Bulemia nervosa; Binge-purge behavior; Eating disorder - bulemia
Bulemia is an illness in which a person binges on food or has regular episodes of significant overeating and feels a loss of control. The affected person then uses various methods -- such as vomiting or laxative abuse -- to prevent weight gain. Many (but not all) people with bulimia also have anorexia nervosa.
Causes, incidence, and risk factors:
Many more women than men have bulemia, and the disorder is most common in adolescent girls and young women. The affected person is usually aware that her eating pattern is abnormal and may experience fear or guilt with the binge-purge episodes.
The exact cause of bulemia is unknownr. Genetic, psychological, trauma, family, society, or cultural factors may play a role. Bulemia is likely due to more than one factor.
There is little data on the prevalence of bulemia nervosa in-the-large, on general populations. Most studies conducted thus far have been on convenience samples from hospital patients, high school or university students. These have yielded a wide range of results: between 0.1% and 1.4% of males, and between 0.3% and 9.4% of females. Studies on time trends in the prevalence of bulemia nervosa have also yielded inconsistent results. According to Gelder, Mayou and Geddes (2005) bulemia nervosa is prevalent between one and two per cent of women aged (15–40) years. Bulemia nervosa occurs more frequently in developed countries
There are higher rates of eating disorders in groups involved in activities which idealize a slim physique, such as dance, gymnastics, modeling, cheerleading, running, acting, rowing and figure skating. Bulemia is more prevalent among Caucasians .
In bulemia, eating binges may occur as often as several times a day for many months.
People with bulemia typically eat large amounts of high-calorie foods, usually in secret. The person generally feels a lack of control over their eating during these episodes.
These binges cause a sense of self-disgust, which leads to what is called purging, in order to prevent gaining weight. Purging may include: making oneself vomit, excessive exercise, and use of laxatives, enemas, or diuretics (water pills). Purging often brings a sense of relief.
Body weight is often in the normal range, although people with bulemia often see themselves as being overweight. Because weight is often normal, this eating disorder may not be noticed by others.
Symptoms or behaviors that may be noticed include:
- Compulsive exercising
- Evidence of discarded packaging for laxatives, diet pills, emetics (drugs that induce vomiting), or diuretics (drugs that reduce fluids, also called water pills)
- Regularly going to the bathroom right after meals
- Suddenly eating large amounts of food or buying large quantities of food that disappear right away
Signs and tests
- A dental exam may show dental cavities or gum infections (such as gingivitis). The enamel of the teeth may be eroded or pitted because of excessive exposure to the acid in vomit.
- A physical examination may also reveal:
- Broken blood vessels in the eyes (from the strain of vomiting)
- Dry mouth
- Pouch-like appearance to the corners of the mouth due to swollen salivary glands
- Rashes and pimples
- Small cuts and calluses across the tops of the finger joints due to self-induced vomiting
- A chem-20 test may show an electrolyte imbalance (such as hypokalemia) or dehydration.
- People with bulemia rarely need to be hospitalized, except under the following circumstances:
- Binge-purge cycles have led to anorexia
- Drugs are needed for withdrawal from purging
- Major depression is present
Most often, a stepped approach is taken for patients with bulemia. This treatment approach follows specific stages, depending on the severity of the bulimia, and the person's response to treatments:
Support groups may be helpful for patients with mild conditions who do not have any health problems.
Cognitive-behavioral therapy (CBT) and nutritional therapy is the preferred first treatment for bulemia that does not respond to support groups.
Drugs used for bulemia are typically antidepressants known as selective serotonin-reuptake inhibitors (SSRIs). A combination of CBT and SSRIs is very effective if CBT is not effective alone.
Patients may drop out of programs if they have unrealistic expectations of being "cured" by therapy alone. Before a program begins, the following should be made clear:
A number of therapies are likely to be tried until the patient succeeds in overcoming this difficult disorder.
It is common for bulemia to return (relapse), and this is no cause for despair.
The process is painful and requires hard work on the part of the patient and the patient's family.
Bulemia can be dangerous and may lead to serious medical complications over time. For example, frequent vomiting puts stomach acid in the esophagus (the tube from the mouth to the stomach), which can permanently damage this area.
Possible complications include:
- Dental cavities
- Electrolyte abnormalities
- Inflammation of the throat
- Tears of the esophagus from excessive vomiting
Calling your health care provider:
Call for an appointment with your health care provider if you (or your child) have symptoms of an eating disorder.
Bulemia is a chronic illness and many people continue to have some symptoms despite treatment. People with fewer medical complications of bulemia, and who are willing and able to engage in therapy, tend to have a better chance of recovery
Less social and cultural emphasis on physical perfection may eventually help reduce the frequency of this disorder.
You don’t want to binge—you know you’ll feel guilty and ashamed afterwards—but time and again you give in. During an average binge, you may consume from (3,000 to 5,000) calories in one short hour.
After it ends, panic sets in and you turn to drastic measures to “undo” the binge, such as taking ex-lax, inducing vomiting, or going for a ten-mile run. And all the while, you feel increasingly out of control.
