Therapy Analysis - Anorexia & Bulimia
Bulimia nervosa
Bulimia is an eating disorder associated with episodes of bingeing, followed by intentional purging in the form of vomiting, or by the use of diuretics or laxatives to compensate for the excessive food consumption and thus prevent weight gain. Less commonly, bulimics may fall into a non-purging category, which involves other methods of preventing weight gain, such as over-exercising or fasting. Despite the unpleasant nature of the disease, it is estimated that 8% of women will develop bulimia at some point in their lives, more than double the number of cases of anorexia.
..it is estimated that 8% of women will develop bulimia at some point in their lives, more than double the number of cases of anorexia.Metabolic disturbances are common in those suffering with bulimia, leading to a weakened immune system and lack of energy. Hypoglycaemia, for example, is very common in bulimics, particularly in those who fast or vomit frequently. Low plasma insulin C peptide and increased β-hydroxybutyrate and free fatty acid levels are also major contributors to the metabolic weakness associated with bulimia. Indicative of the downward spiral of the condition, it has also been found that the plasma concentration of ghrelin (an appetite stimulating hormone) is negatively correlated with body mass index (BMI) in women with eating disorders. Another common occurrence in bulimics is amenorrhea, or lack of the menstrual period, with about half of bulimic women having a reduced pulsatile secretion frequency of lutenizing hormone, and associated reduced levels of estradiol and progesterone. Sadly, in addition to the hightened risk of infertility, this can also lead to osteoporosis later in life.
Despite not carrying the high mortality rate of anorexia, bulimia is still a disease associated with fatality, although surprisingly, it is often not the severe weight loss and malnutrition that leads to bulimia-related deaths. The induced vomiting and the subsequent hydrochloric acid released from the stomach results in damage to the throat, mouth and oesophagus, and many deaths are attributable to rupture of the oesophagus or heart. Ruptures to the bowels, owing to the excessive use of laxatives, are also frequent and extremely unpleasant complications in bulimics.
As with all eating disorders, bulimia predominantly occurs in women; however, it is important to note that the statistical representation in men may be inaccurate. The widespread belief that it is a female disease often results in the symptoms being overlooked in men; excessive exercising, for example, may be attributed to a desire to keep fit. In many cases it is the dentist that first recognises the problem, due to obvious hydrochloric acid damage to the teeth.
The incidences of bulimia and anorexia seem to be highly interlinked, with many reports suggesting that people with bulimia often have a history of anorexia, and that after 'recovery' from anorexia the disorder may re-emerge as bulimia. However, strangely and unlike anorexics, bulimics are often a normal weight or even overweight. During the course of the illness, individuals may receive several diagnoses, potentially meeting the criteria for anorexia, bulimia and even binge-eating disorder (bulimia without compensationary acts after bingeing).
