Bulimia Nervosa
Not just enjoying or hating food,
it’s an addictive behaviour!
By Abdallah Fahmy
B
ulimia Nervosa comes from a Greek word which means "ravenous hunger", described by the British psychiatrist
"Gerald Russell" in 1979.
It’s a psychiatric eating disorder characterized by recurrent episodes of overeating "binging", and inappropriate
compensatory conducts to get rid of the ingested extra food in an unhealthy way "purging".
Binge-eating involves eating large amounts of calorie-rich foods
(over 3000 calories) in a short period, when patients start with
the binge-eating it becomes really difficult to stop, that they
can hardly taste the large amounts of food they are consuming.
It starts as a way of coping with emotional problems, but soon
becomes an obsession that the patient is unable to control.
And this lack of self-control is felt by the afflicted individual.
The binge is usually followed by a series of emotions like
shame and guilt, and it even gets worse with the fear of
gaining weight, that sometimes the patients imagine that
they can already feel the extra weight. This often ends
in purging by several ways like: self-induced vomiting,
overusing diuretics, enemas and even using laxatives.
Patients also diet, fast for long periods of time, over exercise,
and take amphetamines or other illegal drugs to lose the weight.
Those strict methods are hard to fulfill continuously, so
the patient gives up and starts to eat everything that wasn't
allowed, and so, there is a continuo us vicious circle of guilt,
which
becomes
compulsive
over
time,
and
is
similar
to
that
of
addiction.
BN (Bulimia Nervosa) emerges during adolescence, and is more
common in women (80%), but children may also suffer from it.
It’s a life-threatening disorder, as about 3.9% of the
people with BN die prematurely from the disorder, and it’s
the 2nd highest cause of death among adolescent girls.
Boston Children's Hospital states that (1-5%) of adolescents,
and (1.1-4.2%) of females in the U.S. have BN, and up to 8% of
females probably have had or will have Bulimia Nervosa at some
time in their lives according to The National Health Service, U.K.
To discover why women are so liable to eating disorders
more than men, Dr. Catherine Preston —a lecturer at The
Department of Psychology in York University— and her
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colleagues made an experiment on healthy individuals (both
men and women) who had no history of any eating disorders.
They had them wear a virtual reality headset through
which they will see their own body, but at an obese
form. During the experiment, their brain activity was
monitored by magnetic resonance imaging (MRI).
When they looked at their obese bodies, there was a direct
link between the activity in the parietal lobe (associated
with body perception) and in the anterior cingulate cortex
(associated with processing subjective emotions like anger
and fear). This brain activity was more prominent in women.
Scientists do not yet know the exact cause behind Bulimia but
assume that its rate is higher in people with a history of physical
or sexual abuse, experiences of being bullied at school, and
traumatic life events such as divorce or switching homes.
As we mentioned that females are much more likely to
have BN, young girls are much more vulnerable, and this
is probably because of the media they are exposed to
these days, which adjusts their definition of beauty and
perfection according to the pictures of slim models all over
the internet. These pictures kill their self-confidence, and
they end up developing eating disorders, and what we don't
know is that 20-40% of these models suffer from eating
disorders themselves, and BN is even the most common one.
Hormonal changes may also be responsible, as the onset
of BN in most cases coincides with puberty, as it is a period
in life in which teenagers become more aware of their
own bodies. 30% of females with Bulimia Nervosa may be
suffering from an imbalance of sex hormones according
to the scientists at the "Karolinska Institute" in Sweden.
It’s also associated with other psychological
problems such as personality and anxiety disorders, diagnostic criteria that the patient must meet:
obsessive-compulsive
disorder,
and
depression. Binging
and
purging
occurs
at
least
once a week for at least three months.
Also, genetic factors may be involved, a Bulimic woman’s The
patient's
feeling
of
self-esteem
is
too
brain shows a reduction in the ability of the chemical influenced by their body shape and weight.
hormone "Serotonin" —which controls mood and The patient doesn't suffer from other disorders
appetite— to bind to receptors in certain brain regions, that may force any type of restriction on their diet.
also these women don’t show the normal decline in Patients who don’t meet all these criteria may still
serotonin binding ratio that decreases normally with aging. have some kind of eating disorder but not BN.
