Professor & Head, Department of Psychiatry Medical Superintendent, I.H.B.A.S., New Delhi
What is bulimia nervosa?
Bulimia Nervosa is an eating disorder found most commonly in girls of late adolescence and early adulthood. It is characterized by frequent episodes of binge eating (rapid consumption of food in one sitting) followed by purging (ridding the body of food). Purging can involve vomiting, using laxatives, exercising compulsively and fasting. Binging and purging is associated with intense feelings of guilt and shame.
What are the causes?
Family problems, inability to adjust in society, self-identity conflict (problem in body image) depression and other psychological problems are the associated causes for this disorder. The person may try to deal physically with emotions that are otherwise difficult to express. Her energies and emotions become so tied up in her relationship with food and weight that she is not able to deal with anything else in life.
How is the condition diagnosed?
Recurrent episodes of binge eating: The person may eat at frequent intervals, an amount of food that is larger than what most people would eat during a similar period of time and under similar circumstances.
Recurrent inappropriate behaviour to prevent weight gain, such as self induced vomiting, exercising, fasting, using laxatives.
A preoccupation of the person with food and body weight.
Dental examination may show dental cavities or gum infections. The enamel of the teeth may be eroded because of excessive exposure to acid.
Bulimia nervosa is a secretive condition. The people affected by it try to avoid situations in which they have to eat with friends or family. They may suddenly disappear immediately after eating, to go to the toilet.
People with this disorder may have money worries because buying junk food to binge on can prove to be expensive to them.
They may show withdrawn or anxious behaviour in social situations or may be excessively tired and run down.
What is the treatment?
Treatment focuses on breaking the binge-purge cycles of behaviour. The problem should be discussed with a friend or someone in the family whom the person can confide in for help. She should be made to feel that she is in charge of her recovery and can certainly help herself overcome it. She should never be ridiculed or laughed at. If she tries to sort out the problem and shows a lapse from time to time to the original behaviour pattern, she should be given total support and encouragement.
A form of psychotherapy called CBT (cognitive behavioural therapy) may be used by a psychiatrist or any other mental health professional to treat people with eating disorders. This form of talking treatment helps because the deeper emotional issues are sorted out. CBT will help a person adopt a healthier way of thinking about and dealing with food and help her overcome the guilt associated with eating. The results may take many weeks or months and support from family and friends is important for its success.