Eating Disorders: Bulimia nervosa - Symptoms and Signs

Bulimia nervosa is defined as a medical condition of  consuming a large amount of food in a short amount of time or one setting (binge eating), followed by self induced vomiting, taking a laxative or diuretic and/or excessive exercise, etc. to compensate for the binge. Bulimia nervosa also effects almost 90% of female. Unlike anorexia nervosa, people suffering from bulimia nervosa are usually normal or slightly over weight.

II. Symptoms and Signs
A. Symptoms
A.1. Binge Eating Symptoms
1. Eating and impulsive behavioral symptoms
In the study of the implications of impulsivity in its relationship with binge-eating or purging behaviors, with all participants (n=180) asked to complete a series of self-reported inventories of impulsive behaviors and other psychological measures. Dr. Tseng MC and  Hu FC. at National Taiwan University Hospital and National Taiwan University College of Medicine showed that three latent classes of bulimic women were identified. These were women who exhibited relatively higher rates of purging, symptoms of impulsive behavior, and multiple purging methods (17.8%), women who used no more than one purging method with a low occurrence of impulsive behavior (41.7%), and women who showed higher rates of purging behaviors and the use of multiple purging methods with a low rate of impulsive behavior (41.7%). The impulsive sub-group had comparable severity of eating-related measures, frequency of binge-eating, and higher levels of general psychopathology than that of the other two sub-groups(1).

2. Greater fat consumption
In the study to investigate the association of fruit, vegetable, and fat consumption to binge eating symptoms in African American (AA) and Hispanic or Latina (HL) women. AA and HL women in the Health Is Power (HIP) study (N=283) reported fruit and vegetable intake, fat intake, and binge eating symptoms. Women were middle aged (M=45.8 years, SD=9.2) and obese (M BMI=34.5 kg/m(2), SD=7.5). Greater fat consumption was correlated with lower fruit and vegetable consumption (r(s)=-0.159, p<0.01). Higher BMI (r(s)=0.209, p<0.01), and greater fat consumption (r(s)=0.227, p<0.05) were correlated with increased binge eating symptoms. Multiple regression analysis demonstrated that for HL women (β=0.130, p=0.024), higher BMI (β=0.148, p=0.012), and greater fat consumption (β=0.196, p=0.001) were associated with increased binge eating symptoms (R(2)=0.086, F(3,278)=8.715, p<0.001). Findings suggest there may be a relationship between fat consumption and binge eating symptoms, warranting further study to determine whether improving dietary habits may serve as a treatment for BED in AA and HL women(2).

3.  Depression and/ or anxiety and eating preocuoation
Binge eating is often triggered by stress, depression, or other negative emotions. Compared with the normal-eater group, the BS(either BN or normal weight Eating Disorder NOS with regular binge eating or purging) women demonstrated significantly less dexamethasone suppression test (DST) suppression. Among BS women, DST non-suppression was associated with more severe depression, anxiety and eating preoccupations. BS women to show less DST suppression compared to normal eater women, and results link extent of non-suppression, in BS individuals, to severity of depression, anxiety and eating preoccupations(3).

4. Other symptoms include
In the study of among the 3,714 women and 1,808 men who responded, men were more likely to report overeating, whereas women were more likely to endorse loss of control while eating. Although statistically significant gender differences were observed, with women significantly more likely than men to report body checking and avoidance, binge eating, fasting, and vomiting, effect sizes ("Number Needed to Treat") were small to moderate(4). Other studies indicated that increasing evidence shows that the combination of ubiquitous ads for foods and emphasis on female beauty and thinness in both advertising and programming leads to confusion and dissatisfaction for many young people and have revealed a link between media exposure and the likelihood of having symptoms of disordered eating or a frank eating disorder(5).

5. Etc.

A.2. Purging Symptoms
Women who develop the Bulimia vervosa may consider purging as a method of regaining control of themselves after binge eating of that can lead to
1. Damage to teeth and gum as a result of self induced vomitting causes of acid exposure
2. Dehydration due to self induced vomiting
3. Fatigue due to nutrients deficiency
4. Irregular heart beat as a result of dehydration cause of low levels of potassium due to self induced vomiting.
5. Colon damage as a result of laxative abuse
6. Gastrointestinal symptoms
In bulimic patients, the most commonly reported gastrointestinal symptoms were bloating (74.4%), flatulence (74.4%), constipation (62.8%), decreased appetite (51.2%), abdominal pain (48.8%), borborygmi (48.8%), and nausea (46.5%). The average symptom score (sum of severity ratings) on the gastrointestinal symptoms questionnaire decreased from 20.6 +/- 10.8 (mean +/- SD) on admission to 13.46 +/- 10.5 (t(27) = 3.31, p < 0.01) on discharge but remained significantly higher than that of the control group (4.4 +/- 6.2, t(43) = 4.02, p < 0.001). However, the severity of reported gastrointestinal symptoms was correlated with the severity of depression (r = 0.43, p < 0.05), and when the possible mediating effects of depression on gastrointestinal symptoms were controlled statistically (analysis of covariance), the effects of treatment on gastrointestinal symptoms were not statistically significant. Dr. Chami TN, and the research team at Florida Medical Clinic indicated(6).

A.3. Psychological  symptoms 
In the review of symptoms of Bulimia vervosa, most of reviews have focused on reductions of binge eating and purging; however, the cognitive model of BN that underlies the CBT approach identifies three additional symptoms as central to the disorder: restrictive eating, concerns with shape and weight, and self-esteem(7).
Other suggested that Binge eating is often triggered by stress, depression, or other negative emotions. Compared with the normal-eater group, the BS(either BN or normal weight Eating Disorder NOS with regular binge eating or purging) women demonstrated significantly less dexamethasone suppression test (DST) suppression. Among BS women, DST non-suppression was associated with more severe depression, anxiety and eating preoccupations. BS women to show less DST suppression compared to normal eater women, and results link extent of non-suppression, in BS individuals, to severity of depression, anxiety and eating preoccupations(8).

A.4. Non Purging technique
Although many bulimics use purging technique, others may engage in excessive exercise and fasting  to prevent weight gain.

B. Signs
People with Bulimia vervosa are very good in hiding the health problems and related symptoms, but some possible signs of a person may have bulimia nervosa include:
1. Eats in isolation
2. Frequent sore throats from vomiting
4. Gastrointestinal symptoms
5. Feelings of withdrawal
6. Frequently spending time alone and wanting privacy
7. Obsession with food, dieting and exercise
9. Mood swings and irritability
10. Perfectionism
11. Etc.

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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22200525
(2) http://www.ncbi.nlm.nih.gov/pubmed/22365808
(3) http://www.ncbi.nlm.nih.gov/pubmed/22575215
(4) http://www.ncbi.nlm.nih.gov/pubmed/19107833
(5) http://www.ncbi.nlm.nih.gov/pubmed/19227390
(6) http://www.ncbi.nlm.nih.gov/pubmed/7801956
(7) http://www.ncbi.nlm.nih.gov/pubmed/11584518
(8) http://www.ncbi.nlm.nih.gov/pubmed/2257521