Bulimia Nervosa Treatment

How can you know when following a strict diet turns into an eating disorder? For many people, bulimia symptoms can be hidden or remain unnoticed for a long period of time, at which point the condition may have developed into a chronic eating disorder.

In the United States, more people die from eating disorders each year than from any other psychiatric disorder.

Despite eating disorders like anorexia nervosa or bulimia nervosa being quite common, it’s not always easy to access the specialized treatments needed to begin the journey to recovery.

In fact, statistics show1 that only 10% of people with an eating disorder receive any type of treatment at all. Sadly, of those who do get the treatment they need, only 35% of them receive individualized treatment and care in a specialized eating disorder treatment facility.

What Is Bulimia Nervosa?

Bulimia nervosa is a serious psychiatric disorder characterized by sessions of binge eating, followed by purging to eliminate the excess calories consumed.

Someone suffering from bulimia nervosa may have sessions where they will binge, or eat excessively, before purging. Some people may consume thousands of calories in one sitting before trying to purge those excess calories.

Self-induced vomiting is the most commonly recognized type of purging, but sufferers also abuse laxatives or enemas or exercise excessively in an effort to purge. These sessions are known as binge-purge cycles.

Binge-Purge Cycles

During the binge part of the cycle, the person will eat food in excess, more than would usually be eaten in a regular meal. In most cases, bingeing is usually done in private, in instances when they’re home alone or out in the car visiting various fast-food restaurants and eating between each stop.

When the binge is over, the person may experience overwhelming feelings of shame, guilt and self-loathing. These strong emotions often trigger a compulsion to purge in an effort to get rid of the additional calories that have just been consumed.

As the bulimia becomes worse, the person may begin purging even after regular meals or small snacks.

What Causes Bulimia Nervosa?

The causes of bulimia nervosa are almost impossible to determine, as every person’s underlying triggers for developing an eating disorder are unique to them. However, there are some common characteristics that could be contributing factors for the onset of the disorder.

For example, many people struggling with bulimia symptoms also have feelings of low self-worth. Others may experience strong feelings of self-loathing, while still others struggle with negative body image or body dysmorphia.

There is also popular culture reinforcing an unrealistically thin model as being the ‘pinnacle’ of beauty. Pressure to appear thin, along with conflicting emotions of self-hatred can increase the risk of an eating disorder and the subsequent development of bulimia symptoms.

According to a report published in the Journal of Psychiatry & Neuroscience2, there are several possible causes for developing serious eating disorders such as bulimia. Some of these include:

Serotonin imbalance:
Serotonin is a neurotransmitter in the brain responsible for regulating emotion. Also known as the feel-good hormone, serotonin promotes feelings of well-being and happiness. Yet when a person’s serotonin levels are imbalanced it can result in symptoms of anxiety and depression, as well as increasing the risk of developing eating disorders.

Low self-esteem:
At the heart of many people’s eating disorders is a deep-seated feeling of low self-esteem. Regardless of how much weight they might lose or how thin they already are, they have a distorted perception of their own bodies that makes them believe they’re fat. They also seem to believe that being thin might somehow make them feel less like a failure and more acceptable to society in general.

Ego deficits and insecurities:
Many women struggle with feeling as though they’re deficient in some area of their lives. Studies show3 a large number of people struggling with bulimia reported having high levels of insecurity. Some struggle with shyness or insecurity or low confidence levels, can also lead to alcohol abuse in an effort to promote a false sense of confidence or to compensate for the ego deficiencies.

In some cases, eating disorders are more prevalent when a close family member also has the same condition. Some eating disorders may be seen in sisters or in mothers and daughters.

Peer pressure:
America’s preoccupation with dieting and being thin is thought to contribute to the development of eating disorders. As more people attempt to live up to other’s expectations, they may go through periods of self starvation, followed by uncontrolled bingeing, which prompts purging when feelings of self-disgust take over.

Mood disorders:
People with mood disorders such as anxiety, depression or obsessive-compulsive disorder (OCD) may have a higher predisposition to developing an eating disorder.

Signs and Symptoms of Bulimia Nervosa

Most people recognize the primary bulimia symptoms of vomiting after eating. However, many other bulimia symptoms are often overlooked. Some symptoms are also so subtle that they can be easy to miss.

Physical Signs and Symptoms of Bulimia

A person with bulimia may be of normal weight or even a little overweight, so they don’t always have the stereotypical wafer-thin figure of a person with anorexia. As a result, many friends, family members or even medical professionals may overlook important underlying bulimia symptoms.

Typical physical symptoms to watch for in bulimia nervosa, include:

  • Eating much more food during a binge session than a regular meal or snack
  • Inability to stop eating once a binge starts
  • Hiding or hoarding food
  • Eating to the point of discomfort
  • Going to the bathroom immediately after eating
  • Abusing laxatives, enemas or ipecac syrup
  • Raspy voice from regular vomiting
  • ‘chipmunk cheeks’, or swollen saliva glands in the cheeks
  • Abnormal bowel functions
  • Irregular menstrual cycle
  • Muscle cramps
  • Damaged teeth and gums
  • Insomnia
  • Fainting
  • Dehydration
  • Irregular heartbeat
  • Seizures

Psychological Signs and Symptoms of Bulimia

Shame and guilt are two of the core psychological bulimia symptoms. An individual suffering from bulimia nervosa may have a distorted sense of body image or an extremely negative self-image.

