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Bulimia Nervosa

By Sasha de Beausset Aparicio, MSc

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Bulimia Nervosa

What is Bulimia Nervosa?

Bulimia Nervosa is a psychological disorder that manifests through an improper correction of nutrition, based mostly on a poor self-image or other similar emotional stress. The patient can induce vomiting after ingesting a large quantity of food in a short time period, or they can try to lose the weight by using other methods, for example, laxatives or other substances with similar effects, or even excessive exercise. This disorder seems to affect more women than men, at a ratio of approximately nine to one. Furthermore, higher rates were registered in groups that were involved with activities in which one’s physique is idolized, like gymnastics, dance, cheerleading, swimming, modeling, acting, diving, figure skating, running, and dancing. It is also believed to be more prevalent in Caucasians.

This disorder was described for the first time in the year 1979 by Gerald F. M. Russell. He presented some of the main clinical features of Bulimia Nervosa after observing thirty patients between 1972 and 1978. He presented the syndrome as “ominous variant” for Anorexia Nervosa. The original description was the following: “In 30 patients whose illness bears a close resemblance to Anorexia Nervosa,[…]episodes of overeating constituted the most constant feature of the disorder… Overeating was often overshadowed by more dramatic clinical phenomena-intractable self-induced vomiting or purgation[…]. The constancy and significance of overeating invite a new terminology for a description of this symptom-Bulimia Nervosa.”


There is no single cause for the development of Bulimia Nervosa, but most clues point out to the psychosocial factors as being the most dominant source. Any type of emotional stress that affects the self-image can contribute to the development of the disorder. Dysfunctional family and social relationships can provide a proper environment for the illness, as it takes time for it to develop; the patients are subjected to stress factors that change their perception of themselves and their own body one step at a time.

Being more of a psychological disorder, people that share certain personality characteristics are more prone to develop the illness; those who are concerned about the way they are seen in society, who follow a path of idealism, and who have obsessive-compulsive habits are exposing themselves to the type of stress related to the issue at hand. But anyone can be afflicted by the disorder, as anyone can have an unstable emotional relationship with a personal characteristic that leads to self-undermining.

Depression can be a cause or a symptom, depending on the patient’s mental status and their anxiety levels. Irregularities in the levels of serotonin and dopamine can be a factor as it controls the mood swing.

Family or social members that have the disorder can be a powerful influence upon others close to them, by creating a familiar environment in which the issue can be seen as normal, thus affecting other person’s vision upon them and also themselves.

Besides the social factor, some people have a need to manage work-related stress, especially if their appearance and weight is directly related with the job, like athletes and models, and so begin to develop bulimic behaviors to keep themselves close to the desired model of the employees. On the other hand, one doesn’t necessarily have to be a model to suffer from this disorder. Unfortunately, due to the media influence on everyday life, there is a wide array of teenagers that idolatrize the perfection they see in magazines and try to reach it by appealing to extreme measures.

Most cases can be resumed to the fact that people are pushed into using these methods because of an improper way of relating themselves to the model expectations of the people in their interest groups.

Signs & Symptoms

The signs of the illness depend on how it manifests itself. In the case of patients that vomit, wear and tear of the teeth is visible due to the fact that stomach acid severely damages the exterior of the teeth. Also, lesions inside the mouth and at the back of the throat are common, due to the fact that most people who choose to inflict vomit do it by using their fingers to obstruct the throat.

Other symptoms can be noticed in the changes of behavior of the patients; a very poor self-image followed by an unnatural worry for weight gain and calories consumption is the most common behavior. Most of the symptoms are similar to the early stages of depression; self-isolation and social inactivity can be clues in spotting the disorder.

Some social signs may appear after the illness has taken effect, due to the fact that the patients need special conditions in which to continue their habits. In some cases, the unnatural pattern of bathroom breaks may indicate the ill behavior, especially if it occurs shortly after eating. A more unusual situation, even for bulimics, is when they start using laxatives and similar products excessively, which can lead to severe complications.

