Definition

Bulimia Nervosa, commonly known as bulimia, is a serious eating disorder characterized by a very large meal period (binge eating) and continued with inappropriate compensation to prevent weight gain. To get rid of calories and prevent weight gain, individuals with bulimia can use various methods, including:

• Purging, that's how to prevent weight gain by intentionally creating vomiting, using pencahars, diuretics, enemas, or other drugs to 'clean the intestines'
• Non-purchasing, namely prevention methods with other things, such as fasting or excessive exercise

Bulimia is often preceded by feelings of shame and dissatisfaction with their body weight and body shape. Effective treatment can help someone with bulimia to be able to adopt a healthy diet and restore serious complications.

Causes

The causes of bulimia are not known for certain. Many things can contribute to the emergence of eating disorders, including genetics, emotional health, environmental expectations, and others. Cultural and community values also affect body shape and weight. It is believed that this eating disorder arises as a person's dissatisfaction with his body and a very heavy concern for his size and body shape.

Risk factor

Factors that increase the risk of developing nervosa bulimia, among others:

• Women's gender
• Teenagers or young adults
• Has a history of nuclear family (parents or siblings) with eating disorders or other mental disorders, such as drug abuse, anxiety disorders, and mood disorders
• Having psychological and emotional problems, such as depression, anxiety disorders, or drug abuse.
• Having a bad view of yourself
• Having an experience history that triggers trauma or stress
• Taking a calorie restriction diet is too strict. This can lead to habits of binge eating and compensation in a way of purchasing or non-purging.
• Exposure to things that can trigger binge eating, such as stress, food, and boredom

Symptoms

Symptoms from bulimia include:

• Has persistent negative thoughts about body shape and weight
• Fear of gaining weight
• Eating large amounts of food (binge eating)
• Feeling of loss of control when experiencing binge eating (feeling like you can't stop eating or can't control what you eat)
• Forcing yourself to vomit or exercising excessively after binge eating to avoid gaining weight
• Using laxatives, diuretics, or enemas after meals (even if you don't have another medical condition)
• Fasting, extreme calorie restriction, and avoiding certain types of food after experiencing an episode of binge eating
• Using supplements or herbal products to lose weight

The severity of bulimia depends on the number of purging episodes, generally around 1 time per week for the last 3 months.

Diagnosis

Your doctor can diagnose bulimia based on your complaints and a physical examination. A diagnosis of bulimia nervosa can be made if it meets the criteria of the Guidelines for the Classification and Diagnosis of Mental Disorders in Indonesia III (PPDGJ III), namely:

• There are periods of overeating accompanied by feelings of not being able to control yourself (binge eating)
• Fight the effects of obesity in one or more of the following ways:
  • induce vomiting by oneself
  • using excessive laxatives
  • periodic fasting
  • using appetite-suppressing drugs, such as thyroid preparations and diuretics
• Fear and worry about obesity. Often preceded by anorexia nervosa.

Your doctor will also ask about your diet, weight loss methods that you have used, and other physical symptoms. The doctor will also ask about your views on weight and body shape. If necessary, your doctor will conduct additional examinations, such as heart records, blood tests, and urine tests. Before diagnosing bulimia nervosa, your doctor will rule out other causes that may cause symptoms similar to this condition.

Management

When a diagnosis of bulimia has been made, you need to undergo several types of therapy, starting with certain drugs and psychotherapy.

Psychotherapy

Bulimia treatment involves conversing about your condition with a psychiatrist and implementing strategies to manage its symptoms. Evidenced-based psychotherapies proven to be successful in addressing bulimia include: 

• Cognitive-behavioral therapy. This method aims to restore normal eating patterns and change negative and unhealthy views regarding body image.
• Family-based treatment. This method is intended for parents to help stop unhealthy eating patterns in their children.
• Interpersonal psychotherapy to identify and overcome other external factors that can influence current conditions

Discuss this therapy option with your psychiatrist.

