Column: Dr Avdesh Sharma

Nightmare At The Table

Repeated vomiting and purging causes electrolyte and fluid imbalance and acidity which not only wears away the enamel of the teeth but also disturbs the blood chemistry

This week while the world is remembering Princess Diana and her tragic death, one also recalls her struggle with a vicious eating disorder called bulimia nervosa literally meaning 'insatiable hunger'. Similar in some ways to anorexia and yet quite distinctive in its pattern, people with bulimia consume large amounts of food within a short time span, and then rid their bodies of excess calories by vomiting, abusing laxatives or diuretics, taking enemas or exercising obsessively. Some may resort to a combination of all these forms of purging. This is usually a closely guarded secret and the bulimic can successfully hide their problem from others for years.

Take the case of 20-year-old Aditi, for example. She developed bulimia when she was 18. It all started with an intense desire to lose the excess flab she had on her. She was a lonely person, given to moods. Matters worsened when things turned sour with her boyfriend who ditched her for a slim, attractive girl. Smitten with feelings of anger and rejection she threw herself headlong into an obsessive regimen of rigorous dieting and exercise workouts. Unable to cope with this tough routine, she would suddenly and uncontrollably go into eating binges consuming large quantity of junk food especially sweets and pastries, all at one go! Then overcome with disgust and guilt for having done so, she would inducing vomiting, at times using laxatives also to purge. This soon become an established pattern of behavioróbinging and purging, caught in a bind, till her mounting depression pushed her to attempt suicide, landing her in a hospital emergency. 

Who develops it? 

As with anorexia, bulimia typically begins in adolescence, most commonly occurring in women and also a few men. It is more often prevalent in families wherein obesity may exist in parents or siblings. Many anorectics may also eventually develop bulimia and both illnesses have shared family characteristics. Some bulimics have a greater general level of disturbance in other areasómoody and intolerant, unable to keep social relationships, abusing alcohol and drugs, and given to promiscuity. The emotional aspects of this disorder ultimately become increasingly important, making it doubly hard to give up the maladaptive eating behaviour. Unfortunately, more numbers of young glamour-stricken women in the modeling and fashion professions, in search of that elusive hour-glass figure are becoming victims of bulimia. 

Risks of bulimia 

Repeated vomiting and purging causes electrolyte and fluid imbalance and extreme acidity which not only wears away the enamel of the teeth but also disturbs the blood chemistry and can lead to rupture of the stomach. The esophagus becomes inflamed as food is gobbled rapidly without chewing, also leading to intense abdominal pain and distension. There is an association of ovarian cysts with the illness that is likely to reduce fertility. But the worst threat as in anorexia is the risk of self harm or suicide as a result of the accompanying emotional disturbance, and failed interpersonal relationships.

Management plan 

Bulimia is often undetected for years as the person manages to maintain normal weight or being ashamed of her strange habits, does not seek help till very late. Even the family may miss diagnosing the condition. But the sooner itís detected, the better is the treatment outcome. Most of them can be treated on an outpatient basis, unless there is a serious medical complication requiring hospitalisation. Anti-depressant medications along with cognitive behavioral therapy ensures the best results. 

The initial phase of therapy should focus on behavioral modification to set right faulty eating patterns and purging behaviour through a daily monitoring of binging episodes and laying down firm rules and conditions for regularised meals. The later phase of the therapy helps the bulimic identify the emotional circumstances that lead to loss of control, low self esteem, and then explore alternative strategies of coping that are healthy. Family therapy is also initiated to make the family more encouraging and supportive as the bulimic struggles to overcome this distressing disorder. 

óDr. Avdesh Sharma is a celebrated mental health expert and Heads 'Media and Public Education Committee' of 'Psychiatry in Developing Countries Section' of World Psychiatric Association.

February 2007

 >> Cover Story
 >> From the Editor
 >> Young India
 >> NRI-PIO Section
 >> Hot Types
 >> Mail From Reader
 >> Business News
 >> Realty Check
 >> Travel and Tourism