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Bulimia

Overview

Bulimia nervosa is an eating disorder somewhat similar to anorexia nervosa. Patients suffering from bulimia nervosa are called bulimics and the characteristics may represent those of a binge-eating-purging type of anorexia nervosa. The word bulimia is from a Greek word meaning ‘ox’ hunger. A bulimic indulges in periods of binging (eating excessively within less than two hours) followed by compensatory behavior of losing weight (or to avoid gaining weight) such as rapid and excessive exercise, self induced vomiting or fasting. The striking difference between bulimia nervosa and anorexia nervosa is that the former do not lose weight while anorexics lose weight tremendously.

The binging session usually occurs in secrecy, and is usually preceded by stress or a situation arousing unpleasant emotions. Foods that can be hastily consumed such, especially sweets such as chocolates and ice creams are regular binging items. During the first step of bulimia nervosa, a person is usually not aware of themselves or their actions. It may appear that they lose control during their binge. After this is over, the second step involves feeling of guilt, discomfort and disappointment over what has been done. This result in the patient fearing that their binge may cause excessive weight gain and this leads to self induced vomiting to undo the caloric effects of the binge.


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Causes

The actual causes of bulimia are not known. However, a vast amount of research suggests that endogenous opioids play a role in eating disorders, especially bulimia. Low levels of the endogenous opioid beta – endorphin were found in patients with bulimia. However, it is not clear whether the opioid system is directly or indirectly linked with bulimia.

On very important cause of bulimia is the sociocultural influence mainly involving the perception of what women think is the right body structure. Over time the standards of body shape and size considered desirable and attractive have been changing. No matter how much the think the models on the ramp these days appear, for many women, that figure is surely desirable. This strong desire to stick to what the society appreciates and admires have led many young women into adopting such eating patterns and purging behavior. Another indication of our society’s preoccupied with thinness is what happened with Miss Universe of 1996, Alicia Machado. When after winning the title, she gained a few pounds; some people became outraged and suggested that she give up her crown.


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Signs & Symptoms

Although many people indulge in binging, bulimics are diagnosed when the binging and purging occur at least twice a week for two months. Bulimics are also afraid of gaining weight and their self esteem is highly related to their ability to maintain a normal weight.

Two subtypes of bulimia are distinguished – a purging type and a non purging type. Purging type as is obvious involves a period of purging after binging. In the non purging type the compensatory behavior involves fasting or excessive exercise. Patients with non purging type of bulimia are found to be heavier and showed less of psychopathology than with people with purging type of bulimia.

People with bulimia nervosa are always associated with other disorders such as depression; personality disorders especially anxiety disorders, substance abuse etcetera. Also, studies have shown that bulimia and depression are genetically related. Also, due to continuous binging – purging patterns several physical changes are bound to occur in a patient suffering from bulimia nervosa. Frequent purging can cause potassium depletion. Heavy use of laxatives can cause diarrhea, which can cause changes in electrolytes and irregularities in the heartbeat. Persistent vomiting cause tearing of tissues in the stomach and throat and the stomach acids cause loss of dental enamel. Also, persistent vomiting has been linked to menstrual problems. The salivary glands may also be swollen in some cases.

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Prevention

Bulimia is a psychological disorder which cannot be prevented, but to stop the condition from becoming worse, early detection of the symptoms, followed by psychological counselling can be beneficial.


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Treatments
Anti-depressant drugs Modern Medicine

Treatment for bulimia has mainly involved use of anti – depressant drugs. Although somewhat effective the drop out rates have been found to be very high and relapse is quite common when patients stop taking the medication.

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