Bulimia Nervosa

The term ‘bulimia’ refers only to the episodes of uncontrollable excessive eating, and may also be present in other forms of eating disorder.

Moreover, Unlike anorexia nervosa, for which there are historical accounts dating back to medieval times, bulimia nervosa was first described as a distinct clinical entity in 1979.

Gerald Russell, a British psychiatrist, published a case series of 30 patients with bulimia nervosa also used them to describe the defining features of the condition.

Since Russell’s initial work, it has been realized that bulimia nervosa is a common condition, additionally, effective treatments have since been developed to treat it. [1]

Indian epidemiology then other

Biological i.e.:

• Female sex Age (15–40 years)
• Family history of:

1. 1. Mood disorders
   2. Substance abuse
   3. Eating disorder
   4. Obesity

• Type 1 diabetes
• Early menarche

Psychological i.e.:

• Critical comments in early life about eating, either shape, or weight
• Family environment with a focus on shape also dieting
• either Sexual or physical abuse in childhood
• Low self-esteem
• Perfectionism

Social i.e.:

• Living in a developed country
• Cultures that encourage dieting and value thinness
• Occupation (e.g. ballet dancer) [1]

Types of Bulimia Nervosa

1. Bulimia of purging type

• This type is characterised by the use of self-induced vomiting or excessive usage of laxatives to purge food in order to prevent weight gain. Some patients may use diuretics.

    2. Bulimia of non-purging type

• This type is characterised by using means, other than the self-induced methods, to avoid weight gain, like extreme degrees of fasting or excessive exercising that are both inappropriate. (6)

Risk factors of Bulimia Nervosa

• Social isolation
• Change in mood or personality
• Refusing to eat in front of people
• Constantly talking about weight or food
• Impulsive behaviors
• Excessive or new substance or alcohol use
• Striving for perfectionism
• Intense fear of weight gain
• Obsession with body image
• Compulsive behaviors such as counting calories and tracking weight
• Distorted body image
• Participating in ritualistic behaviors while eating a meal
• Frequently weighing oneself
• Isolating oneself from the outside world
• Refusing to wear revealing or bright colored clothing
• Food hiding or hoarding
• Obsession with neutral and baggy clothing (4)

Pathophysiology of Bulimia nervosa

• Bulimia is related to deep psychological issues and feelings of lack of control.
• Sufferers often use the destructive eating pattern to feel in control over their lives.
• They may hide or hoard food and overeat when stressed or upset.
• They may feel a loss of control during a binge, and consume great quantities of food.
• There are higher rates of eating disorders in groups involved in activities that emphasize thinness and body type such as gymnastics, dance and cheerleading, figure skating.
• Bulimia is more prevalent among Caucasians but is increasing among African Americans and Hispanics.
• In one study, diagnosis of bulimia was correlated with high testosterone and low oestrogen levels, and normalizing these levels with combined oral contraceptive pills reduced craving for fat and sugar. (5)

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It is characterized by recurrent also frequent episodes of eating unusually large amounts of food also feeling a lack of control over these episodes.

This binge-eating is followed by behavior that compensates for the overeating for instance; forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. [3]

There is an intense fear of becoming higher-weight person . There may be an earlier history of anorexia nervosa.
It is usually body-image disturbance and the person is unable to perceive own body size accurately. [2]

There is a persistent preoccupation with eating, also an irresistible craving for food. Besides this, There are episodes of overeating in which large amounts of food are consumed within short periods of time (eating binges). [2]

Fascinated by food they sometimes buy magazines also cookbooks to read recipes, and enjoy discussing dieting issues. [3]

Weight control e.g.:

• Strict dieting interspersed with episodes of indulging eating
• Compensatory behaviours to prevent weight gain
• Self-induced vomiting
• either Laxatives or diuretics
• Excessive exercise
• Diet pills

Psychopathology e.g.:

• Excessive concern about shape and weight
• Distorted body image
• Low self-esteem also perfectionism

Physical consequences of weight control behaviours i.e.:

• Normal body weight
• Hypokalaemia, hyponatraemia, hypochloremia
• Menstrual abnormalities
• Swollen parotid glands
• Erosion of dental enamel
• Calluses of the dorsal aspect of the fingers (in other words, Russell’s sign)
• Peripheral oedema
• Increased plasma amylase

Other comorbid psychiatric conditions e.g.:

• Depression
• Anxiety
• Deliberate self-harm
• Misuse of either alcohol or drugs
• Borderline personality disorder [1]

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The formal diagnostic criteria for bulimia nervosa are i.e.:

1. Recurrent episodes of indulging eating, characterized by eating a large amount of food and by a sense of lack of control over eating
2. Recurrent inappropriate behavior to prevent weight gain
3. Evaluation of self-worth primarily based on weight also shape
4. Symptoms do not occur exclusively during episodes of anorexia nervosa.

The last point means that a diagnosis of anorexia nervosa effectively ‘trumps’ bulimia nervosa; additionally, if the patient has a BMI of less than 17.5, the diagnosis is always anorexia nervosa. [1]

1. Anorexia nervosa:

It can be differentiated from bulimia nervosa principally by a low body weight (BMI <17.5). Binges may occur in anorexia nervosa, but must be present for a diagnosis of bulimia nervosa.

2. EDNOS:

It describes those patients with disordered eating which is clinically significant, but which does not fit criteria for a specific eating disorder; for example, a patient with all the features of bulimia nervosa, except for the use of compensatory behaviors to prevent weight gain.

