The urge to eat is not only caused by physiological hunger, but is known to be also affected by emotional status or psychological stress. Bulimia is one of the most common eating disorders along with anorexia nervosa, the opposite condition of not eating enough food.

The improving socioeconomic status of Korea and the increasingly popular diet culture is contributing to this eating disorder. Bulimia and anorexia nervosa both commonly occur in young women, and generally start in adolescence.

Bulimic patients repeatedly binge eat and cannot control their urge to eat. After binge eating, they obsessively repeat efforts to lose weight. They may eat ravenously, without even chewing the food sufficiently, or may eat alone away from other people.

The diagnosis of bulimia is made when such abnormal behavior occurs at least twice a week for more than three months. These patients often immediately regret binging, so induce vomiting or use medications such as laxatives or diuretics, or become obsessed with exercise afterwards. 

These patients generally feel that they are overweight and show extreme interest in diet and weight loss. The majority of these patients maintain a normal weight, despite their repeated binge eating. However, some of these patients may be significantly underweight, or even slightly overweight.

Complications and the causes of such complications in bulimia

Repeated induced vomiting or overuse of diuretics in Bulimic patients can lead to electrolyte imbalance, hypokalemia (low potassium in the blood), and hyponatremic alkalosis. In a small number of patients, the frequent vomiting can lead to tears in the stomach or esophagus. Other common complications include depression, personality disorders, compulsive disorders and substance abuse.

On the other hand, anorexic patients may develop alopecia, hypothermia or dry skin from excessive weight loss and dietary limitation, which may pose a threat to their lives. Electrolyte imbalances can lead to other complications such as problems with the kidneys and heart function.

Bulimia is believed to be associated with abnormalities in serotonin, norepinephrine and endorphins which are neurotransmitters produced by the cerebrum. The correction of such abnormalities together with medication can often improve the symptoms.

Bulimic patients are often goal-driven, have anger management problems and often experience difficulties with compulsiveness, which can affect their relationships with other people. They often feel extreme emotions toward those that are psychologically closest to them. Also, they often feel psychological stress when separated from these people. This is thought to induce symptoms of bulimia.

Many of these patients suffer from depression, and may have a family history of depression. Therefore, bulimia is thought to be closely associated with depression and other mood disorders.

Treatment of bulimia

One method of treatment is pharmacological. These are antidepressants that inhibit the reuptake of serotonin, mentioned previously. However, some patients may not respond to such pharmacological treatment.

Other treatment options include cognitive behavioral therapy, which is aimed to correct abnormal behavior, or psychiatric treatment which is focused on the psychiatric conditions associated with bulimic patients. More recently, combined therapies consisting of pharmacological treatment, cognitive behavioral therapy and psychiatric therapy are being used commonly.

When symptoms are severe, the patient may need to be hospitalized temporarily. It is also important for appropriate nutrition education and management in bulimic patients. A trained nutritionist needs to assess the patient’s eating habits, patterns, and the effect of these on the patient’s weight, as well as providing education on balanced nutrition. It is also beneficial to educate family members about nutrition and eating habits.

By Yu Bum-hee

The author is a doctor at Department of Neuropsychiatry at Samsung Medical Center and a professor of Sungkyunkwan University School of Medicine. ― Ed.