When an excessive eating disorder is attempted to be compensated by self-stimulated vomiting, rigorous and prolonged exercise or fasting at a very short period, the disorder is called Bulimia Nervosa. The cycle of binge eating and purging continues, and if not treated accordingly, this psychological issue can be life-threatening or fatal for various organs; namely, the heart, brain, and kidneys.

Bulimia nervosa can be diagnosed by eating a large amount of food in an interval of 1 to 2 hours without any control, self-evaluation regarding weight and body shape, and compensatory behavior for weight loss.

Causes of Bulimia Nervosa
Those who have a poor body image or those with too much self-image consciousness can get tempted to eat too much and then lose the calories through rigorous exercise and forceful vomiting. The change of lifestyle like starting or quitting a job or educational institution or having a tough time in relationships can trigger a binge eating and purging frenzy. Perfectionism, criticism, and depression are some of the reasons to have low self-confidence, which leads to bulimia nervosa. Other causes include any childhood or sudden trauma, abuse or assault, or lack of support.

Symptoms of Bulimia Nervosa
Although the patients tend to try leaving no trace of their uncontrollable eating disorders, the binge eating involved in the condition of bulimia nervosa can be indicated by them having no control over eating, being secretive about eating, eating excessively without gaining weight, and a changing period of fasting and overeating. As for purging, the symptoms are using the bathroom after overeating and returning with the smell of vomit in the bathroom or on the patient’s body, engaging in running after meals, aerobics or high-intensity exercising and having diuretics, enemas, laxatives or other supplements to lose weight. Behavioral symptoms can include the ones mentioned below:

• Being uncomfortable while eating with others
• Skipping meals
• Starting a new diet like suddenly becoming vegan or non-vegetarian and cutting out certain food groups like carbohydrates and proteins
• Keeping food at unusual places
• Using too much mint, mouthwash, perfume, etc to mask the smell of vomit
• Rigorous exercise regardless of the weather or physical condition
• Extreme concern about physical appearance

The physical symptoms of bulimia nervosa are as follows:

• Stained or colorless teeth, sensitivity, cavity or erosion of teeth
• Unusually swelled jaws or cheeks
• Knuckles and back of hands having calluses and cuts
• Abdominal pain and constipation
• Fluctuations in thyroid, potassium, blood cell count, heart rate, and hormonal level
• Feeling cold often
• Dry skin
• Fainting, dizziness, and insomnia
• Brittle and dry nails
• Dry, thin, or brittle hair
• Poor healing of wounds
• Irregular menstrual cycle

Treatment of Bulimia Nervosa
The binge-and-purge cycle runs as tension and cravings leading to binge eating, then purging to avoid gaining weight followed by the feeling of shame and strict dieting. Parents or close friends should talk to the patient and assure them that physical beauty cannot be gained from eating and purging. If the patient has indicated the symptoms, he or she should address the psychological issues that trigger the craving for food and stay away from anything that triggers the temptation. The patient should pay attention to the following aspects.

• Focus on healthy eating, without restricting food and skipping meals
• Not letting emotions dominate the body, instead of avoiding them or getting engaged, accept the fact that the emotions are temporary
• Get psychological treatment and if needed, take proper dosage of prescribed antidepressants
• Take advice from an expert about proper physical exercise
• Start yoga, tai chi, or similar physical activities as well as pleasurable hobby activities to be mentally happy and physically supple