SIGNS AND SYMPTOMS INCLUDE:
• Binging and purging.
• Too much interest in body shape and weight, with fear
of gaining weight.
• Changing Body weight.
• Patient is always complaining about being overweight
even if they are not.
• Obsession with eating and food, and devotion of much
money to it.
• Denial of hunger during periods of strict fasting.
• Patient disappears after eating mostly in the toilet to
vomit.
• Not wanting to eat in public or in front of others.
• Scars on the knuckles "Russell's Sign", due to self-
induced vomiting, because of forcing the fingers down the
throat, so the knuckles rub against the teeth.
• Small red pinprick marks on the face as a result of
burst blood vessels, which may be seen also in the eyes
due to severe vomiting.
• Repeated vomiting erodes the enamel of teeth, leading
to yellow teeth, mouth sensitivity, and rapid tooth decay.
• Chronic gastric reflux.
BN MAY HAVE SEVERAL COMPLICATIONS AS:
• Stomach rupture, Gastroparesis (which is a partial
paralyzation of the stomach muscles).
• Swollen fingers caused by regular overuse of laxatives.
• Chemical imbalance resulting in arrhythmia, muscle
spasm, and convulsions.
• Kidney damage due to dehydration by repeated
vomiting, and so increasing the risk of kidney stones.
• Damage to the bowel muscles leading to chronic
constipation.
• Heart failure due to loss of potassium.
• Inflammation of the gums and the esophagus.
• The acidity of vomit causes chronic inflammation of the
throat.
• Swollen cheeks due to damage of the parotid glands.
• Suicidal behaviour.
• Absent or irregular menstrual periods.
Diagnosing bulimia is, however, hard. Most patients are not
even underweight despite their desire to be very slim, and they
do everything possible to hide their disorder and to look normal.
The "American Psychiatric Association" published
MEDICINE
Treatment
usually
begins
with
psychological
therapy, and medications may be suggested.
PSYCHOLOGICAL TREATMENT:
Cognitive behavioural therapy (CBT) involves talking to a
therapist to work out new ways of thinking about situations,
feelings, and food. It may also involve keeping a food diary,
which will help determine what triggers the binge-eating.
Interpersonal therapy (IPT) involves enhancing personal
relationships to draw the patient’s focus away from eating.
MEDICATION:
Selective serotonin reuptake inhibitors (SSRIs) which are
used as antidepressants, can reduce the urge to binge
and purge by balancing the level of serotonin in the brain,
but they aren’t recommended if the patient has epilepsy
or a family history of heart, liver, or kidney disease.
Although existing treat ments are effective for many
patients, a fundamental proportion doesn’t get better,
but neuroscience-based technologies give us new hope.
Neuroimaging studies assume that BN originates from
problems with self-control and reward processing.
Alterations in reward processing occur due to aberrations
within ventral limbic neural networks, making patients
consider the food as much more interesting than normal.
Deficient self-regulatory control occurs due to aberrations
within the dorsal cognitive frontostriatal neural networks,
which increases instability and erratic responding
to rewarding stimuli, with an increased tendency to
devalue delayed rewards (Temporal discounting "TD").
Negative mood may trigger binge-eating by altering the reward
value of food and diminishing the self-regulatory processes.
There’s some area at the front of the brain, called "The
dorsolateral prefrontal cortex (DLPFC)", it's a part of the
dorsal cognitive frontostriatal neural networks, representing
the major neural structure involved in executive functions
(including self-regulatory control), and is also implicated
in reward processing due to its anatomical and functional
connections with ventral limbic neural networks.
The new trial therapy by King's College London
depends on normalizing this alteration in neural
networks to alleviate symptoms of the disorder
using trans-cranial direct current stimulation (tDCS).
tDCS is a non-invasive brain stimulation technique, it depends
on the basis of stimulation of particular brain parts using electric
currents, and here, it will be used to stimulate the DLPFC.
39 afflicted adults were treated by tDCS and placebo tDCS
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