3. Klein–Levin syndrome:

In brief, This is a sleep disorder seen in adolescent males, characterized by recurrent episodes of indulging eating also hypersomnia.

4. Mood disorder such as:

Core features include low mood, fatigue, also anhedonia. Weight gain and indulging eating may occur, but the patient will not show the specific psychopathology and other weight control behaviours seen in bulimia nervosa.

5. Iatrogenic drugs such as:

Many drugs may cause weight gain, either through increased appetite or a direct effect on metabolism; for example, antipsychotics, lithium, steroids.

6. Organic disorders:

These can usually be identified by a clear history and lack of associated core psychopathology, but specific investigations may need to be done; for example, upper GI disorders with associated vomiting, brain tumours. [1]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Investigation of Bulimia Nervosa

• serum electrolytes
• serum creatinine
• serum magnesium
• urine pregnancy test
• ECG
• serum ferritin
• serum B12
• serum red blood cell folate (6)

Treatment of Bulimia Nervosa

• 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.
• Treatment generally involves a team approach that includes you, your family, your primary care provider, a mental health professional and a dietitian experienced in treating eating disorders. You may have a case manager to coordinate your care.

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

Ask your mental health professional which psychotherapy he or she will use and what evidence exists that shows it’s beneficial in treating bulimia.

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. (8)

Prevention of Bulimia Nervosa

• Education about and awareness of the disorder and associated risk factors
• Early intervention if risk factors are identified
• Knowledge and maintenance of healthy eating habits
• Cultivation of a positive self-image of the body
• Maintenance of good mental health
• Counseling as needed to identify and resolve areas of conflict and stress
• Balancing school, work, social life, rest, and exercise (7)

Homeopathic Treatment

Homeopathic Treatment of Bulimia Nervosa

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Bulimia Nervosa

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Argentum nit:

Binging especially with chocolate, fixed ideas, impulsive behaviour, anticipation, overriding impulses for certain foods, chocolate, salty foods, they will eat a whole box of chocolates until they get sick.

Carcinosin:

Obsessive compulsive disorder. Moreover, Perfectionism, fear of becoming fat, fear of rejection. Etiology-abuse, grief or fears, often related to weight.

Ignatia:

Perfectionism, fear of becoming fat, fear of rejection. Hysteria-loss of control of emotions, fainting. Besides this, Etiology-grief or big disappointment, often related to weight.

Medorrhinum:

Ups and down in the person’s energy, very outgoing for 2 or 3 days than wiped out for several days and with that their diets fluctuate from good to binging. Bulimia also with alcohol and drugs.

Natrum mur:

Often indicated remedy in anorexia, a lot of guilt. Furthermore, Fear of being rejected, hurt easily. Very self-conscious of their weight.

Pulsatilla:

Fear of being abandoned also unloved. Fixed ideas about food, their weight, they gain and lose weight easily, eat also indulging to console themselves, binges out of loneliness, or depression, then they get guilt and fear about it and then suppress it.

Staphysagria:

indulging out of guilt, depression. Additionally, Poor self-confidence and worthlessness. It is out of self-denial, they do not deserve that -lemon meringue pie so they suppress their desire for it, and then indulging on it. [3]

Diet & Regimen of Bulimia Nervosa

• Eat stable nutritious diet.
• Take enough sleep.
• Don’t think too much about weight.
• Avoid over exercising.
• Stay away from cigarette & alcohol.

Tab Content

Tab Content

1.  Psychiatry, Fourth Edition- Oxford Medical Publications – SRG- by Geddes, Jonathan Price, Rebecca McKnight / Ch 27.
2. A Short Textbook of PSYCHIATRY 7th edition by Niraj Ahuja / ch 12.
3. Homeopathy in treatment of Psychological Disorders by Shilpa Harwani / ch 15.
4. https://www.medainc.org/causes-and-risk-factors-for-bulimia-nervosa-2/
5. https://www.wikidoc.org/index.php/Bulimia_nervosa_pathophysiology
6. https://bestpractice.bmj.com/topics/en-gb/441
7. https://bulimiaguide.org/prevention-cure-triggers/
8. https://www.mayoclinic.org/diseases-conditions/bulimia/diagnosis-treatment/drc-20353621

Frequently Asked Questions

What is Bulimia Nervosa?

Bulimia nervosa is an eating disorder characterized by recurrent episodes of uncontrolled excessive eating (‘binges’), compensatory methods of weight control, and a fear of becoming fat.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Bulimia Nervosa?

• Argentum nit
• Carcinosin
• Ignatia
• Medorrhinum
• Natrum mur
• Pulsatilla
• Staphysagria

What are the causes of Bulimia Nervosa?

• Female sex Age (15–40 years)
• Family history
• Type 1 diabetes
• Early menarche
• Family environment with a focus on shape and dieting
• Sexual or physical abuse in childhood
• Low self-esteem
• Perfectionism

What are the symptoms of Bulimia Nervosa?

• Strict dieting interspersed with episodes of indulging eating
• Compensatory behaviours to prevent weight gain
• Self-induced vomiting
• Laxatives or diuretics
• Excessive exercise, Diet pills
• Excessive concern about shape and weight
• Distorted body image
• Menstrual abnormalities
• Depression, Anxiety
• Deliberate self-harm