram, and sertraline, which are selective serotonin reuptake inhibitors. Currently, only fluoxetine (Prozac) is FDA-approved for bulimia nervosa. For instance, studies show that the higher the fluoxetine dose (60 mg) is, the greater the reduction in bingeing and vomiting. Since monoamine oxidase inhibitors and tricyclic antidepressants are lethal and have potentially dangerous side effects, they are reserved for resistant cases. Besides, it has been found that one antiepileptic medication "topiramate", reduces binge episodes, but monitoring the side effects closely especially weight loss and cognitive issues is vital.

Psychotherapy:

Patients with bulimia nervosa benefit from cognitive-behavioral therapy and interpersonal psychotherapy in clinical trials. Indeed, there is a higher risk of other mental diseases among individuals with bulimia nervosa that they are at risk of suicidality and comorbid psychiatric disorders.

Alternative treatment: 

For example, hypnotherapy has shown positive results and it involves using hypnosis to achieve focused attention and enhanced suggestibility in bulimia patients.

Diet plan:

It is important to eat regularly and not restrict your food intake in order to overcome this eating disorder. To clarify, your dietitian can help you put together an eating plan to help you achieve healthy eating habits to avoid uncontrollable craving. Notably, soluble fiber intake is a good approch for a healthy diet.

How to prevent bulimia:

Unfortunately, you can't prevent bulimia, but what you can do is give advice regarding someone else's weight obsession. Indeed, you can always help prevent a person's complications, by talking and understandin their condition all through. Also, as a person with such condition, you should always consult and check with your healthcare provider.

• Try to encourage people around you, whether your friends or your kids, to have a strong self-esteem regardless of their appearance or weight gain.
• DO NOT mock or make fun of anyone's weight issues.
• Encourage healthy ways of controlling weight, especially patients abuse unhealthy dieting behaviors such as fasting, using laxatives, and self-induced vomiting.
• Your healthcare provider may be able to identify early signs of an eating disorder and prevent its development if you keep in touch.

Complications:

The complications of bulimia are hardly serious. Some complications are:

• Dental erosion (teeth and gum are in bad shape)
• Swelling if salivary glands (noticeable as cheeks swelling)
• Oral/hand trauma
• Imbalance of electrolytes such as calcium, potassium, hydrogen and sodium
• Irritation of the gastrointestinal pathway
• Depression and anxiety
• Metabolic alkalosis
• Constipation
• Dehydration
• Cardiac arrhythmias

When to see a doctor:

As has been noted, complications can be severe and plenty, so they should be avoided at any cost. Without doubt, if you have your doubts, seek medical care as soon as you can. Therefore, discuss your bulimia symptoms, feelings, and thoughts with your primary care provider or mental health professional.

References:

-Castillo M, Weiselberg E. Bulimia Nervosa/Purging Disorder. Curr Probl Pediatr Adolesc Health Care. 2017;47(4):85-94. doi:10.1016/j.cppeds.2017.02.004

-Mcgilley BM, Pryor TL. Assessment and treatment of bulimia nervosa. Am Fam Physician. 1998;57(11):2743-2750.

-Jain A, Yilanli M. Bulimia Nervosa. [Updated 2021 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.