What is bulimia nervosa?
Bulimia Nervosa is an eating disorder found most commonly in girls of late adolescence and early adulthood. It is characterized by frequent episodes of binge eating (rapid consumption of food in one sitting) followed by purging (ridding the body of food). Purging can involve vomiting, using laxatives, exercising compulsively and fasting. Binging and purging is associated with intense feelings of guilt and shame.

What are the causes?
Family problems, inability to adjust in society, self-identity conflict (problem in body image) depression and other psychological problems are the associated causes for this disorder. The person may try to deal physically with emotions that are otherwise difficult to express. Her energies and emotions become so tied up in her relationship with food and weight that she is not able to deal with anything else in life.

Who becomes bulimic?
Many people think that eating disorders affect only young, upper-class White females. It is true that most bulimics are women (around 85-90 percent). But bulimia affects people from all walks of life, including males, women of color, and even older women. It is not known for sure whether African American, Latina, Asian/Pacific Islander, and American Indian and Alaska Native people develop eating disorders because American culture values thin people. People with different cultural backgrounds may develop eating disorders because it’s hard to adapt to a new culture (a theory called “culture clash”). The stress of trying to live in two different cultures may cause some minorities to develop their eating disorders.

What are signs of bulimia?
A person with bulimia may be thin, overweight, or have a normal weight. Also, bulimic behavior, such as throwing up, is often done in private because the person with bulimia feels shame or disgust. This makes it hard to know if someone has bulimia. But there are warning signs to look out for. Someone with bulimia may use extreme measures to lose weight by:
* Using diet pills, or taking pills to urinate or have a bowel movement
* Going to the bathroom all the time after eating (to throw up)
* Exercising a lot, even in bad weather or when hurt or tired
Someone with bulimia may show signs of throwing up, such as:
* Swollen cheeks or jaw area
* Calluses or scrapes on the knuckles (if using fingers to induce vomiting)
* Teeth that look clear
* Broken blood vessels in the eyes
People with bulimia often have other mental health conditions, including:
* Depression
* Anxiety
* Substance abuse problems
Someone with bulimia may also have a distorted body image, shown by thinking she or he is fat, hating her or his body, and fearing weight gain.
Bulimia can also cause someone to not act like her or himself. She or he may be moody or sad, or may not want to go out with friends.

How is the condition diagnosed?
Recurrent episodes of binge eating: The person may eat at frequent intervals, an amount of food that is larger than what most people would eat during a similar period of time and under similar circumstances.
Recurrent inappropriate behaviour to prevent weight gain, such as self induced vomiting, exercising, fasting, using laxatives.
A preoccupation of the person with food and body weight.
Dental examination may show dental cavities or gum infections. The enamel of the teeth may be eroded because of excessive exposure to acid.
Bulimia nervosa is a secretive condition. The people affected by it try to avoid situations in which they have to eat with friends or family. They may suddenly disappear immediately after eating, to go to the toilet.
People with this disorder may have money worries because buying junk food to binge on can prove to be expensive to them.
They may show withdrawn or anxious behaviour in social situations or may be excessively tired and run down.

What is the treatment?
Treatment focuses on breaking the binge-purge cycles of behaviour. The problem should be discussed with a friend or someone in the family whom the person can confide in for help. She should be made to feel that she is in charge of her recovery and can certainly help herself overcome it. She should never be ridiculed or laughed at. If she tries to sort out the problem and shows a lapse from time to time to the original behaviour pattern, she should be given total support and encouragement.

A form of psychotherapy called CBT (cognitive behavioural therapy) may be used by a psychiatrist or any other mental health professional to treat people with eating disorders. This form of talking treatment helps because the deeper emotional issues are sorted out. CBT will help a person adopt a healthier way of thinking about and dealing with food and help her overcome the guilt associated with eating. The results may take many weeks or months and support from family and friends is important for its success.

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