BULIMIA NERVOSA

What is bulimia nervosa?

Bulimia nervosa, also called bulimia, is an eating disorder. Eating disorders are mental health
conditions that can be potentially life-threatening. If you have an eating disorder, one may be
obsessed with food and weight. This obsession can harm their physical and emotional well-
being.

Bulimia nervosa can be defined as a pattern of eating characterized by:

1. Consuming an unusually large amount of food in a short period of time (binge eating).
2. Getting rid of the food (purging). Purging may involve making yourself throw up
(vomiting) or taking laxatives. Laxatives are medications that speed up the movement of
food through your body.

Other characteristics of bulimia nervosa may include:

 Misuse of water pills (diuretics) or diet pills.

 Eating very little or not at all (fasting).
 Excessively exercising.
 Hiding food to binge and purge later.

People with bulimia are usually at a normal, healthy weight. But they judge themselves harshly
based on their view of their body shape and/or weight. They usually have self-esteem issues
closely linked to their body image.

What are the signs and symptoms of bulimia nervosa?

Bulimia nervosa can be hard to spot. People with this condition often binge and purge privately.
But empty food wrappers and laxative packaging can be warning signs of bulimia. Other
behavioral and emotional symptoms of bulimia nervosa include:

 Frequent visits to the bathroom, particularly after meals.

 Excessive exercising.
 Preoccupation with body image.
 Intense fear of gaining weight.
 Depression, anxiety or substance abuse.
 Feeling out of control.
 Feeling guilty or shameful about eating.
 Withdrawing socially from friends and family.
The physical symptoms of bulimia nervosa can include dental issues. Self-induced vomiting can
cause erosion of your tooth enamel from your stomach acid. Your teeth may also appear clear
instead of white and be more sensitive. Other physical symptoms of bulimia nervosa can include:

 Swollen cheeks or jawline

 Gastrointestinal problems such as constipation and acid reflux

 Scars, scrapes, or calluses on your knuckles (from forced throwing up)

 Fainting
 Irregular menstrual periods
 Muscle weakness
 Bloodshot eyes
 Dehydration

Behavioral symptoms of bulimia may include:

 Eating uncontrollably, followed by purging. The National Institutes of Health says you have
bulimia if you do this at least twice a week for 3 months.
 Hoarding or stealing food
 Food rituals, like eating only a certain food, chewing more than necessary, or not allowing
foods to touch.
 Skipping meals or eating only small portions during meals
 Feeling out of control
 Vomiting or abusing laxatives, diuretics, enemas, or other medications to try to lose weight.
 Using the bathroom frequently after meals
 Excessive exercising
 Preoccupation with body weight. Your thoughts about body weight and shape even
determine how you feel overall.
 Depression or mood swings
 Drinking large amounts of water or calorie-free beverages
 Often using mints, gum, or mouthwash
 Avoiding friends and activities you used to enjoy.

DSM 5 Bulimia Diagnostic Criteria

A. Recurrent episodes of binge eating, as characterized by both:

1. Eating, within any 2-hour period, an amount of food that is definitively larger than what most
individuals would eat in a similar period of time under similar circumstances.
2. A feeling that one cannot stop eating or control what or how much one is eating.
B. Recurrent inappropriate compensatory behaviors to prevent weight gain such as self-induced
vomiting; misuse of laxatives, diuretics, or other medications; fasting or excessive exercise.

C. The binge eating, and inappropriate compensatory behaviors occur, on average, at least once a
week for 3 months.

D. Self-evaluation is unjustifiability influenced by body shape and weight.

E. Binging or purging does not occur exclusively during episodes of behavior that would be
common in those with anorexia nervosa.

F. Severity

 Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per week.

 Moderate: An average of 4-7 episodes of inappropriate compensatory behaviors per
week.
 Severe: An average of 8-13 episodes of inappropriate compensatory behaviors per week.
 Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors
per week.

What causes bulimia nervosa?

Medical professionals are unsure of the exact cause of bulimia, but it’s believed genetics and
environment play a role in someone’s development of bulimia. Examples of risk factors include: 5

 Traumatic life experiences

 Physiological influence
 A family history of eating disorders
 Exposure to an environment focused on body size and dieting.

