Bulimia Nervosa: The Silent Killer
July 24, 2023
Eating disorders (ED) are an ever-growing epidemic that is continuously tethering closer to a tipping point. Prevalence research conducted in the early 2010s found that 1% to 3.8% of the USA population had a diagnosis of ED, 2020 research found an increase in prevalence to 3% to 14.3%. This concerning trend is not specific to the USA as different Western countries have mirrored this increase, including the UK and many EU countries. Which begs the question, what is the cause behind this trend?
The rise of social media brought forward new trends that unfortunately increased ED exposure. Time spent on social media and types of interactions made on social media were both correlated to an increased risk of developing an Eating Disorder. This was particularly prevalent in girls under the age of 20, but the effect extended to all genders and ages. More time spent on social media equated to reduced self-esteem and lower satisfaction with body image. This trend is expected to grow in impact as social media continues to move to more video-based formats and as the fear of missing out continues to drive engagement with social media.
There is currently a lot of research happening to investigate the prevalence, risk factors, and prevention of eating disorders. However, both media and research have a bias to pursuing discourse that is most topical. In terms of ED popularity, Anorexia Nervosa is the most widely reported and covered disorder in movies and TV series, social media, and scientific journals. However, this does not mean that is the most prevalent ED. Anorexia and Bulimia Nervosa are often compared in prevalence with some research indicating Anorexia is as twice prevalent as Bullimia while other research indicates Bulimia is more than twice as prevalent as Anorexia. The Global Burden of Disease in 2017 estimated that Bullimia is almost 4 times more common than Anorexia. Unfortunately, Bullimia has been under-researched in relation to Anorexia. A search of Springer and Nature journals revealed that there are more than 5 times as many Anorexia journal articles as Bullimia. As these disorders have similar incidence rates, why is there such a divide between Anorexia and Bullimia, and how do these disorders differ?
Anorexia Nervosa develops from a combination of factors: genetic disposition, psychological difficulties, and environmental factors. Psychological factors can be varied from past trauma to other comorbid mental health disorders. Genetic factors are still under investigation but they go hand in hand with environmental factors. A predisposition to Anorexia might increase one’s chances of developing the disorder when faced with adverse events in life, but some studies suggest that the environment and a person’s behaviour may also alter the genetic activity to increase chances of developing Anorexia. And there are multiple environmental factors that could increase the likelihood of Anorexia, from immediate social circle such as family conflict or school bullying to the greater social environment of television and social media.
While the same predisposing factors are true for bulimia, there is an even greater focus on the unhealthy relationship to food. Both disorders have a number of overlapping symptoms, such as severe weight loss, weakness and fatigue, distorted body image, and distorted diet. A person with Anorexia is likely to limit their diet and monitor their calorie intake, but Bullimia centres on the relationship to food in particular. The Diagnostic and Statistical Manual of Mental Disorders uses this relationship to define two types of Bulimia: Purging and Non-Purging.
Purging Bulimia is characterised by ways of expelling food soon after consuming it. This is most commonly done through induced vomiting and or through laxative and enema use. In some cases, people with Bulimia engage in binge eating prior to purging which results in a binging-purging cycle. These episodes can be triggered by a number of different emotions such as sadness, guilt, hopelessness, or as an overcompensation for feelings of hunger resulting from a restrictive diet.
As the name suggests, Non-Purging Bulimia is characterized by a more restrictive diet rather than purging behaviours. People with Non-Purging Bullimia often go through periods of fasting and look for appetite-suppressing drugs and supplements. An element of binging is more prevalent than Purging Bullimia and is often followed by extreme exercise or even further restrictions on food intake.
From a psychological side, precipitating and perpetuating factors for both types of Bulimia is similar enough to class them as different sides of one disorder. However, the physical complications arising from these disorders are quite different. Purging Bullimia can result in problems relating to tooth decay, acid reflux, throat swelling, haemorrhoids from laxative use, and other gastrointestinal problems. Non-Purging Bullimia is in particular danger of irregular blood pressure, heart problems, and pancreatitis.
Another important physical factor that is often overlooked in media is the body type of Bulimia. Too often characters with Eating Disorders are portrayed as extremely underweight. In fact, binging behaviours can lead to weight gain, and an ED diagnosis may be missed for people with higher weight. Most of the health complications mentioned arise from behaviours associated with Bulimia and not from being underweight. A combination of underdiagnosis and higher risk of health complications such as Diabetes, can result in people with higher weight receiving interventions later and having to undergo more intensive treatment. Therefore, it is important to recognise that signs of Bulimia and other ED are not dependent on a body type.
If you or someone you know suffers from Bulimia or other types of ED, reach out for help before it is too late. Online support groups and self-help tools are good first steps to understanding the disorder and the journey ahead. Currently, Cognitive Behaviour Therapy (CBT) is recognised as the most effective treatment available for Bulimia.
Here at Mindsum, we have highly experienced Eating Disorder therapists who are able to offer CBT in a form that is most preferable to you: phone, video, or in clinic.