Is it hard to control your eating? Let's learn about Bulimia (Bulimia Nervosa)

Have you ever had a binge, uncontrolled eating experience, and then felt a great deal of sadness, regret, and perhaps even shame? Imagine, sometimes unable to cope with those feelings, you ended up vomiting after eating, or trying to rid yourself of the food in other ways? This is the kind of situation we are going to talk about today, called bulimia nervosa, or simply "bulimia." This is a mental and physical health problem that many people are reluctant to talk about, but it can affect many people, and it is a serious eating disorder . But you are not alone, and you can get help for this.

What exactly is Bulimia Nervosa?

Simply put, bulimia is the act of eating large amounts of food in a short period of time (this is called "binging") , followed by trying to purge the food from the body (this is called "purging" ). This "purging" can take many forms.

You may feel like you have no control over what you eat. You may eat an incredible amount of food at one time, sometimes secretly. This can be followed by feelings of guilt and shame. When you can't deal with these feelings, you may try to get rid of the food by vomiting, using laxatives, or exercising excessively.

This condition also affects how you see yourself. You may feel that your worth is determined by your appearance and body shape. You may also feel that the only thing you can control is how food passes out of your body. This cycle is very unhealthy and can have serious, even life-threatening, consequences. But remember, you are not alone. There is help.

What types of bulimia are there?

There are two main types of bulimia, depending on the ways you try to purge food from your body or reduce weight gain:

Purging type

Here are some things you can do to eliminate food from your body after you eat it:

• Self-induced vomiting.
• Use of laxatives.
• Taking diuretics.
• Using liquids (e.g., enemas) to relieve constipation.
• Using other drugs to remove food from the body.

Non-purging type

In this method, you don't directly remove food from your body, but instead you can do the following:

• Excessive exercise : Exercising beyond the level that is beneficial for general health and to the point that it interferes with daily activities.
• Fasting : This means not eating. This is also not normal, but unhealthy, restriction of food for a long period of time.

Imagine, some people run for hours after eating a lot, or they don't eat properly for days. This can also be part of bulimia.

What are the symptoms of bulimia?

A person with bulimia may exhibit the following symptoms. However, not everyone will have all of these symptoms, and some people may only have a few of them:

• Consuming a large amount of food at one time (as we mentioned earlier, "binging").
• Removing the food after eating (purging methods such as vomiting, use of laxatives).
• An extreme fear of gaining weight and the urge to do anything to lose weight.
• Feeling out of control over eating.
• Low self-esteem and a feeling of worthlessness.
• Feelings of great guilt or shame after eating.
• Depression, anxiety, mood swings, or resorting to substance abuse.
• Frequent fainting.
• Constipation.
• Irregular menstrual cycles in women.
• Muscle weakness.
• Redness of the eyes (especially in those who vomit).
• Facial swelling (some people also call this "chipmunk cheeks" because the sides of the cheeks swell).

This can affect each person differently. For example, you may not have eaten much before you "purged." Sometimes, even a small amount of food can make you feel bad and make you want to "purge." The way you "purge" can also vary from person to person.

What are the causes of bulimia?

It's hard to say exactly what causes bulimia nervosa, but researchers think it may be a combination of both genetic influences (that is, things that are passed down from generation to generation) and learned behaviors.

Think about it, what you see in society and the media – ideas like "this is what a beautiful body looks like" – can put a lot of pressure on you. These external influences can affect the way you think about your body (`body image`) and your self-esteem. Also, when you feel a lot of stress , when you feel sad, frustrated, or when you feel like you can't control things in life, all of these can affect the development of this eating disorder.

Who is at higher risk of developing this condition?

Bulimia nervosa can affect anyone, but the following people are at higher risk:

• Teenagers or young adults.
• If someone in the family has an eating disorder (biologically related).
• If you already suffer from a mental health condition such as anxiety or depression.
• For women (it can also occur in men, but is more common in women).

What are the possible complications of bulimia?

This eating disorder comes with many health risks . These are very dangerous, and many of them can even be life-threatening. Possible complications include:

• Abnormalities in heart rate (e.g. `(Arrhythmia)`).
• Damage to the intestines and stomach.
• Dental problems (tooth decay, tooth erosion, tooth transparency).
• Esophagitis and esophageal perforation.
• Stomach acid reflux (GERD - Gastroesophageal Reflux Disease)
• Heart failure.
• Conditions associated with intestinal sensitivity (Irritable Bowel Syndrome - IBS)
• Increased risk of suicide.
• Malnutrition and dehydration (lack of water in the body).
• Swelling of the cheeks.
• Sore throat and stomach.
• Type 2 Diabetes.

