Eating Disorders – Bulimia Nervosa
Bulimia nervosa is an eating disorder characterized by severe disturbances in one’s eating behavior. Bulimia nervosa is characterized by increasing food intake followed by compensatory behaviors like self-induced vomiting. This eating disorder usually occurs among healthy young females who become overly concerned with body shape and body weight. Bulimia nervosa may occur in someone who has a history of anorexia nervosa or vice versa but patients who have bulimia usually have a normal weight compared to those with anorexia who are underweight.
Bulimia nervosa has a lifetime prevalence of 1-3% among females but occurs less commonly among male individuals. Like anorexia nervosa, the cause of bulimia nervosa is multifactorial. People who have a high predisposition to obesity are at a higher risk of this eating disorder and cultural factors have also been implicated in some studies.
Bulimia nervosa typically presents as a female, in her twenties with a history of episodic binge eating associated with self-induced vomiting (purging) for a couple of years. This eating disorder is associated with a depressed mood and self-restriction of food intake which eventually leads to increase intensity of hunger which eventually leads to overeating. With the episodes of overeating associated with the avoidance of weight gain, people with bulimia nervosa would do remedies like self-induced vomiting, taking laxatives, and taking diuretics. People with bulimia nervosa usually favor food with high sugar or high fat content foods during their eating binge episodes.
People with bulimia usually have a feeling of satisfaction from overeating early in the course of the disorder, but as it progresses they usually lose control of their eating binge episodes. Binge eating episodes are usually triggered by episodes of depression or anxiety; however some patients with bulimia nervosa exhibit serious behavioral disturbances like suicidal thoughts and attempts, alcohol and drug abuse and sexual promiscuity. People with bulimia nervosa usually have bilateral hypertrophy of their salivary glands due to recurrent vomiting and a scarred or a callus hand due to trauma from the teeth. Laboratory findings electrolyte imbalances (hypokalemia, hyponatremia) and alkalosis may be present secondary to repeated vomiting. Esophageal and stomach rupture are rare complications also attributed to vomiting.
Compared to anorexia nervosa, the outcome and prognosis of bulimia nervosa are more favorable. Mortality for bulimic patients are low and a majority of patients would fully recover, however in some patients, symptoms of bulimia will persist and some would eventually developed anorexia nervosa.
Harrison's Principles of Internal Medicine
Anorexia nervosa is characterized by severe disturbances in eating behaviour with voluntary restriction of food intake as its salient feature