Health

Bulimia
Binge-purge Behaviour

Alternative Names
Bulimia nervosa;
Binge-purge behaviour;

Bulimia is an illness defined by food binges, or recurrent episodes of significant overeating, that are accompanied by a sense of loss of control. The affected person then uses various methods -- such as vomiting or laxative abuse -- to prevent weight gain.

Someone with bulimia may also suffer from anorexia nervosa, an eating disorder involving severe, chronic weight loss that proceeds to starvation, but many bulimics do not suffer from anorexia.

In bulimia, eating binges may occur as often as several times daily for many months. These binges cause a sense of self-disgust, which leads to compensatory behaviours like self-induced vomiting or excessive exercise. A person with bulimia may also abuse laxatives, diuretics or enemas in order to prevent weight gain.

Such behaviour can be quite dangerous and may lead to serious medical complications over time. For example, the stomach acid which is introduced into the esophagus (the tube from the mouth to the stomach) during frequent vomiting can permanently damage this area.

Women are much more commonly affected than men. The affected person is usually aware that her eating pattern is abnormal and may experience fear or guilt associated with the binge-purge episodes. Although the behaviour is usually secretive, clues to this disorder include over-activity, peculiar eating habits or rituals, and frequent weighing. Body weight is usually normal, although the person may perceive themselves as overweight. If bulimia is accompanied by anorexia, body weight may be extremely low.

The exact cause of bulimia is unknown, but factors thought to contribute to its development are family problems, perfectionist personalities, and an overemphasis on physical appearance. Bulimia may also be associated with depression and occurs most often in adolescent females.

Less social and cultural emphasis on physical perfection may eventually help reduce the frequency of this disorder.

Bulimia Nervosa is best considered as three separate illnesses that share the essential features described above. They are Simple, Anorexic, and Multi-impulsive Bulimia Nervosa. There is quite a lot of overlap between them so that there are a number of sufferers who show characteristics that belong midway between these subgroups.

Simple Bulimia Nervosa is an illness that begins most commonly when the girls are about 18 years of age. They are a fairly normal group before the illness. They tend to have been mildly under confident and unassertive but come from a broad range of unexceptional family backgrounds. They have probably made friends in a normal way at school and are often fairly popular. The illness is frequently triggered by a period of unhappiness and this is often caused by a destructive relationship with a boyfriend. The feeling of self dislike focuses on appearance and dieting is begun in an attempt to improve self esteem. In contrast to an anorexic the diet is not very successful with the rigid control needed breaking down into bouts of cheating. Vomiting is used as part of increased efforts to achieve the weight loss and so the cycle of bingeing and vomiting begins. There is more loss of control as the body's normal mechanisms of appetite control are over ridden and confused. The weight will remain close to normal but the eating pattern becomes gradually worse. This form of bulimia is the least severe but the severity varies considerably. It is likely that there are large numbers of girls with fairly mild symptoms that never come to medical help but there is a significant risk that it will slowly get worse with time. A common time for sufferers to seek help is when they are planning to start a family in their early twenties and are concerned about possible effects on having babies.

Anorexic Bulimia Nervosa is a variant of the illness that is preceded by a bout of Anorexia Nervosa. Quite often this anorexic episode is a brief one and the sufferer begins to recover without treatment. It is followed typically by a short period of stabilised weight just below that at which the menstruation may restart, around 46 kg. The control of the anorexic is not sustained and bingeing begins usually in a very small way but becomes more severe especially once vomiting begins. Often they begin by vomiting after what would for a normal person be an ordinary meal but this leads to a loss of control of the appetite drive and true bingeing gradually starts. Occasionally the vomiting and bingeing start first but then there is a period of significant weight loss in an anorexic phase that includes restrictive eating. The illness becomes dominated by the bingeing and vomiting behaviour but the weight remains low for a while before gradually rising to near and in time above normal. The personality profile and backgrounds of these girls is similar as for a group with Anorexia Nervosa. A description may be found in the leaflet "Introducing Anorexia Nervosa". When there are differences the Bulimic group seem to be slightly less obsessive and to be marginally more mature in emotional development. The are more likely to have boyfriends and to show their feelings.

Multi-impulsive Bulimia Nervosa is a severe variant of Bulimia Nervosa that begins in a similar way to Simple Bulimia and in a similar age group of girls. This group suffers from a range of abnormal behaviours all of which indicate problems of emotional and impulse control. Often some of these other behaviours are already causing difficulty before the Bulimia begins. In association with the eating disorder will be found a mix of other problems including drug abuse, alcohol abuse, deliberate self harm (usually cutting of forearms), stealing and promiscuity. They have a range of backgrounds but it is quite common to find that there is a high level of disturbance within the family. In personality they are likely to have shown evidence of poor impulse control from an early age and they often have rather poor records of schooling, academic achievement, or making friends that last. They have a difficulty in modifying their behaviour because of predictable consequences of their actions and as result helping them to change the pattern of their lives often requires prolonged help. The severity of the illness as with all types of bulimia is varied and in this group it seems to depend on severity of the underlying abnormality personality.

Treatment focuses on breaking the binge-purge cycles. Outpatient treatment may include behavior modification techniques as well as individual, group, or family counseling.
Antidepressant drugs may also be used in cases that are coincide with depression.
Symptoms
*binge eating
*self-induced vomiting
*inappropriate use of diuretics or laxatives
*overachieving behaviour

Complications
*pancreatitis
*dental cavities
*inflammation of the throat
*electrolyte abnormalities
*dehydration
*constipation
*hemorrhoids
*esophageal tears/rupture

Source: Yahoo Health

Copyright (R) thedailystar.net 2005