Bulimia - Is it the answer to your personal demons?
	Read this if: You have a problem with food You have or are at risk of having an eating disorder You know somebody with a problem “What is food to one, is to others bitter poison.”  Lucretius   Eating disorders are on the increase and are very distressing for all concerned.  In this article Dr. Reval Sukkhu, who is a Physician, helps us understand Bulimia Nervosa. Much has been written about Eating Disorders in a variety of contexts. They are becoming more common and indeed more serious. In fact, according to BEAT (Beat Eating Disorders) support group, there are as many as 90,000 people being treated for Anorexia Nervosa or Bulimia Nervosa in the UK. It is well known that most of those who suffer these conditions are women, but that is not to say men are not affected. The Royal College of Psychiatrists estimates that women and girls are ten times more likely to suffer an eating disorder than men and boys. The problem I have with this statistical quagmire is the number of undiagnosed women with either anorexia or bulimia and, of course, those with subtle symptoms that somehow fall through the net and present much later with severe depression, self-harming or suicidal behaviour. I will relate the case of a “healthy” 26 year old with a first class degree from an elite English University and a rewarding but demanding job. She had good friends and a burgeoning social life. However, she did suffer severe low self-esteem and low self-confidence. She had been bullied a great deal by an over-demanding father and always felt she was not good enough. She was intimidated by other women, seeing them as better than her, and her relationships with men were problematic. Sometimes she broke down, unable to cope and at times found herself crying at work or crying herself to sleep. Her way of dealing with all of this was to purge herself, a means, she felt, of cleansing or ridding herself of all of her problems. This was the only way in which she felt she could exercise some control over her life. Surprisingly she did not value thinness as much as someone with typical bulimia would and she did not binge much. Occasionally, however, she would become depressed and remedied this with alcohol. She began to realise she was spending excessive amounts of time on her own and lacking much direction in her daily life so she finally decided to seek help. I do realise that the above case does not seem serious because she was not horrifically thin and eventually did seek help, but she did have numerous symptoms of bulimia, a seriously dangerous disorder. When I first met her she had numerous physical complaints: Her sleep was very erratic and she had difficulty concentrating, she felt weak and tired all the time, the enamel on her teeth began to erode and she easily became constipated. A blood workup showed slightly abnormal liver function due to her alcohol over-consumption. Let us take a more detailed look at what bulimia is. It is defined as a syndrome characterized by repeated bouts of overeating and an excessive preoccupation with the control of body weight, leading to a pattern of overeating followed by vomiting or use of purgatives or laxatives. It shares many psychological features with Anorexia Nervosa, including an excessive concern with body shape and weight. Repeated vomiting is likely to give rise to physical complications. Referring to the above case study, what could have caused her to become bulimic? There is no precise known cause, but multiple factors are implicated such as social pressure, craving a sense of control, emotional distress and low self-esteem, which are highlighted in her case. One should also note that people who have close relatives with bulimia are four times more likely to develop the disease than people who do not. It is easy to get caught in a vicious circle of bingeing and purging and once the above four factors come into play it becomes difficult to break the cycle. It is interesting that research is pointing to a potential physical cause of eating disorders. One must bear in mind that it is possible for a bulimic to go on to develop anorexia. In contrast to anorexia however, bulimia is seldom fatal. It was very difficult for her to accept that she had an eating disorder, which a lot of the time is half the battle – self-realization and acceptance. Of course acceptance of the disorder does not necessarily mean that treatment will be easy. She strongly resisted all forms of care in particular psychological therapy, which I felt she needed most. Sometimes bulimia can be tackled with a self-help manual and with guidance from a therapist, but in her case I felt more intensive psychotherapy was necessary to deal with events in her life, her low self-esteem and other triggers for her purges. Her diet was generally healthy but she did appreciate advice from a dietician on healthier eating options. She was very averse to medication, which does play a role in the treatment of bulimia. I did feel that in her case, the common high doses of anti-depressants (usually Prozac) that reduce the urge to binge eat were not required. I must add though, to anyone using anti-depressants as a treatment for bulimia, that they do reduce symptoms over a period of time and assist the psychological therapy, but if used in isolation without therapy, the effect can wear off with time. What I intend to highlight with her case is that subtle symptoms are difficult to pick up, especially if someone appears to be both relatively healthy and functionally normal. I would not classify her as having a conventional eating disorder but what we call Atypical Bulimia Nervosa. This means that some of the features of Bulimia Nervosa are identified but not all. She was very close to the edge and she could have easily fallen into anorexia, depression, alcohol and drug addiction or even suicide. Fortunately however, she recovered well and cut the purging episodes by half after just a few months. She soon gained some control over the life that she felt was falling apart and fitting in with the average time for recovery, after almost a year of treatment she recovered from her bulimia. I have always believed that conditions of this type emphasize that a healthy body and mind is a delicate balancing act. Taking that first step to realizing that one has psychological issues is always the most challenging but if ones physical health is compromised, it is a step worth taking. Dieting or purging are never the answer to the personal demons that plague us. They eventually take over and become the demon. Dr. Reval Sukkhu, Physician at the Number One Health Group, takes another look at Bulimia Nervosa. Reval was born and educated in South Africa and has worked in multiple medical specialities there and in the UK . He has a particular interest in Women's Mental Health, Sexually Transmitted Diseases and Human Rights.   For more information on Number One Health Group please go to www.numberonehealth.co.uk or call +44 (0)207 580 5467.     To contact Dr. Reval Sukkhu please e-mail info@numberonehealth.co.uk or drsukkhu@doctors.org.uk   Have you, or anybody close to you, had an eating disorder?  Please talk about it on the Forum.