Bulimia Nervosa: A yo-yo syndrome
If you want to learn about bulimia nervosa, an interesting means may be to familiarize yourself with the well-chronicled struggle of TV celebrity Kirstie Alley. As stated in part I of this article, bulimia is one of the three most common eating disorders in our country. Like anorexia nervosa, the majority of people affected with bulimia nervosa are young females between the ages of 12 and 25.
What are the symptoms?
The hallmark symptoms of bulimia nervosa are two-fold: binge eating and purging. Binge eating consists of consuming an enormous amount of food in one sitting. Purging consists of an attempt to get rid of eaten food shortly after consuming it with various means. These include self-induced vomiting, use of laxatives or water pills (diuretics), excessive exercise etc. This pattern of behavior is known as the binge-purge cycle.
Anorexia vs. bulimia
For the sake of proper recognition and treatment of these two eating disorders, it is important to understand the similarities and differences between the two. The common threads between anorexia and bulimia include an intense fear of gaining weight, purging and sometimes compulsive exercising. Anorexic people are almost always underweight while those with bulimia tend to be normal weight or overweight. Those with bulimia tend to have significant fluctuations in weight (as has been the case with Kirstie Alley) which is not common in those with anorexia. Bulimic people are more likely to suffer from conditions such as bipolar disorder, body dysmorphic disorder, impulse control disorders and substance abuse disorders than those with anorexia.
Is bulimia common only among actresses/models?
Not at all. Mental health professionals treat a good number of ordinary people who have bulimia. One of these people I treated was Haley* who, at the age of 22, was brought to me by her parents. Haley was apparently having significant mood swings and fleeting suicidal thoughts. Around age 13, she began having extreme fluctuations in her weight. Her mother recalled that during the past two years, Haley’s dress size had fluctuated between 8 and 20. Her family had noticed that she would go from not eating much to eating large quantities of food. Her brother, whose bedroom shared a bathroom with Haley’s, would frequently hear retching sounds in the bathroom shortly after Haley had gone to the kitchen in the middle of the night and helped herself to food. Haley was attending a local college and was a cheerleader for the football team. She was known to spend a lot of time daily at the gym. Recently, she was diagnosed by her family doctor as having ulcers and severe constipation. Haley had recently divulged to her family that she had been using large amounts of laxatives for the past 4-5 years in an apparent attempt to lose weight. Haley’s parents were also concerned about her shopping sprees, sexual promiscuity and increased risk-taking behaviors. It was of great concern that she had recently contracted genital herpes as well. Upon thorough evaluation of Haley, she was diagnosed with bulimia nervosa and bipolar disorder. She was placed on a mood stabilizer and referred to a nutritionist and a therapist. Her family doctor was notified about the need for regular medical check-ups. She was promptly given treatments for ulcer and genital herpes.
Are there any medical complications of bulimia?
Like anorexia, bulimia can lead to several medical complications, some of which can be life threatening. These include:
• Damage to teeth.
• Damage to and swelling of inner lining of the esophagus (a tube that connects mouth to stomach).
• Swelling of parotid glands (glands that make saliva) near cheeks. This can produce a ‘chipmunk face’ which has been associated with long-term bulimics.
• Stomach ulcers.
• Pancreatitis (swelling of pancreas)
• Chronic constipation.
• Electrolyte imbalance.
• Irregular heartbeat and/or heart failure.
• Deaths.
Treatment of bulimia nervosa
• The first step is a proper diagnosis including any co-morbid psychiatric conditions and medical complications. • If substance abuse disorder exists, that needs to be addressed first. • Any serious medical complications such as irregular heart beat and/or heart failure need to be treated immediately. This may require hospital admission. • A thorough medical work-up is essential. This must include a physical exam, lab tests, EKG, etc. Low potassium is common among bulimic patients (especially those who engage in self-induced vomiting) and should be treated promptly as it can lead to life threatening cardiac complications. • The obvious goal is to eliminate binging/purging behavior. Behavior therapy, individual and family therapy (when applicable), and psychotropic medications should all be utilized. SSRI’s (Selective Serotonin Re-upatke Inhibitors) have been found to be helpful. • All co-morbid psychiatric conditions should be treated concurrently. • Self-help groups and group therapy may be helpful.
The purpose of this article is for educational purposes only. It is not intended to diagnose or treat any medical or psychiatric issue. Dr. Rakesh Ranjan is a practicing psychiatrist and a researcher. He is a recipient of several research awards and has authored several peer reviewed journal articles and book chapters on psychiatric illnesses and their treatments. He is a national speaker for several organizations and serves on the medical advisory board for the NAMI of Greater Cleveland. If you or a loved one is experiencing any symptoms that would lead you to believe that there could be a mental imbalance, please email your questions to Dr. Ranjan at askthedoctor@charakresearch.com. Each Wednesday, Dr. Ranjan will address some of these questions in this column. All contact info will be kept confidential.