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Bulimia Nervosa. Bulimia nervosa is an eating disorder characterized by recurrent binge eating, followed by compensatory behaviours. The most common form is defensive vomiting, sometimes called purging; fasting, the use of laxatives, and over exercising are also common. Categories.
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Bulimia nervosa is an eating disorder characterized by recurrent binge eating, followed by compensatory behaviours. The most common form is defensive vomiting, sometimes called purging; fasting, the use of laxatives, and over exercising are also common.
Categories • There are two sub-types of bulimia nervosa: • Purging type bulimics self-induce vomiting to rapidly remove food from the body before it can be digested, or use laxatives, diuretics, or enemas • Non-purging type bulimics (approximately 6%–8% of cases) exercise or fast excessively after a binge to offset the caloric intake after eating. Purging-type bulimics may also exercise or fast, but as a secondary form of weight control. Diagnosis • According to the World Health Organisation, the criteria for a diagnosis of bulimia nervosa include the following: • constant obsession with eating and an irresistible craving for food. • episodes of overeating in which large amounts of food are consumed in short periods of time. • excessive exercise, induced vomiting after eating, starving for periods of time or taking medicines such as laxatives or diuretics to counteract the bingeing. • fear of obesity, which is also seen in people with anorexia nervosa, and there is some overlap in the symptoms of these two diseases.
Common signs that a person may have bulimia are when the person: • Is very secretive about eating and does not eat around other people. • Sneaks food or hides food in the house. You may notice that large amounts of food are missing. • Often talks about dieting, weight, and body shape. • Looks sick or has symptoms such as: • Tooth decay or erosion of tooth enamel. • Sore gums or mouth sores. • Dry skin. • Loose skin. • Thin or dull hair. • Swollen salivary glands. • Lack of energy. • Teeth marks on the backs of the hands or calluses on the knuckles from self-induced vomiting. • Feels depressed, anxious, or guilty. Symptoms • Repeatedly eating large amounts of food in a short period of time (less than 2 hours). • Frequently getting rid of the calories you've eaten (purging) by making yourself vomit, fasting, exercising too much, or misusing laxatives, diuretics, ipecac syrup, or enemas. Misuse of these medicines can lead to serious health problems and even death. • Feeling a loss of control over how much you eat. • Feeling ashamed of overeating and very fearful of gaining weight. • Basing your self-esteem and value upon your body shape and weight.
Facts and figures • Studies have shown that up to 1 per cent of the population in UK is suffering from bulimia nervosa at any one time, and this may well be an underestimate. • Other studies show that up to 7 per cent of young women consulting their GP have the symptoms of bulimia nervosa. • Every year there are as many as 18 new cases of bulimia nervosa per 100,000 population per year. • Approximately 4 percent of women suffer with bulimia during their lifetime, but it is less common in men. • Bulimia affects mainly women between the ages of 16 and 40, and is most likely to begin at about 19 years of age.
'Bulimia need not be a way of life'For eight years, Suzannah Jackson suffered from a debilitating eating disorder. “I was 18 and it was triggered by personal problems I had at the time,” she says. “Not eating takes your mind off your problems and gives you something else to focus on. By the time you realise what damage you are doing, it is too late – you can’t stop.” Throughout those years, bulimia took over her life and, as she desperately fought to overcome it, she found a lack of understanding surrounding the illness. “When I was trying to get better I just wanted someone who understood what it was like; all the experts I saw just didn’t seem to understand.”
Amy Winehouse Amy confesses that she’s struggled with disordered eating since 2004. Her confession was made after pictures were published of her looking very thin, opposed to her naturally curvy figure. She is firm that she is in recovery but is still insecure. “I went through every eating disorder you can have. A little bit of anorexia, a little bit of bulimia,” she said, “I’m not totally okay now but I don’t think any woman is.” "I've had a flirtation with every eating disorder there is, I wouldn’t tie myself down to one, and then i realise that I have to eat and I will fatten myself up and put on half a stone in a week, because I’m good like that." The tabloid News of the World reported that Whitehouse and her husband Fielder-Civi, l cut their arms together. Spin.com reports that the couple "have matching crisscross scars and scratches up and down their left arms," though says the marks are "presumably from a misbehaving house cat.“ Amy Winehouse shocked a journalist from Spin Magazine when she started to carve the words "I Love Blake" into her own stomach during an interview. "I went through every eating disorder you can have. A little bit of anorexia, a little bit of bulimia," she said. "I'm not totally OK now but I don't think any woman is." Her confession comes after recent pictures show the singer looking gaunt and very thin. According to the Daily Mirror, her record label, Island Records, has told her to cut back on her drinking. This has been revealed after Amy turned up to The Charlotte Church Show last week bleary-eyed and slurring her words. The 23-year-old has admitted to drinking excessively in the past due to a painful split with an ex-boyfriend. An inside source told the Daily Mirror: "We're worried that she's going off the rails."