An extreme preoccupation with body shape and weight are also common bulimia symptoms. For example, they might be at a completely normal body weight and shape, but he or she may have the distorted view of being grossly overweight

A person struggling with bulimia may feel socially isolated or may begin to increasingly isolate themselves socially. Many may also suffer with symptoms of anxiety or depression, which could lead to an increased risk of suicidal tendencies in some people.

Is Bulimia Nervosa Dangerous?

It’s common for many people to simply assume that a person struggling with bulimia just has a problem with throwing up after eating. They often don’t understand how dangerous bulimia symptoms can become.

In reality, untreated bulimia can cause potentially dangerous symptoms that could become life threatening and require emergency medical attention.

Serious Health Complications

Serious health complications of untreated bulimia could include:

  • Internal bleeding
  • Self injurious behavior
  • Drug or alcohol addiction
  • Low blood pressure
  • Malnutrition
  • Weakened immune system
  • Stroke
  • Heart attack
  • Seizures
  • Suicidal tendencies

Increased Risk of Heart Attack

A person who continually purges after binge eating could end up with an electrolyte imbalance. The body becomes deprived of sodium, potassium and fluids.

If the purging continues, a consistent electrolyte imbalance could lead to arrhythmia, or abnormal heartbeat, which could become life threatening if left untreated. There are three types of abnormal heartbeat that could cause serious health problems, including:

  • Tachycardia: fast heart beat or palpitations
  • Bradycardia: slow heart beat
  • Fibrillation: flutter or irregular heart beat

Medical research shows that people experiencing arrhythmias are at an increased risk of stroke, heart failure or cardiac arrest4.

Increased Risk of Cancer

Studies show there is a link between bulimia nervosa and an increased risk of adenocarcinoma cancer of the esophagus. Bulimia can cause chronic irritation and trauma to the esophagus, particularly due to the regular presence of bile in the esophagus when vomiting occurs.

Bulimia and Co-Occurring Mental Health Disorders

Many people struggling with bulimia nervosa also have another co-occurring mental health disorder. Some of the more commonly seen co-occurring mental health disorders recognized in people with bulimia include:

  • Anxiety or panic disorder
  • Clinical depression
  • Posttraumatic stress disorder (PTSD)
  • Borderline personality disorder
  • Self-harm and self-injury tendencies

It’s important that anyone struggling with two or more co-existing disorders seek integrated treatment at a specialist treatment center. Trying to treat one disorder without simultaneously treating the other could reduce likely outcomes for those in recovery.

Bulimia and Addiction

It’s common for many people with serious eating disorders to also develop drug or alcohol addictions. Some people may abuse stimulant drugs, such as cocaine or crystal meth in an effort to lose weight. Others may self-medicate with alcohol or prescription drugs to numb painful feelings or emotions.

Treatment for Bulimia Nervosa

As the underlying psychological triggers behind each person’s eating disorders are unique to them, the treatments needed to begin the journey to recovery also need to be tailored accordingly.

Research indicates6 that using a customized combination of treatments, therapies and medications can help to improve outcomes for people recovering from bulimia. Some of the common treatments and therapies used may include:

Individual counseling:
Individual psychotherapy counseling sessions begin working to identify the underlying psychological triggers behind the eating disorder. Psychotherapy also begins building self-esteem and improving images of self-worth. Counseling also explores ways for the person in recovery to start creating and planning a productive future that leads to feelings of reward, satisfaction, and self-belief.

Pharmacological therapy:
The correct combination of anti-anxiety medications or antidepressants can help relieve some of the symptoms of bulimia. When the symptoms of a co-occurring mental health disorder are properly treated, there is a greater likelihood of long-term recovery.

Cognitive Behavioral Therapy:
Studies show5 that cognitive behavioral therapy can help to improve rates of abstinence from bingeing and purging during recovery. The same study also showed that people in recovery who participated in cognitive behavioral therapy displayed fewer symptoms of depression and anxiety.

Group therapy:
One of the characteristics of bulimia is social isolation. Participation in group therapy sessions helps reduce feelings of isolation. Group therapy also offers the opportunity to begin building new social connections among like-minded people facing similar challenges during recovery.

Nutritional counseling:
Nutritional counseling begins working to replace destructive eating habits with more positive behaviors and attitudes to food and nutrition. Research shows7 that some people struggling with bulimia often experience vitamin and mineral deficiencies. In serious cases those deficiencies can develop into malnutrition.

Relapse prevention:
Bulimia can be a long-term disease that requires ongoing management to keep symptoms controlled. However, the risk of relapsing back into former eating habits is high without proper treatment. During therapy, people in recovery are encouraged to begin developing their own unique relapse prevention strategies that work to identify potential triggers or high-risk situations and build effective new coping strategies to avoid relapse.

Alternative/holistic therapies:
Alternative therapies provide natural ways to cope with symptoms of stress, as well as helping to reduce symptoms of anxiety and depression. Many people in recovery from bulimia report that stressful situations can often trigger binge eating sessions, so having access to a range of holistic or natural therapies to help manage stress can be helpful.

Some common alternative therapies might include:

  • Yoga
  • Mindfulness meditation
  • Acupuncture
  • Therapeutic massage
  • Creative therapies (e.g. art, dance, writing, painting, or journaling)

It’s important that each person’s treatments and therapies are tailored to suit their individual needs. Not every person responds in the same way to the same treatments. However, it’s difficult to know which types of treatments will be most effective unless the person in recovery participates in a range of therapy sessions to gauge the results.

Treatment For Bulimia Nervosa Is Possible

Reaching out and seeking help from a treatment center that specializes in treating eating disorders such as bulimia nervosa could be the first step on the road to recovery.