Bulimia nervosa: clinical features and treatment approaches

Bulimia nervosa is stated by the National Institute of Mental Health to be "characterized by recurrent and frequent episodes of eating unusually large amounts of food, and feeling a lack of control over the eating. This binge-eating is followed by a type of behavior that compensates for the binge, such as purging, fasting..." And may include excessive exercise. (2009) These individuals are distinguished from those with Anorexia since those with bulimia generally "fall within the normal range for their age and weight." (National Institutes of Mental Health, 2009) However, these individuals, just as those with anorexia have a fear of gaining weight as well as wanting "desperately to lose weight, and are intensely unhappy with their body size and shape." (National Institutes of Mental Health, 2009) Bulimic behavior generally takes place in secret and "is often accompanied by feelings of disgust or shame." (National Institutes of Mental Health, 2009) the binging and purging cycle generally is repeated several times each week. This disease is similar to anorexia in that those with bulimia "often have coexisting psychological illnesses such as depression, anxiety and/or substance abuse problems. Many physical conditions result form the pursing aspect of the illness including electrolyte imbalances, gastrointestinal problems, and oral and tooth-related problems." (National Institutes of Mental Health, 2009) There are two types of Bulimia Nervosa: (1) Purging Type; and (2) Non-purging Type. (National Institutes of Mental Health, 2009) the individual with Purging Type Bulimia Nervosa "regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. The individual with non-purging type uses "other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas." (National Institutes of Mental Health, 2009)

I. SYMPTOMS

Symptoms of bulimia are stated by the National Institute of Mental Health to include those as follows: (1) chronically inflamed and sore throat; (2) swollen glands in the neck and below the jaw; (3) worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acids; (4) gastroesophageal reflux disorder; (5) intestinal distress and irritation from laxative abuse; (6) kidney problems from diuretic abuse; and (7) severe dehydration from purging of fluids. (National Institute of Mental Health, 2009)

II. CAUSES

More women are affected by bulimia than are men and in fact, nine out of ten individuals with bulimia nervosa are women. The U.S. Department of Health and Human Services states that Bulimia "is more than just a problem with food. A binge can be set off by dieting or stress. Painful emotions like anger or sadness, can also bring on binging. Purging is how people with bulimia try to gain control and to ease stress and anxiety." (National Institute of Mental Health, 2009)

III. RISK FACTORS and COMPLICATIONS

Factors playing a role in Bulimia are stated to be those as follows:

cultural pressures;

family, as bulimia tends to run in families;

life changes or stressful events;

The individual's psychological makeup;

Biological aspects such as genes, hormones, and brain chemicals. (U.S. Department of Health and Human Services, 2007)

IV. EFFECTS

Individuals with bulimia often have "swollen cheeks or jaw area" as well as rough skin on their knuckles and teeth that appear clear. (U.S. Department of Health and Human Services, 2007) it is also noted by the U.S. Department of Health and Human Services that individuals with Bulimia often have broken blood vessels in their eyes. (U.S. Department of Health and Human Services, 2007)

The effects of Bulimia Nervosa on the individual's body are shown in the following illustration labeled Figure 1 as shown in the following illustration are many negative affects on the body of the individual with Bulimia Nervosa including anemia, irregular heart beat, fatigue as well as a plethora of other negative effects.

Effects of Bulimia Nervosa

Source: U.S. Department of Health and Human Services (2007)

V. TREATMENT

Treatment for Bulimia Nervosa may include inpatient and outpatient care, daycare, and continued care along with a family program for support. Bulimia treatment is a structured treatment plan and involves a combination of sessions with a range of interdisciplinary staff. Findings in a recent study published in the ScienceDaily publication January 7, 2009, states that women who have bulimia nervosa "appear to respond more impulsively during psychological testing than those without eating disorders." (2009) Additionally reported is that brain scans show differences in areas responsible for regulating behavior..." (ScienceDaily, 2009) Specifically stated in the report is: