Eating binges in bulimia may occur several times a day. They are caused by a sense of self-disgust, which is compensated with behaviors already mentioned (self-induced vomiting, excessive exercise, abuse of laxatives, diuretics, or enemas).
Bulimia can start at any age, although it normally starts during late teens. It is thought that bulimia is woman's disease, but it does occur among male population too. It is true though that more women have bulimia than men, and is believed that bulimia is four times more common than anorexia. It is estimated that up to 4% of population are thought to have bulimia. Bulimia is a disease of a Western world.
The exact cause of bulimia is unknown: but scientist think factors, like family problems, perfectionist personality, depression, overemphasis on physical appearance are main reasons that contribute to the development of bulimia nervosa.
From a biological perspective, there's evidence from twin and family studies pointing towards a genetic predisposition to bulimia. Advances in genome-wide association studies are starting to pinpoint specific genetic markers. Additionally, neurobiological research using functional magnetic resonance imaging (fMRI) has revealed unique brain activity patterns in those with bulimia, especially in regions linked to reward, impulse control, and emotion regulation. There's also growing knowledge about imbalances in neurotransmitters like serotonin, dopamine, and norepinephrine and their potential influence on bulimic behaviors.
On the psychological front, cognitive-behavioral models emphasize how those with bulimia may excessively link self-worth to body shape and weight, leading to distortions that fuel the disorder. Traumatic experiences, such as abuse, can also be triggers, acting as maladaptive coping mechanisms that manifest as disordered eating. Specific personality traits, including impulsivity and perfectionism, have been associated with bulimia, shedding light on potential predispositions.
Socio-culturally, the portrayal of idealized body images in media, especially with the rise of social media, is believed to play a role in the disorder's onset and persistence. Peer pressure and cultural standards that emphasize certain body ideals can also act as risk factors.
Many researchers are adopting a biopsychosocial perspective, suggesting that a blend of biological, psychological, and socio-cultural elements come together in unique ways to predispose, trigger, and perpetuate bulimia. Emerging areas of interest include the gut-brain axis, exploring how gut microbiota might influence mental health and eating patterns, and epigenetics, examining how environmental factors can modify gene activity without changing the DNA sequence.
Impacts of bulimic activities on health and personality
First of all, we have to distinguish two types of bulimia behaviors. First type is purging type, for which is typical that during the current episode of bulimia nervosa, the person has regularly engaged in binge-eating or purging behavior, such as self-induced vomiting or the abuse of laxatives, diuretics or enemas.
Second type is nonpurging type, where during the current episode of bulimia nervosa, the person has regularly engaged in other but purging compensatory behavior, such as fasting or excessive exercise, but has not regularly abused laxatives, diuretics or enemas or has not regularly engaged in self-induced vomiting.
Both types, purging and nonpurging type of bulimic behaviors can be extremely harmful to the body, both physically and mentally. However, the purging behavior is proved to have more negative impacts on physical body and its systems. Most complications of bulimia (in both types) result from imbalance of electrolytes, which present salt in the blood. This is however sooner expressed in purging type because of repeated self-induced vomiting behavior.
But this is just the top of an ice berg: self-induced vomiting can erode tooth enamel, which results in increased dental cavities and increased sensitivity of the teeth to hot or cold food. Repeated vomiting results in irritation and tears in the lining of the throat, esophagus, and stomach, which can cause ulcers; swelling and soreness in the salivary glands can occur. If person abuses laxatives and diuretics, it causes loss of sodium and potassium, which can damage the heart muscle, consequently increasing the risk for irregular heartbeats, heart problems or failure, and even death. Abuse of laxative can lead to chronic constipation and irregular bowel movements.
Some of the potential health consequences of binge eating disorder include high blood pressure, high cholesterol levels, heart disease as a result of elevated triglyceride levels, secondary diabetes and gallbladder disease.
Here is a longer list of health consequences of bulimia:
- Malnutrition
- Dehydration
- Electrolyte imbalance (The electrolyte imbalances are caused by losses of potassium and sodium from the body and dehydration as a result of purging behaviors. Electrolyte imbalances can lead to irregular heartbeats and possibly heart failure and death.)
- Hyponatremia
- Vitamin and mineral deficiencies
- Teeth erosion and cavities, gum disease (frequent vomiting causes acids release from stomach, which causes tooth decay and teeth staining, gum disease and bad breath) .
- Sialadenosis (salivary gland swelling)
- Potential for gastric rupture during periods of bingeing
- Esophageal reflux
- Irritation, inflammation, and possible rupture of the esophagus (caused by frequent vomiting)
- Laxative dependence (laxative abuse leads to laxative dependence, and as a result it can cause chronic irregular bowel movements and constipation )
- Peptic ulcers and pancreatitis
- Emetic toxicity due to ipecac abuse
- Swelling of the face and cheeks
- Callused or bruised fingers
- Dry or brittle skin, hair, and nails, or hair loss
- Lanugo
- Edema
- Muscle atrophy
- Decreased/increased bowel activity
- Digestive problems that may be triggered, including Celiac, Crohn's Disease
- Low blood pressure, hypotension
- Orthostatic hypotension
- High blood pressure, hypertension
- Iron deficiency, anemia
- Hormonal imbalances
- Hyperactivity
- Depression
- Insomnia
- Amenorrhea
- Infertility (severe caloric restriction suppresses the hypothalamic-pituitary axis, which results in dramatic suppression of the pituitary production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and without normal cycling of LH and FSH, the circulating level of estrogen is very low and ovulation will not occur. Therefore fertility is compromised in bulimic patients) Polycystic Ovary Syndrome
- High risk pregnancy, miscarriage, still-born babies
- Diabetes
- Elevated blood sugar or hyperglycemia
- Ketoacidosis
- Osteoporosis (although the pathophysiology of osteoporosis is not well understood, it is known that adolescence is a critical time of bone mineralization, where estrogen and nutritional facts are most crucial factors).
- Arthritis
- Weakness and fatigue
- Chronic Fatigue Syndrome
- Cancer of the throat or voice box
- Liver failure
- Kidney infection and failure
- Heart failure, heart arrhythmia, angina
- Seizure
- Paralysis
- Potentially death caused by heart attack or heart failure; lung collapse; internal bleeding, stroke, kidney failure, liver failure; pancreatitis, gastric rupture, perforated ulcer, depression and suicide.
Read More: Eating Disorders (Anorexia, Bulimia and Binge Eating) Among Males Becoming Common
Why is bulimia happening?
There is no one cause for eating disorders, because there are many things that can contribute to them: low self-esteem, feeling helpless, having control over life, avoiding stress, social and family pressure, depression etc.
Personally I blame social pressure the most. Let's just imagine this picture: average American model is 5'11' and weights 117 pounds, while average American woman is 5'4' and weights 140 pounds, which leads to conclusion that 98% of models are thinner than average American women. This is not a real picture of lifestyle that daughters and sons see every day. These people are actually their idols, they look up to them. On the other hand, there were a study made in eating disorder clinic in Britain, and patients say they do not blame models for their eating disorders and that they believe that their problems are much more personal.