Last week, we introduced the first article in the series on eating disorders: Eating Disorders: Anorexia Nervosa.

As we mentioned, the pandemic has led to a sharp increase in requests for help from ANEB (Anorexia and Bulimia Quebec). Indeed, in the past year, requests have more than doubled, reaching an increase of up to 131%.

The more we talk about eating disorders, the more society will become aware. Hopefully, this awareness will lead to reflection, discussion, and increased sensitivity among teenage girls, friends, and families of young girls affected by this eating disorder.

Here is the second part of this series: bulimia nervosa.

Definition of bulimia nervosa

Bulimia nervosa is an eating disorder recognized and listed in the Diagnostic and statistical manual of mental disorders fifth edition (DSM-5), which defines and categorizes mental disorders. This disorder is characterized by binge eating episodes followed by compensatory behaviors (see explanations below).

Symptoms of bulimia nervosa

Individuals with bulimia nervosa experience repeated episodes of binge eating where they consume large amounts of food. These episodes, accompanied by a feeling of loss of control, are often triggered by emotional stress and usually occur in secret. The foods consumed are generally high in fat and sugar. The binges are followed by compensatory behaviors that may include self-induced vomiting, misuse of laxatives or diuretics, fasting or dieting, and excessive physical activity.

Most people with bulimia have a normal weight. Only a minority are overweight or obese. However, people with bulimia are concerned about their weight and shape and believe they should lose weight. Unlike people with anorexia, individuals with bulimia nervosa are often more aware of their condition, feel more guilt about their behavior, and are more likely to recognize their illness. Depression and anxiety are also common in people suffering from bulimia nervosa.

Regarding the physical symptoms of bulimia nervosa, they are mainly caused by compensatory behaviors. Self-induced vomiting can lead to erosion of dental enamel, swelling of the salivary glands, inflammation of the esophagus, and scars on the fingers used to induce vomiting. Vomiting can also cause a decrease in blood potassium, which can affect heart rhythm.

Diagnosis of bulimia nervosa

The diagnostic criteria for bulimia nervosa are as follows:

• Binge eating episodes accompanied by a feeling of loss of control occurring at least once a week for a period of three months.
• Repetitive compensatory behaviors aimed at preventing weight gain.
• Self-esteem largely based on body weight and shape.

Treatment of bulimia nervosa

The main treatment for bulimia nervosa is cognitive-behavioral therapy. Therapy can be individual or group. The goals of therapy are to promote change, establish regular and flexible eating habits, reduce concerns about weight and shape, and prevent relapse. Treatment may also include interpersonal psychotherapy and sometimes the prescription of selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant medication.

Nutritional approach for bulimia nervosa

A dietitian may also be involved in the treatment of bulimia nervosa. They can help establish healthy eating habits and provide recommendations to maintain a healthy weight appropriately. Similar to the nutritional approach for anorexia nervosa, the dietitian's role in treating bulimia nervosa involves teaching normal eating. This teaching may include the following recommendations:

• Plan three regular meals daily.
• Consume normal portions.
• Expand the food repertoire, which is often restricted in individuals with eating disorders such as bulimia nervosa.
• Avoid diet or slimming foods.
• Discourage adopting vegetarianism or veganism, which can often be used to mask compensatory behavior (e.g., dieting).
• Avoid frequent weighing. Limit weigh-ins to those done during follow-ups with various health professionals.
• Keep a food diary.
• Aim to maintain body weight. The initial goals of treatment are to stop bulimic behavior and maintain body weight. At the beginning of treatment, restricting food intake to induce weight loss can maintain or exacerbate bulimic behavior. It is therefore preferable to wait after a remission period of at least six months before aiming for weight loss in individuals with bulimia nervosa who are overweight or obese.

References

1. https://www.merckmanuals.com/en-ca/professional/psychiatric-disorders/eating-disorders/bulimia
2. https://www.merckmanuals.com/en-ca/home/mental-health-disorders/eating-disorders/bulimia-nervosa
3. https://www.merckmanuals.com/en-ca/home/brief-mental-health-facts/eating-disorders/bulimia-nervosa
4. https://www.unlockfood.ca/en/Articles/Teens/When-food-and-body-weight-take-over---a-look-at-eating-disorders.aspx
5. Coughlin, Janelle W., et al. Modern Nutrition in Health and Disease, by A. Catharine Ross, Wolters Kluwer/Lippincott Williams & Wilkins, 2014, pp. 1324–1325.

Article written by:

Marie-Noël Marsan, written in 2021.