Bulimia nervosa is an eating disorder characterized by bouts of binge eating followed by unhealthy compensatory behaviors such as intentional vomiting, use of laxatives, or excessive exercise for fear of gaining weight. This disease is not limited to affecting weight only, but extends to affecting physical and psychological health, causing serious complications such as hormonal disturbances, weak digestive system, and tooth erosion. In some cases, it may lead to infertility or increase the risk of developing some types of cancer.

What is bulimia?

Bulimia nervosa is an eating disorder characterized by episodes of overeating followed by compensatory behaviors to eliminate gained calories, such as intentional vomiting, excessive exercise, use of laxatives, or fasting for long periods for fear of gaining weight.

Causes of the appearance of bulimia

The causes of bulimia nervosa are diverse and complex, and include psychological, social, biological, and environmental factors. The most important possible causes are the following:

Psychological factors

• Anxiety and stress: People who suffer from chronic anxiety or stress are more susceptible to bulimia due to using food as a means of dealing with stress.
• Depression: Mood disorders such as depression are often associated with compulsive eating behaviors and attempts to eliminate food.
• Low self-esteem: People who feel dissatisfied with their body shape may be more likely to develop eating disorders.
• Fear of weight gain: Obsession with ideal weight and fear of obesity may lead some people to engage in unhealthy compensatory behaviors after eating.

Social and cultural factors

• Societal beauty standards: Social pressures that promote thinness as the ideal standard of beauty can lead some to try to lose weight in unhealthy ways.
• Media influence: Idealized images of bodies in advertisements, films, and social media increase feelings of dissatisfaction with body shape.
• Weight bullying: Being bullied or criticized about weight in childhood or adolescence may cause psychological problems that lead to eating disorders.

Biological and genetic factors

• An imbalance in brain chemistry: A disorder in neurotransmitters such as serotonin and dopamine may affect appetite control and eating habits.
• Genetic influence: If a family member has an eating disorder, there may be a genetic predisposition to the disease.
• Hormonal disorders: Some research indicates that certain hormonal disorders may affect feelings of hunger and fullness.

Environmental and educational factors

• Harsh life pressures: such as exposure to psychological trauma, abuse, academic or family pressures may lead to eating disorders.
• Strict eating habits in childhood: Getting used to strict diets at a young age may lead to an unhealthy relationship with food.

Read also: Everything you need to know about anorexia nervosa

Symptoms of bulimia

Symptoms of bulimia nervosa  appear in the form of repetitive and unhealthy food-related behaviors, in addition to physical and psychological effects, and symptoms include the following:

Behavioral symptoms

• Repeated episodes of binge eating over a short period with a feeling of being unable to stop.
• Feelings of guilt and shame after eating large amounts of food.
• Using compensatory methods to eliminate food, such as intentional vomiting after eating, using laxatives or diuretics, fasting for long periods after eating, and excessive exercise to compensate for calories.
• Obsession with weight and body shape and intense fear of gaining weight.
• Avoid eating in front of others or eating in secret.

Physical symptoms

• Swelling of the face and jaws due to enlarged salivary glands resulting from repeated vomiting.
• Erosion of tooth enamel and increased tooth sensitivity due to infectious acids.
• Dry skin and hair due to lack of nutrition and constant dehydration.
• Fatigue and dizziness due to a lack of vitamins and minerals.
• Digestive problems such as bloating, constipation, or esophageal reflux.
• Irregular menstrual cycle in women due to the effect of eating disorders on hormones.
• Heart palpitations due to a disturbance in the balance of salts in the body.

Psychological symptoms

• Mood disorders such as depression and anxiety.
• Low self-confidence and a constant feeling of dissatisfaction with body shape.
• Severe mood changes due to fluctuations in sugar and hormone levels.
• Social isolation and avoiding events that include food.

Methods of diagnosing bulimia bulimia

The diagnosis of bulimia nervosa is made by evaluating the symptoms and behaviors associated with eating, in addition to medical and psychological examinations that help confirm the condition and rule out any other disorders. We now mention the most important methods that doctors rely on in diagnosis:

Clinical assessment and medical interview

The doctor or psychologist conducts an interview with the patient to find out his medical and behavioral history, and the following questions include:

• Do you have episodes of binge eating during which you feel out of control?
• Do you use elimination methods such as vomiting, using laxatives, or exercising excessively?
• How do you feel about your weight and body shape?
• Do you suffer from mood changes, anxiety, or depression?

Diagnostic criteria according to DSM-5

Doctors rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose bulimia, which requires the presence of the following:

• Repeated episodes of binge eating (at least once a week for 3 months).
• Using unhealthy compensatory behaviors after eating (such as vomiting or using laxatives).
• Exaggerated self-evaluation based on weight and body shape.
• No comorbid anorexia nervosa.

Medical and laboratory tests

The doctor may order some tests to rule out health complications resulting from bulimia, such as the following:

• Blood analysis: to detect mineral and vitamin deficiencies and salt disturbances in the body.
• Kidney and liver function tests: to determine the effect of frequent vomiting on vital organs.
• Electrocardiogram (ECG): To check for any disturbances in the heart rhythm due to a deficiency of potassium and sodium.
• Dental examination: to determine the presence of erosion in tooth enamel due to infectious acids.
• Gastrointestinal examination: to check for any ulcers in the stomach or esophagus.

Psychological evaluation

Since bulimia is a psychological disorder as well as an eating disorder, psychological tests may be performed to determine the following:

• The level of depression or anxiety associated with the condition.
• Self-image of the body and its impact on the psychological state.
• Other eating disorders that may be linked to the condition.

