Bulimia nervosa is an eating disorder characterised by uncontrolled eating binges, with compensatory behaviour such as inducing vomiting, taking laxatives and diuretics, and exercising excessively in order to maintain a normal weight.
José de la Osa
Dr. Ovidia Rodríguez Méndez identifies Bulimia as an eating disorder predominant during adolescence.
However, she states that while it is more common than anorexia (rejecting food due to a fear of getting fat), it is more difficult to diagnose because it does not immediately apparent.
Dr. Rodríguez works for the Mental Health Service at the Pedro Borras Astorga Teaching Hospital in Havana and is an Assistant Professor and second degree specialist in Infant Psychiatry. She also holds a Master´s degree in Comprehensive Child Care.
It affects between three and four percent of women approximately, and is less common in men.
Are there any common factors between anorexia and bulimia? Where would the limits be, for example with people that have a very good appetite or a very poor appetite?
Both anorexia and bulimia are eating disorders in that the common factor is a fear of putting on weight, whereas people that are not afflicted by these disorders are not worried about weight gain.
The causes have not been well determined. It is suggested that depressive and obsessive mental disorders and self-esteem disorders coexist in such people. We could consider bulimia nervosa as an addiction in which the substance abused is food.
What consequences can it have on the psychological and physical health of these people?
From the point of view of physical health, repeated vomiting causes the erosion of tooth enamel, esophagitis and gastritis, as well as electrolyte alterations (sodium and potassium).
Calluses appear on the back of the hand which is inserted repeatedly into the mouth and the salivary glands also become swollen.
Bulimia sufferers are aware that they lose control at the sight of food and try to hide away or eat in secret, in order to avoid criticism from their family.
How can they be helped? Who should be consulted, and when?
Primary care doctors should be consulted whenever the disorder is suspected. The patients should generally be treated at an early stage by psychiatrists and psychologists to avoid the disorder becoming chronic, and to allow other illnesses with similar symptoms to be ruled out.
It is established when it is confirmed that the patient has at least two episodes of uncontrolled food consumption a week, over a period of more than three months, an unstoppable desire which drives them to eat any type of food, followed by guilt and compensatory actions resulting from a fear of gaining weight.
Can it be treated? What does it consist of?
The treatment is multifaceted. It requires medical care and individual, group, family and behavioural psychotherapy, with the cooperation of the patient and understanding of the fact they have a disorder.
In general, what is the prognosis for these patients?
In a large percentage of cases the disorder persists for a number of years, at least. The course may be chronic or intermittent with periods of remission. Some patients with bulimia nervosa might have hidden forms of anorexia nervosa with significant weight loss.
Do you have any particular message for these patients and their families?
The disorder can easily go unnoticed if the doctor doesn’t ask about eating habits and body image. Teenagers that show these eating disorders and are taken to a specialist by their parents can be difficult to treat, as they are ambivalent in accepting the disorder or resolving it. This concern can be created in teenagers who live in families which constantly talk about going on a diet to lose weight.
Yes. It is important to point out that these eating disorders can arise in children with insulin-dependent diabetes mellitus, in the form of relapsing and unexplained episodes of decompensation, because the patient does so in order not to have to use insulin. (PL)
(Translated by Alfie Lake)