BULIMIA NERVOSA

It is only in the last 30 years that bulimia nervosa has been recognised by doctors as an eating disorder in it's own right. The term, bulimia nervosa, means literally 'the hunger of an ox'. It is characterised by episodes of binge eating; eating large quantities of food in a short time. This behaviour may be very severe with enormous quantities of food, most typically carbohydrates being consumed. To prevent the otherwise inevitable consequence of weight gain there are periods of food restriction and often vomiting, laxative abuse or excessive exercising. When vomiting is used then the binges may become multiple with repeating cycles over several hours in which the sufferer eats until full, then vomits and eats again. Such is the drive to eat that they may scavenge leftovers from a dustbin or steal in order to feed the compulsion. They generally find their own behaviour disgusting and are deeply ashamed of it so that it almost always occurs in secret. Signs that may indicate that there is a problem include a tendency to leave the table immediately after a meal. Vomiting is most frequently induced by forcing two fingers of the right hand down the throat. This often causes a chronic blister just below the knuckle where it rubs on the upper teeth.

Bulimia is more difficult to detect as the person often will not lose weight so dramatically. In fact, even people close to them at home or work may not recognise the illness and so it can persist for many years undetected. As with anorexia, people who develop bulimia may use the control of food and eating as a way of coping with emotional difficulties in their life.

Bulimia Nervosa is an illness that is most commonly found in girls of later adolescence and early adulthood. It is very rarely found in men.  They may have had - or go on to develop - anorexia. This sometimes occurs because they believe bulimia will help them to diet successfully where other attempts to lose weight have failed.

CAUSES OF BULIMIA NERVOSA

The causes of Bulimia Nervosa remain unknown although there is probably a small genetic contribution. In sub-clinical form bulimic behaviour is probably very common in our society. The incidence of Bulimia Nervosa is usually given as 3% of young women but the true incidence is likely to be much greater. The pressure to be thin and resulting abnormal eating patterns that are regarded as normal are probably partly to blame. Certainly the desire to be thin and attempts to restrict weight are the triggers that provoke the illness. Once established bulimia influences the way that emotions are felt. It is paradoxical that bulimia causes them to become increasingly out of control in a wide variety of ways and yet it is the one thing that enables them to feel in control.

Once the illness has become established the trigger to binge is often partly or wholly related to feelings. Periods of depression, boredom, and anger are likely to increase the risk especially when the sufferer is alone. It is a habit forming behaviour and some girls plan being alone and having food available in order to make bulimia easier. They can become addicted to the emotional feelings that are generated in this way.

PHYSICAL SIGNS OF BULIMIA

• Frequent weight changes
• Disappearing to the toilet after meals in order to vomit food eaten Sore throat and tooth decay caused by excessive vomiting
• Swollen salivary glands making the face more round
• Poor skin condition
• Irregular periods
• Lethargy and tiredness

PSYCHOLOGICAL SIGNS OF BULIMIA

• Uncontrollable urges to eat vast amounts of food
• An obsession with food
• Distorted perception of body weight and shape
• Emotional behaviour and mood swings
• Anxiety and depression; low self-esteem, shame and guilt
• Isolation - feeling helpless and lonely

• Eating large amounts of food within a short period of time, accompanied by loss of control
• Feeling ashamed, depressed or guilty after bingeing
• Self-induced vomiting
• Abuse of laxatives, diuretics or enemas
• Periods of fasting
• Excessive exercise
• Secrecy and reluctance to socialise

The frequency of these bulimic cycles will vary from person to person. Some will suffer from an episode every few months whilst others who are more severely ill, may binge and purge several times a day. Many people do not regard their illness as a problem, whilst others despise and fear the vicious and uncontrollable cycle they are in.

LONG TERM EFFECTS OF BULIMIA

In a similar way to anorexia, bulimia can take over the life of the person with the disorder, making them feel trapped and desperate. Chaotic eating and dramatic loss of fluids can cause physical problems which can usually be corrected once the body is nourished in an even and moderate way.

Although the dangers of anorexia are more apparent because of a person's substantial weight loss or very low weight, bulimia can, in extreme cases, be fatal due to, for instance a heart attack. An imbalance or dangerously low levels of the essential minerals and electrolytes in the body can significantly or fatally affect the working of vital internal organs. Irregularity of the menstrual cycle is common and sometimes it stops altogether. There is an association of ovarian cysts with the illness that is likely to reduce fertility but most are able to conceive normally once they are recovered. Other dangers of bulimia include rupture of the stomach, choking, and erosion of tooth enamel. The greatest risks are from suicide or self harm as a result of feelings of depression and hopelessness.