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How to treat bulimia

Treatment of bulimia nervosa depends on several integrated methods, including psychological treatment, proper nutrition, and medical follow-up to avoid complications and restore a healthy lifestyle. Below is a detailed explanation of this:

Psychological and behavioral therapy

Cognitive behavioral therapy helps in modifying negative thoughts related to eating and weight and replacing them with healthy habits. It also works to improve control of compulsive behaviors such as binge eating or intentional vomiting, and dealing with negative feelings in ways other than resorting to food. Family therapy is especially useful for adolescents, as it helps parents understand the condition and support the person positively. Group therapy and joining support groups help reduce feelings of loneliness and increase the chances of recovery.

العلاج الدوائي

The doctor may prescribe some medications that help reduce episodes of binge eating and improve mood, such as some antidepressants that work to improve the chemical balance in the brain and reduce impulsive eating, but they must be taken under the supervision of a specialist doctor.

Nutritional therapy and behavioral rehabilitation

Establishing a regular meal schedule helps regulate eating habits and prevent episodes of binge eating. You must also learn to eat naturally without feeling guilty while avoiding harsh diets that may exacerbate the problem. It is also important to compensate for nutritional deficiencies by restoring the balance of fluids and salts in the body and taking nutritional supplements when needed under the supervision of a doctor.

Medical treatment and follow-up of complications

The physical effects that may result from bulimia must be monitored, such as heart problems resulting from a lack of salts, tooth erosion due to repeated vomiting, and digestive system disorders such as stomach ulcers or esophageal reflux. A doctor must also be consulted if there are any serious complications. In some severe cases, the patient may need treatment in a hospital or specialized center if there are health problems that require this, such as severe dehydration or serious heart disorders.

Changing lifestyle and daily habits

Practicing relaxation exercises such as meditation and yoga help reduce stress and anxiety. You should also avoid isolation and engage in positive social activities that support recovery. Staying away from following unrealistic beauty standards promoted by social media helps improve a person’s view of himself and increase his confidence in his body.

Read also: ما هو علاج الوسواس القهري وأسبابه وأعراضه وطرق تشخيصه

Ways to prevent bulimia

Ways to prevent bulimia nervosa depend on increasing healthy habits and developing a positive outlook towards food and the body, which reduces the risk of developing this disorder. Here are the most important methods that help in prevention:

Promote a healthy relationship with food

• Eat regularly according to a balanced schedule that includes complete meals to avoid bouts of binge eating.
• Avoid extreme deprivation diets as they increase the likelihood of overeating later.
• Focus on eating when you feel actual hunger and not in response to a psychological state.

Build a positive self-image

• Stay away from comparing body shape with unrealistic beauty standards spread in the media and social networking sites.
• Accept your natural body shape and work to improve health instead of striving to be too thin.
• Enhance self-confidence by focusing on the positive aspects of personality instead of focusing only on external appearance.

Dealing with psychological stress in a healthy way

• Practice activities that help relieve stress, such as walking, yoga, and meditation.
• Talk to a trusted person when feeling stressed instead of using food as a way to escape negative feelings.
• Avoid resorting to eating when feeling anxious or sad and replace it with other healthy methods such as writing or practicing a favorite hobby.

Monitoring the eating habits of adolescents

• Encouraging children and adolescents to adopt healthy eating habits from a young age.
• Avoid weight criticism or imposing strict food restrictions within the family as this may lead to eating disorders later on.
• Focus on the importance of healthy eating and physical activity rather than excessive concern about weight or body shape.

Get psychological support when needed

• Consult a psychologist or nutritionist if you notice any abnormal behaviors towards food.
• Join support groups or treatment programs if there is a family history of eating disorders.

Complications of bulimia

Complications of bulimia nervosa may be serious and affect physical and psychological health, especially if the disease is not treated early. The most important of these complications that may occur as a result of this disorder are the following:

Physical complications

• Dehydration and electrolyte imbalance, which may lead to heart problems. 
• Tooth erosion and throat infections due to frequent vomiting. 
• Swollen salivary glands and change in facial shape. 
• Digestive disorders such as constipation, bloating, and stomach ulcers. 
• Rupture of the esophagus or stomach in severe cases. 
• Osteoporosis and muscle weakness due to nutritional deficiency.
• Menstrual disorder in women.

Psychological complications

• Anxiety, depression and increased risk of social isolation.
• Obsessive-compulsive disorder and excessive preoccupation with food and weight.
• Sleep disturbances and constant stress.

 Social and behavioral influences

• Isolation and avoiding food in front of others.
• Poor academic or professional performance.
• Problems in relationships due to mood swings.

Does bulimia cause cancer?

Bulimia nervosa does not directly cause cancer, but it increases the risk of some types, such as esophageal and stomach cancer due to repeated vomiting, which leads to erosion of esophageal tissue and chronic inflammation that may turn into cancer cells. Malnutrition also weakens immunity, which increases the risk of tumors.

Does bulimia cause infertility?

Bulimia nervosa may cause infertility due to hormonal disturbance resulting from malnutrition and frequent vomiting, which leads to irregular or complete cessation of the menstrual cycle, and poor ovulation. The lack of vitamins and minerals also affects the health of the uterus and ovaries, which reduces the chances of pregnancy and increases the risk of miscarriage.

Does bulimia make you slim?

Bulimia nervosa does not always lead to thinness. Most sufferers have a normal or fluctuating weight due to bouts of binge eating followed by vomiting or the use of laxatives. However, the body loses muscle and water instead of fat, causing general weakness and serious health problems without sustainable weight loss.

Bulimia nervosa is not just an eating disorder, but rather a complex health problem that requires psychological and behavioral treatment in addition to medical and nutritional care. Neglecting treatment may lead to serious complications that affect life and public health.

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