A video explaining what Bulimia is, including symptoms and the impact on a person who is suffering from this diagnosishttp://www.nhs.uk/Livewell/eatingdisorders/Pages/Bulimiarealstory.aspx Other Celebrities suffering from Bulimia http://www.casapalmera.com/blog/top-10-celebrities-with-eating-disorders/
TWO TYPES OF BIOLOGICAL EXPLANATIONS FOR BULIMIA NERVOSA Serotonergic dysfunction Hypothalamic dysfunction Serotonergic dysfunction may be associated with negative mood states and with number of neurotransmitters. Hypothalamic dysfunction is a problem with the area of the brain called the hypothalamus, which helps control the pituitary gland and order many body functions.
Biological explanations Genetic origin: Family studies have shown that first-degree relatives of bulimia nervosa have an increased risk of developing an eating disorder (Holland et al. 1988) Set Weight or Point” Theory: The set-point theory essentially argues that an individual's metabolism will adjust homeostatically to maintain a weight at which the body is comfortable. Hypothalamic dysfunction:
Biological explanations Serotonergic dysfunction: Imbalance of Serotonin: It has been suggested that food restriction and several other behaviors which are characteristic of anorexia may be associated with increased serotonin activity. Imbalance of serotonin neurotransmitter Link: Increase in serotonin makes you happy and suppresses hunger Disturbances of the serotonin pathways within the brain have been linked to the onset and maintenance of eating disorders. In particular, it seems that increased serotonin activity in the brain may be responsible for this type of behavior. There is considerable evidence that increased serotonin activity in the brain is associated with appetite suppression. In fact, drugs which act on serotonin pathways in the brain are commonly used for the short-term management.
Psychological explanations:Behavioural explanations Operant conditioning • The individual avoids food to gain a reward • such as feeling positive about themselves • In early stages – individuals can be • admired or congratulated for losing • weight and looking slim and healthy • (positive regard) • Gain the reward or satisfaction of • being in control of their food intake
Classical conditioning Eating can be associated with anxiety since it can make people overweight Losing weight ensures that the individual reduces these feelings of anxiety Social learning theory People imitate and copy people they admire – vicarious reinforcement
Psychological explanations:Psychodynamic explanations -Adolescents don’t want to grow up and separate from their parents • They become fixed at oral stage when they were completely dependent on their parents • Anorectics lose weight, lose secondary sexual characteristics, become childlike again (asexual) and return to the safety of the family • In Freudian terms, eating and sex are symbolically related • A refusal to eat (the only control, they feel they have) represents a refusal of sexuality
Psychological explanations:Cognitive explanations • This explanation is based on the fact that individuals with bulimia nervosa have incorrect beliefs about their weight problem, which leads to an exaggeration of the consequences of gaining weight • At first the individual may think that they are a little overweight and decide to go on a diet. • However, as time passes they begin to feel that the weight problem is more serious than it really is • They begin to selectively attend to information about losing weight, which leads to more incorrect beliefs, excessive dieting, binge drinking leading to Bulimia Nervosa
Therapy for Bulimia Nervosa Poor body image and low self-esteem are at the core of bulimia, therefore, psychotherapy is an important part of recovery. Here’s what to expect in bulimia therapy: • Breaking the binge-and-purge cycle – The first phase of bulimia treatment focuses on stopping the vicious cycle of bingeing and purging and restoring normal eating patterns. You learn to monitor your eating habits, avoid situations that trigger binges, cope with stress in ways that don’t involve food, eat regularly to reduce food cravings, and fight the urge to purge. • Changing unhealthy thoughts and patterns – The second phase of bulimia treatment focuses on identifying and changing dysfunctional beliefs about weight, dieting, and body shape. You explore attitudes about eating, and rethink the idea that self-worth is based on weight. • Solving emotional issues – The final phase of bulimia treatment involves targeting emotional issues that caused the eating disorder in the first place. Therapy may focus on relationship issues, underlying anxiety and depression, low self-esteem, and feelings of isolation and loneliness.
Self-help Medications • Bulimia can sometimes be treated with a self-help manual and occasional guidance from a therapist. This treatment allows you to develop skills that will help you manage your bulimia. • Keeping a diary of eating habits and learning about healthy eating and sensible weight control may be helpful. • Support groups may also be helpful. It's often comforting to talk to other people who have been through the same thing, and who can offer understanding and acceptance without blame or guilt. Some medications can be extremely helpful in treatment a person who suffers from bulimia. • As always, the medication should be carefully monitored, especially since the patient may be vomiting or taking large amounts of laxatives, which may impact on the medication's use and effectiveness (ethical issues) • A trusting and honest relationship must be established between the physician and the individual or mediation compliance will almost certainly become an issue. Antidepressants (such as desipramine, or phenelzine) are the usual drug treatment and may speed up the recovery process. • Phenytoin and carbamazepine may also help reduce the frequency of the binging behaviors.
Other treatments • A type of talking therapy, or psychotherapy, called cognitive behavioural therapy (CBT) is frequently used. CBT allows you to talk through the issues that upset you and that may lie at the heart of your eating disorder. CBT can help you to learn healthier ways of thinking about food and rebuild your self-esteem. • Interpersonal therapy (IPT) is another talking therapy which allows you to discuss your relationships with other people. Rebuilding these relationships may stop you turning to food for emotional support. Hospital treatment Most people who have bulimia can be successfully treated without being admitted to hospital. But if the person has serious health problems that puts their life at risk, or if they are at risk of suicide or self-harm, they may need to be admitted to hospital.