LGBTQ+ people may experience additional unique factors that play a role in eating disorder
development, including but not limited to:

 Fear of rejection or experiences of rejection.

 Being a victim of discrimination or bullying due to one’s sexual orientation and/or gender
identity.
 Internalized negative beliefs about oneself due to their sexual orientation or gender
identity.
 Conflict between one’s biological sex and gender identity.
 Perception that one doesn’t meet the body ideals and body shape within some LGBTQ+
cultures and communities.
PREVELANCE

 The average age of onset for bulimia is eighteen, with an overall prevalence of 0.3%.
Broken down by gender, bulimia develops in 1.5% of women and 0.5% of men, making
it five times more common to develop in women.

 Studies indicate that the lifetime prevalence of bulimia in sexual minority adults is 1.3%,
which is higher compared to cisgender heterosexual adults.

 Furthermore, the lifetime prevalence of bulimia in transgender men and transgender

women is reported to be 3.2% and 2.9%, respectively which is significantly higher than
in the cisgender population.

COMORBIDITIES

PSYCHIATRIC COMORBIDITIES

Research demonstrates that 55-97% of people diagnosed with an eating disorder also receive a
diagnosis for at least one more psychiatric disorder. The most common psychiatric disorders
which co-occur with eating disorders include mood disorders (e.g., major depressive disorder),
anxiety disorders (e.g., obsessive compulsive disorder, social anxiety disorder), post-traumatic
stress disorder (PTSD) and trauma, substance use disorders, personality disorders (e.g.
Borderline Personality Disorder, OCPD), sexual dysfunction, non-suicidal self-injury, and
suicide ideation.

MEDICAL COMORBIDITIES

Comorbid conditions experienced by people experiencing an eating disorder may be connected

to their eating disorder symptoms and behaviors, for example osteoporosis. For other
comorbidities, the direction and mechanisms underlying any connection are unclear and a focus
of future research.

The following complications have been shown to have an increased prevalence in people
experiencing an eating disorder compared with the general population:

· Type 1 and 2 diabetes

· Polycystic ovarian syndrome (PCOS)

· Osteopenia and osteoporosis

· Hypotension

· Gastrointestinal problems

· Joint pains

· Headache and migraine

· Menstrual problems

How is bulimia nervosa treated?

Your healthcare provider may treat bulimia nervosa using a variety of techniques. They may
refer you to a team of specialists including dietitians and mental health professionals.

When you have bulimia, you may need several types of treatment, although combining
psychotherapy with antidepressants may be the most effective for overcoming the disorder.
Treatments may include:

Psychotherapy

Psychotherapy, also known as talk therapy or psychological counseling, involves discussing your
bulimia and related issues with a mental health professional. Evidence indicates that these types
of psychotherapy help improve symptoms of bulimia:

 Cognitive behavioral therapy to help you normalize your eating patterns and
identify unhealthy, negative beliefs and behaviors and replace them with healthy,
positive ones.
 Family-based treatment to help parents intervene to stop their teenager's
unhealthy eating behaviors, to help the teen regain control over his or her eating,
and to help the family deal with problems that bulimia can have on the teen's
development and the family.
 Interpersonal psychotherapy, which addresses difficulties in your close
relationships, helping to improve your communication and problem-solving skills
Medications

Antidepressants may help reduce the symptoms of bulimia when used along with psychotherapy.
The only antidepressant specifically approved by the Food and Drug Administration to treat
bulimia is fluoxetine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI), which may
help even if you're not depressed.

Nutrition education

Dietitians can design an eating plan to help you achieve healthy eating habits to avoid hunger
and cravings and to provide good nutrition. Eating regularly and not restricting your food intake
is important in overcoming bulimia.

Hospitalization

Bulimia can usually be treated outside of the hospital. But if symptoms are severe, with serious
health complications, you may need treatment in a hospital. Some eating disorder programs may
offer day treatment rather than inpatient hospitalization.

Self-care for bulimia

Along with following your treatment and therapy plan, you can take steps to care for yourself:

 Look after your body: Include healthy foods in your diet to make sure you're getting the
nutrients you need. Ask your doctor whether supplements are right for you. And check with
your doctor about how much exercise is healthy for you.
 Connect with others: Support from friends and family can help you overcome unhealthy
habits and feel better about yourself. A support group might help, too. The National
Association of Anorexia Nervosa and Associated Disorders lists several. The National Eating
Disorders Association also offers help via chat, text, or phone.
 Avoid your triggers: Don't linger over social media images of people with bodies that are
unrealistic for you. Stay away from the scale and your mirror. If stress or boredom triggers
binges, practice using healthier ways to deal with them.

