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Bulimia nervosa is an eating disorder characterised by a cycle of starving,
overeating, self-induced vomiting/purging and a preoccupation with body
weight. Laxative abuse, excessive exercise and slimming tablets are
used as other ways of controlling weight. Bulimia is often preceded
by anorexia nervosa. It begins in late adolescence or early adulthood.
It may be hard to notice as weight may be normal and vomiting is carried
out secretly.
Bulimia can start with an occasional eating binge, usually consisting
of large quantities of chocolates, sweets and biscuits. This progresses
to a routine pattern of overeating and vomiting. Eventually the bulimic
may feel trapped in a frightening, compulsive vicious circle.
Food is turned to in times of stress for comfort, but eating produces
feelings of guilt. Those suffering from bulimia nervosa have a pathological
fear of becoming overweight and tend to radically over-emphasise the
connection between self-image and body size. Sufferers recognise that
the eating pattern is not normal, and as a result tend to feel guilty
and hugely self-critical.
Bulimics often suffer from depression or anxiety. Some patients may
also have a drug addiction. Bulimics sometimes find themselves with
financial difficulties because of the huge amounts of money spent on
food, laxatives and drugs. Research indicates that up to one per cent
of the population may be suffering from this condition at any one time,
although this is probably a conservative estimate.
Orthodox treatment
The aim of treatment is to stop vomiting and laxative use and to return
to a normal eating pattern and body weight. Emotional difficulties tend
to underlie the eating disorder and these deeper problems need to be
explored. The false perception of body size must be challenged.
Cognitive Behavioural Therapy has been used with considerable success.
(Cognitive Behavioural Therapy: 'cognitive' (adj) from noun 'cognition'.
This therapy is a form of psychotherapy based on the view that the manner
in which they perceive themselves and the world around them, strongly
influences their feelings and emotions. Help is given to identify false
perceptions and thereby in recognition of them, can do something to
correct them.
Dietary and lifestyle intervention:
Nutritional therapy involves aiming to restore regular, less erratic
eating habits. High fibre foods may be needed, because of laxative overuse.
While gastrointestinal function is rebalancing the abdomen may swell.
This may produce alarm, as it may be misinterpreted as putting on weight.
It is important that support is given during this time.
The energy content of the diet is determined by whether the patient
is under, overweight or of normal weight. A healthy, balanced diet should
be encouraged, rather than one that focuses just on calories and it
is vital that the bulimic is made aware of the damaging effects that
vomiting has on the body.
A food diary allows the nutritional content of the diet to be monitored
and mood diary may help understand what triggers an eating binge.
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