Bulimia nervosa is another common eating disorder. Unlike Anorexia nervosa, here the patients are usually at or near normal weight. However they have a grave fear of gaining weight. The interesting part though is that in spite of this fear, they recurrently have these ‘eating binges’. And to compensate for this over eating they do few things like self induced vomiting. To get rid of the food, they often take pills and other laxatives which can remove the food quickly from their body. The disease might be more prevalent that anorexia nervosa but the good part is that most of the patients do not need much treatment.
Bulimia can be triggered by stress. Genetic, environmental and social factors have known to play some role in causing this disorder. Bulimia nervosa usually begins later in adolescence. The diagnosis is made when patients tells about ‘recurrent bouts of binge eating’. The patients would also often complain of lack of self control over eating during those binges. The weight will usually be within normal limits. There will also be a history of self induced vomiting, purgation, taking laxatives after binges. Recurrent self induced vomiting can lead to pitted teeth (this is due to gastric acid exposure). There can also be enlargement of the parotid gland and calluses on knuckles.
Esophageal tear may occur due to excessive vomiting. Cardiac arrhythmias and renal problems can also occur. Electrolyte abnormalities have also been associated with Bulimia nervosa. Patient can also have impaired bone mineralization.
Cognitive behavior therapy is usually very useful. Interpersonal psychotherapy and self-help can also help in this eating disorder. Selective serotonin reuptake inhibitors like Fluoxetine in dose of 60mg per day have also been found to be effective. Long therapy for a period of 1 year is usually indicated.
The mortality rate in bulimia nervosa is quite less compared to anorexia nervosa. However few bulimia patients may cross over to anorexia. Most of the bulimia patients recover. Only about 10% are unwell even after 10 years.
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