Early treatment of bulimia can prevent these complications and reduce long-term effects. Therefore, it is very important to seek medical advice immediately if you have any doubts about this.

How do doctors diagnose bulimia?

To diagnose this condition, your doctor will first do a physical examination. He or she will ask about your medical history and symptoms. It is normal for you to feel a little scared or uncomfortable talking about these things with your doctor. However, doctors are there to help you, not to judge you. Therefore, it is very important to be honest about your eating habits and behaviors, so that they can help you properly.

The doctor will compare your symptoms with the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) of the American Psychiatric Association. He or she may ask you questions like:

• Do you have recurring episodes of binge eating?
• Do you feel out of control over your eating?
• Do you engage in purging behaviors?
• Have you had episodes of binge eating at least once a week for a period of three months?
• Does your body weight or shape have a strong impact on how you see yourself (self-image)?

There are no specific tests to diagnose this eating disorder. However, your doctor may order some tests to see how the condition is affecting your health. For example:

• Blood tests.
• Checking the heart rate (Electrocardiogram - EKG or ECG)).
• Kidney function test.
• Urinalysis.

What treatments are there for bulimia?

A doctor may recommend treatments such as:

• Counseling/Therapy : Talk therapy, especially cognitive behavioral therapy (CBT), is very helpful. In this, you meet with a therapist and work with them to change the way your thoughts affect your behavior.
• Nutritional counseling : This involves working with a Registered Dietitian or counselor to help you develop a healthier relationship with the food you eat.
• Medication : Antidepressants in the class of medications called Selective Serotonin Reuptake Inhibitors (SSRIs) are sometimes used. These can reduce binge eating and vomiting. They can also help treat anxiety and depression.
• Support groups : These can be very helpful when combined with other treatments. Connecting with others who have gone through similar experiences can be beneficial to your recovery journey.

Remember, one treatment method doesn't work for everyone . You may have to try different methods and different paths to reach your goals.

When should you see a doctor?

If you are feeling stressed because of your relationship with food, or if it is interfering with your daily life, you should definitely talk to a doctor.

If you have these symptoms , seek medical attention immediately :

• Chest pain.
• Dizziness.
• Fainting.
• Feeling of an abnormal heart rate (Heart palpitations).
• Shortness of breath / Dyspnea.
• Severe sore throat.

If you are having suicidal thoughts, please don't suffer alone . There is someone who can help. (In Sri Lanka, you can call organizations like Sumithrayo 0112692909). Even if you are not in a major crisis, don't hesitate to speak up. If you are in an emergency, call 1990 (Suvaseriya) or the nearest police station.

About recovering from bulimia

Recovery is definitely possible. But it takes time. Your doctors and therapists will work with you to create a treatment plan that works for you and your symptoms. Your therapist will help you set realistic goals and work towards them.

It's important to know that sometimes symptoms can come back (relapses) . A "relapse" is when you go back to your unhealthy habits after a period of healthy habits. When you "relapse," it can feel like a huge failure, but it's not a judgment on who you are. Recovery is challenging and hard work. But remember, you're never alone. Your care team will help you get back on track. They will make changes to your treatment plan as needed.

If left untreated, you can develop serious, often life-threatening complications. So if you haven't started treatment yet, it's important to get it right away .

What is it like to live with bulimia?

Everyone's experience with this eating disorder is different. Living with bulimia may feel and think things like:

• "I'm afraid to go out to eat because I worry that I'll eat too much too quickly and then not be able to find a washroom."
• "I don't like to look at myself in the mirror, because I don't like the way I look."
• "I feel like the only thing I can control in my life is 'purging'."
• "Binging is a comfort when I'm stressed, but I eat so fast that I don't really appreciate the taste of food."
• "After eating, I feel very guilty (as if I've committed a big crime). I feel like the only way to make up for that mistake is to 'purge'."

If these thoughts sound familiar to you, it's time to see a doctor or mental health counselor . They can help you build a better relationship with food and your self-image.

Finally, the most important thing to remember

It's normal to worry about what you eat and your body size. But bulimia is much more than that. It's a deeply ingrained condition that can lead to many health complications . If you think you have this condition, don't hesitate to seek help. With the right medical treatment and mental health support, recovery is definitely possible. Talking to a doctor is the first step to protecting your well-being. You are not alone, and help is always available.

` Bulimia nervosa, eating disorders, binge eating, vomiting, mental health, nutrition, bulimia treatment