understanding bulimia nervosa

Sick with guilt: Understanding the Impacts of Bulimia

Eating disorders are a group of mental health conditions characterised by an individual’s unhealthy eating habits. This may include a distorted relationship with food and an unhealthy preoccupation with eating, exercise and/or body shape. There are several different types of eating disorders, each with different features. However, some main elements shared between many of these disorders include secretive eating habits and food-related behaviours. Bulimia (Bulimia Nervosa) is one type of eating disorder, and accounts for approximately 12% of all eating disorder cases. This post is aimed at helping people in understanding the impacts of bulimia and some of its common misconceptions.


Understanding bulimia nervosa

Bulimia is characterised by recurrent consumption of excessively large amounts of food within a short period of time (binge-eating) immediately followed by compensatory behaviours, mainly regurgitation (purging). For patients with bulimia, binge-eating episodes are typically triggered by and associated with a sense of loss of control, and followed by consequent feelings of shame, guilt, and remorse. This leads the individual to engage in compensatory behaviours such as purging, and further perpetuates the vicious cycle of disordered eating behaviours.


Physical and psychological impacts of bulimia

The physiological damage caused by bulimia is typically associated with (and thus varies according to) the methods of purging, and include sore throat, enlarged glands in the neck and jaw, dental problems (e.g., tooth decay), various gastrointestinal issues (e.g., acid reflux), dehydration and electrolyte imbalance (which in severe cases can lead to a stroke or heart attack). The severity of these effects typically worsens (and many eventually become irreparable) the longer the disordered eating behaviours continue if left untreated. At best, the resulting physical impacts of a bulimia are uncomfortable and cumbersome: side effects such as fatigue, constipation, dizziness, slowed breathing and reduced mental capacity are common and can work singularly or in combination to impede function and ability to perform general daily tasks. Lack of vitamin intake and other physiological effects of bulimia may also contribute to a decrease in mood, and behavioural changes such as social withdrawal and secretive purging habits may further impact an individual’s mental health and wellbeing. Mood disorders (such as major depression) and anxiety disorders (such as obsessive-compulsive disorder) are common comorbidities in patients with bulimia.


Misconceptions surrounding bulimia

In contrast to anorexia, someone struggling with bulimia may not necessarily restrict their intake or be underweight. It is a common misconception that an individual must be severely underweight to have an eating disorder. While this may be true in most cases of anorexia (as severely low body weight is one of the diagnostic criteria of this condition), patients with bulimia often maintain a relatively average weight, and fortunately, have a lower mortality rate as a result. That said, it is important to note that patients with bulimia can and do die prematurely, and the lack of obvious physical presentation (e.g., malnourishment and/or emaciation as commonly observed in patients with anorexia) makes this disorder even more difficult to recognise, diagnose and treat. It is important to receive appropriate care and treatment for patients suffering from bulimia; due to the various complexities and comorbidities commonly associated with this disorder, psychological as well as medical professionals are often involved and form a team of health professionals that work with the patient towards recovery.


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