Rapid weight fluctuations are also common for bulimic people, especially caused by the fact that most of the techniques used to evacuate food are not effective, and they start actually to gain weight, which can aggravate the methods used forward by the patient. Other symptoms include ending of the enamel, sore throat, and swelling of the lymph nodes in the neck.
The fear of negative weight changes coupled with the guilt of an improper diet are signs of developing the illness, as it can become the main focus of the individual, which makes room for new destructive personality disorders, as the vision of their own appetite can become a nightmare. They can even wake up during the night for a binge or regard this habit as a solution for any type of stressful situation. As this disorder evolves, the patient would have difficulties in hiding his or her problem because they would lack energy, faint due to bad eating, or find themselves constantly tired and unable to go through with daily tasks.

Diagnosing Bulimia Nervosa

Bulimia Nervosa is extremely hard to spot if the person who is suffering from it goes to long lengths to hide it. In most cases, the family members or close friends can spot the disorder, by noticing the changes in behavior, as most patients are in denial of having the issue or they don’t even consider themselves ill.

Being associated with emotional stress and a poor self-image, it usually takes time for the person to understand what he or she is experiencing and accept it, thus making it harder to spot or at least to evaluate the degree of progress it is in. People seek treatment for recurring symptoms without considering the main problem, as by the sheer power of will it becomes a way of living for them. At a late stage, all the organs of the body can be affected, the circulatory system and also to hormonal balance, this can lead to severe menstrual changes and even infertility. When some of the above-described symptoms are spotted in a person, one should immediately act on it and either try to discuss it or take that person to a specialized doctor. The problem is that bulimics don’t realize the risks they are exposed to when they’re eliminating everything they eat by using extreme measures and they tend to believe that nothing is going to go wrong until the disorder becomes stronger than their will and they can’t control themselves.

Treatment for Bulimia Nervosa

The treatment usually starts with taking care of the physical shape of the patient, when the organism has to be stabilized and properly fed through a strict diet, depending on the complications specific to each person. During this stage, physical therapy may be required, depending on the severity of the case.

The most difficult part is the psychological treatment when the progress depends on what the person’s views upon the matter are and on what past experience they had. This is most difficult in the case of abused or mistreated persons, which the emotional damage can severely affect their views upon themselves and even their surroundings.

Because the emotional damage can be so instrumental in the treatment of bulimia, the first concerns are to create a proper environment for the patient to first understand his problem and start being aware of the differences between their habits and a normal way of living.

There is also some prescribed medication that is usually prescribed for patients who suffer from Bulimia Nervosa and include fluoxetine, Sarafem, desipramine, Norpramin, and Prozac. However, people should keep in mind that by taking these drugs they expose their bodies to potential side-effects and before deciding to follow any type of treatment, a personal healthcare provider should be visited. While the whole purpose behind the cure for Bulimia Nervosa is making the patient balance his or her diet, little steps should be taken in this direction and the person should be encouraged to eat healthily and foods like vegetables which have vitamins and assist to the normal functionality of the body and fruits. For instance, oranges are viewed as one of the best fruits that can help one surpass this bodily problem.

Other natural treatments are nutritional counseling and dietary supplements. It is also important to properly choose the dietary remedy prior to beginning any type of treatment because the organism has already been exposed to certain risks and there is no need in furthering this exposure. Therefore, when seeking for dietary remedies, ingredients like multivitamins that include vitamin A, B-group, C and E, trace minerals like phosphorus, zinc, selenium, copper, magnesium and calcium, Omega-3 fatty acids, Coenzyme Q10 and Probiotic supplements. Omega-3 should be taken one to two capsules or one to two tablespoonfuls three times per day in order to improve immunity and decrease inflammation. Cold-water fish are generally recommended, thus halibut or salmon can be a better decision. Coenzyme Q-10 can be consumed 100-200 mg at bedtime and its role is to provide muscular and immune support while also being an antioxidant. On the other hand, it doesn’t represent the best treatment for people who are taking blood-thinners, blood pressure medication or are going through chemotherapy because it may be too risky in these situations.

While the usage of dietary supplementation is not specifically encouraged, it may present with lower risks in comparison to the ones of prescribed medication. Before choosing any type of treatment, consider the options and consult a personal doctor.


“Symptoms of Bulimia Nervosa” Wawarra Mercury, February 23, 2001
“An introduction to anorexia nervosa and bulimia nervosa” by Murphy B. Manning Y (2003)