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Bulimia: Its symptoms and treatment

bulimia, treatment, symptoms, CBT, fluoxetine

Its full name is Bulimia Nervosa. Cousin to its starving relation; Anorexia Nervosa, Bulimia is also quite an insidious mental illness, whose presence is not noted until its symptoms are seen.

Bulimia involves the act of bingeing; eating copious amounts of food in one sitting, and then purging out the food through self induced vomiting, via the use of fingers to activate the gag reflex at the back of the throat or through stomach convulsions. The purging process can also involve the abuse of laxatives, or periods of fasting and excessive exercise.

What makes Bulimia so insidious is that one can never know that your love one is suffering from it until the symptoms start appearing, or the painful scene of catching them in the act of purging into a toilet bowl. Physical symptoms include blood shot eyes after disappearing into the toilet after taking a meal; this is due to the exertion caused by vomiting, where the blood rushes to the head and thereby straining the delicate veins in the eyes.

Yellowed or blackened fingernails or teeth: this is caused by the caustic hydrochloric stomach acid, which degenerates the protein and calcium in the nails and teeth, making them yellow. Bad breath is another minor symptom due to the acrid smell of vomit, and the persistent sore throat or loss of voice after their visit to the toilet.

Another not so obvious symptom would be the increased levels of potassium in their bodies, because the severe vomiting induces dehydration and potassium is essential in keeping the body’s water mass balanced, potassium levels will go up to keep the body’s electrolyte levels stable. The increase of potassium will hereon create even more problems for the Bulimic’s body; with muscle cramps, fatigue, diarrhea, low blood pressure, nausea and even changes in heart rhythm. Most of these physical symptoms become more obvious when the person is suffering from bulimia in its later stages.

Treatment for this mental disorder is varied and disputed between many psychiatrists over the world. Many doctors advocate that the patient’s health is more important than their mental facilities in the first place and hospitalization is enforced upon the bulimic. This is very similar to the treatment for Anorexia Nervosa, where priority is given to keeping the body’s health in balance. For the bulimics, tube feeding is never necessary unless the bulimic’s weight falls dangerously below their acceptable weight based on their body mass index(BMI). So hospitalization is used to monitor the behavior of the bulimic only in the most serious of cases, in other words, most bulimics only get hospitalized when their family checks them in for psychiatric help or when they voluntarily check themselves in. Most of the time bulimics are treated in out-patient programmes, going for therapy once or twice every two weeks.

Medication for bulimia would come in the form the pill called high-dose fluoxetine. Treatment is recommended to begin and continue at a dose of 60 mg. (The dose of 20 mg commonly used for depression was no better than a placebo.) Bulimics benefit from fluoxetine regardless of whether they are depressed. Moreover, if fluoxetine is going to be helpful, the results will be apparent within 4 weeks. What fluoxetine does is selectively inhibit serotonin uptakes that are being released in the synapses between neurons, so that the recipient neurons have more time to recognize the serotonin in front of it and thus connect the electrical impulses in the brain correctly. This thereby reduces the neurological disturbances that further exacerbate the disorder in the mind of the bulimic.

In addition to medication, most psychologists use cognitive behavioural therapy (CBT) to straighten out the distorted thinking of the bulimic. Where they mainly probe into the distorted thinking that though the cycle of bingeing and purging leaves the bulimic high for the moment, the feeling of control slowly goes away, just like all addictions do. Psychologist will use CBT to pinpoint the faux feelings of control that bulimics have when they control the food that goes in and out of their body, because they inherently feel a lack of control over their own environment, thus seek to restrain or eliminate feelings of helplessness by controlling their food intake.

However, doctors that use the aforementioned treatment of treating the body before the mind; will experience a greater resistance from the bulimic because of their ‘mistreatment’ of the patient. As the bulimic gets overwhelmed with feelings of helplessness in the period of time, he/she was not in control of his/her own body.

Yet treatment is not only done with the help of medication and therapy, the family of the patient must help as well in correcting the patient’s fractured mind, by giving their full support. Under the supervision of a therapist, family meetings will also be held to address issues pertaining to the bulimic’s personal history. This provides closure and support for the patient to recover from the illness.

Although it is heartening to know that 60% - 80% of those who receive treatment for bulimia are in remission within three months – relapse is common – with 15% - 25% meeting the criteria for the diagnosis years later.
Published: 2008-04-03
Author: Christopher Fok

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