PSYHOLOGY REPORT

Name: Jasleen Kaur Sangha

Height: 5.5ft

Weight: 67kg

Past medical history: No medical history

Educational qualification: 10+2

Family history

1. The subject is a healthy girl at 5.4ft with a round face, brown coloured eyes and
shoulder-length brown hair with black roots. The subject has a mole on her
bottom lip and broad shoulders.

2. The subject is an ambivert and has a happy go lucky personality. She does not
read into things a lot and tries to save her peace of mind. She doesn’t like getting
into drama and tries to avoid it at all costs. She is outspoken with the people close
to her and a bit reserved when meeting new people for the first time. She normally
doesn’t initiate conversations. She is open to meeting new people and having new
experiences. She is usually calm and approaches things with a can-do attitude and
tries her best to remain kind and respectful to the people and her surroundings
despite of whatever way she is feeling.

3. The subject’s father is a businessman, and her mother is a government teacher.

Her relationship with her parents is a bit complicated, they are good people and
always want the best for her but while wanting that they sometimes get a little
overbearing. Several factors contribute to the dynamics of their relationship such
as generation gap and difference in mindset. She often struggles to communicate
with her parents which leads to some of her unaddressed emotions.

4. Her brother has OCD and her grandfather had diabetes.

5. The subject has issues with her body which led to body dysmorphia with
increasing body insecurities. She started having issues with food which later led
to bulimia.

SOCIAL HISTORY

1. The subject is open to meeting new people and having new experiences. She is
usually friendly and tries to make everyone around her comfortable. She is a bit
hesitant to start conversations but has no problems in continuing them.

2. In terms of how much the subject goes out and participates in activities, they go
out quite a lot and like it very much. She likes to participate in activities if they
are related to something she is interested in. She has an active social life and
loves to attend different events and social gatherings.
 3. The subject has quite a few friends but most of them are acquaintances whereas
she has 4 or 5 close friends with whom she shares every little detail of her life
and is open to about her disorder. The subject tries to be a good team player but
tends to be a little judgemental sometimes. The subject does engage in active
conversations but only with a limited number of people.

4. The subject was quite an extroverted child and had quite a lot of friends during
the early stages of her life and loved being around people and was much more
outspoken compared to her current self and was less conscious of her actions.

EMOTIONAL HISTORY

The subject is friendly, loving, and sweet. She naturally has a happy go lucky personality and
always looks forward to meeting new people and doing creative activities. She tries to make
everyone feel involved and listened to.

There is no particular event that led to the subject developing bulimia but the constant nagging
and bullying by her family and the presence of social media in her life led to her having an
unrealistic body image and in order to achieve it she developed the disorder.

The overwhelming fear of not having the perfect body leads to a state of anxiety and body
dysmorphia. She often pictures herself as the ugliest version of herself which leads to an episode
of binge eating and then out of guilt purging to feel less guilty and ashamed.

PHSYCHOLOGICAL HISTORY

 The subject is 5’4 feet and weighs around 67 kgs. The subject doesn’t suffer with any
disabilities and doesn’t take any medications.
 The subject is non vegetarian and eats out twice a week or sometimes more than that. She
doesn’t get tired easily and is often very active.
 She does drink sometimes but she doesn’t smoke. She has a regular menstrual cycle. She
has a sleep cycle of about 8 hours.
Psychological History

 She was told that she suffers from Bulimia nervosa.

 She shows the following symptoms:
Frequent visits to the bathroom, particularly after meals
Preoccupation with body image
Intense fear of gaining weight
Feeling out of control
Feeling guilty or shameful about eating
 Comorbidity: Anxiety and body dysmorphia

EDUCATIONAL HISTORY

The subject is in grade 12th. She prefers studying subjects which are more open to people’s
interpretation like English as well as practical subjects like economics. The subject does not like
study and only studies if it is necessary like during exams and practicals. She likes to read
romance novels and books which have emotional endings. The subject is quite regular in going
to their institute of education.