Drugs

Antidepressant medication can help reduce the symptoms of bulimia along with psychotherapy. Usually,  the doctor will prescribe medication based on the symptoms you are experiencing. Discuss the choice of antidepressants with your psychiatrist.

Nutritional education

A nutritionist can help formulate a healthy and balanced diet to restore your eating patterns, reduce cravings, and prevent excessive hunger. Consuming food regularly and not limiting yourself to certain foods is very important to overcome bulimia.

Hospital treatment

Generally, doctors treat bulimia as an outpatient (not in a hospital). However, if the symptoms are severe enough or serious complications have occurred, your doctor can admit you to the hospital for treatment.

Self-care at home

Apart from the treatment options above, you can do the things below to speed up healing, including:

• Carrying out the prescribed treatment and diet plan
• Learning about bulimia from trusted sites,
• Consume food appropriately
• not isolating yourself from your closest family and friends
• Be kind and accept yourself. Fight the urge to weigh yourself or look at your body in the mirror if it triggers uncomfortable feelings.
• Exercise appropriately
• Although most cases of bulimia can be treated with the above treatment options, bulimia can recur within a few years after the first episode. If you experience this again, immediately check with yourself at the nearest health facility.

Complications

One reason to get proper treatment as quickly as possible is that bulimia has serious complications. These complications include:

• Problems with the teeth and mouth
  • Erosion of tooth enamel due to repeated exposure to stomach acid
  • Holes in teeth and discoloration of teeth
  • Teeth are sensitive to hot or cold foods
  • Gum infection
  • Swollen salivary glands (due to repeated vomiting)
• Disorders of the esophagus and stomach
  • Inflammation of the esophagus
  • Ulcer (injury) on the stomach
  • Gastric and esophageal rupture
• Defecation disorders
• Electrolytes and fluid imbalance
  • Dehydration
  • Mineral and electrolyte imbalances, especially calcium and potassium, can arise due to dehydration.
  • Electrolyte imbalances and low blood sugar can cause seizures
  • Irregular heartbeat due to lack of potassium in the blood
• Psychological complications
  • Increases the risk of suicide and self-harm
  • Addiction, use of alcohol, illegal drugs, and habitual compulsions
  • Depression, anxiety, obsessive-compulsive disorder, and other psychiatric disorders
• Irregular menstrual cycle
• Decreased libido

Prevention

To prevent bulimia effectively, we need to identify its cause with certainty. However, there are several ways to adopt a better perspective regarding diet and body shape, including:

• Have a meal schedule together with the family
• Don't talk about weight, but focus more on healthy living steps
• Promote a good, healthy, and realistic view of body image
• Do not engage in fad dieting, namely diets that have no scientific evidence, especially those that involve excessive calorie restriction, use of laxatives, or deliberate vomiting.

If bulimia has occurred, prevention focuses more on efforts to prevent a person's mental and bodily condition from deteriorating. Eating disorders can go unnoticed for an extended period, making this a challenging action to take. 

When to see a doctor?

If you experience symptoms of bulimia, immediately have your condition checked by a doctor. If left untreated, bulimia can significantly affect your health.

Discuss the symptoms of bulimia, your feelings, and the things you experience with your doctor or psychiatrist. If you are unsure about seeking professional help, share your condition with the people closest to you (family, friends, partner) you trust.

If you know someone around you who is experiencing bulimia, communicate your concerns to them. You can't force them to seek professional help, but you can support them. You can also help find qualified health workers and accompany them if needed.

Someone with a normal or slightly overweight body is generally the one experiencing bulimia, which may not appear dangerous to those around them. Some dangerous signs that you can observe in someone experiencing bulimia include:

• Often complains or worries about the condition of his body, which he considers fat
• Having a negative self-image and body image
• Experienced several episodes of binge eating. The foods consumed during this period are foods that are usually avoided.
• Go on a strict diet or fast after experiencing binge eating
• Don't want to eat in public areas or front of many people
• Going to the bathroom after or in the middle of eating for an extended period
• Exercising excessively
• Having calluses or calluses on the knuckles
• Swollen feet and hands
• Swollen face and cheeks