It is important to note that bulemia doesn’t necessarily involve purging—physically eliminating the food from your body by throwing up or using laxatives, enemas, or diuretics. If you make up for your binges by fasting, exercising to excess, or going on crash diets, this also qualifies as bulemia.
Am I Bulemic?
Ask yourself the following questions. The more “yes” answers, the more likely you are suffering from bulemia.
- Does food and dieting dominate your life?
- Are you afraid that when you start eating, you won’t be able to stop?
- Do you ever eat until you feel sick?
- Do you feel guilty, ashamed, or depressed after you eat?
- Do you vomit or take laxatives to control your weight?
The binge and purge cycle:
Dieting triggers bulemia’s destructive cycle of binging and purging. The irony is that the more strict and rigid the diet, the more likely it is that you’ll become preoccupied, even obsessed, with food. When you starve yourself, your body responds with powerful cravings—its way of asking for needed nutrition.
As the tension, hunger, and feelings of deprivation build, the compulsion to eat becomes too powerful to resist: a “forbidden” food is eaten; a dietary rule is broken. With an all-or-nothing mindset, you feel any diet slip-up is a total failure. After having a bite of ice cream, you might think, “I’ve already blown it, so I might as well go all out.”
Unfortunately, the relief that binging brings is extremely short-lived. Soon after, guilt and self-loathing set in. So you purge to make up for binging and regain control.
Unfortunately, purging only reinforces binge eating. Though you may tell yourself, as you launch into a new diet, that this is the last time, (in the back of your mind there’s a voice telling you that you can always throw up or use laxatives if you lose control again). What you may not realize is that purging does not come close to wiping the slate clean after a binge.
Purging does NOT prevent weight gain
Purging is not effective at getting rid of calories, which is why most people suffering with bulimia end up gaining weight over time. Vomiting immediately after eating will only eliminate fifty percent of the calories consumed at best—and usually much less. This is because calorie absorption begins the moment you put food in the mouth. Laxatives and diuretics are even less effective. Laxatives get rid of only ten percent of the calories eaten, and diuretics do nothing at all. You may weigh less after taking them, but that lower number on the scale is due to water loss, not true weight loss.
Binge eating signs and symptoms:
- Lack of control over eating – Inability to stop eating. Eating until the point of physical discomfort and pain.
- Secrecy surrounding eating – Going to the kitchen after everyone else has gone to bed. Going out alone on unexpected food runs. Wanting to eat in privacy.
- Eating unusually large amounts of food with no obvious change in weight.
- Disappearance of food, numerous empty wrappers or food containers in the garbage, or hidden stashes of junk food.
- Alternating between overeating and fasting – Rarely eats normal meals. It’s all-or-nothing when it comes to food.
Purging signs and symptoms:
- Going to the bathroom after meals – Frequently disappears after meals or takes a trip to the bathroom to throw up. May run the water to disguise sounds of vomiting.
- Using laxatives, diuretics, or enemas after eating. May also take diet pills to curb appetite or use the sauna to “sweat out” water weight.
- Smell of vomit – The bathroom or the person may smell like vomit. They may try to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.
- Excessive exercising – Works out strenuously, especially after eating. Typical activities include high-intensity calorie burners such as running or aerobics.
- Physical signs and symptoms of bulimia:
- Calluses or scars on the knuckles or hands from sticking fingers down the throat to induce vomiting.
- Puffy “chipmunk” cheeks caused by repeated vomiting.
- Discolored teeth from exposure to stomach acid when throwing up. May look yellow, ragged, or clear.
- Not underweight – Men and women with bulimia are usually normal weight or slightly overweight. Being underweight while purging might indicate a purging type of anorexia
- Frequent fluctuations in weight – Weight may fluctuate by 10 pounds or more due to alternating episodes of bingeing and purging.
Effects of bulemia:
When you are living with bulemia, you are putting your body—and even your life—at risk. The most dangerous side effect of bulemia is dehydration due to purging. Vomiting, laxatives, and diuretics can cause electrolyte imbalances in the body, most commonly in the form of low potassium levels. Low potassium levels trigger a wide range of symptoms ranging from: lethargy and cloudy thinking to irregular heartbeat and death. Chronically low levels of potassium can also result in kidney failure.
Other common medical complications and adverse effects of bulemia include:
- Weight gain
- Abdominal pain
- Swelling of hands and feet
- Chronic sore throat
- Broken blood vessels in the eyes
- Swollen cheeks/
The dangers of ipecac syrup:
If you use ipecac syrup, a medicine used to induce vomiting, after a binge, take caution. Regular use of ipecac syrup can be deadly. Ipecac builds up in the body over time. Eventually it can lead to heart damage and sudden cardiac arrest, as it did in the case of singer Karen Carpenter.
One thing is certain. Bulimia is a complex emotional issue.
Major causes and risk factors for bulemia include:
Poor body image: Our culture’s emphasis on thinness and beauty can lead to body dissatisfaction, particularly in young women bombarded with media images of an unrealistic physical ideal. Low self-esteem: People who think of themselves as useless, worthless, and unattractive are at risk for bulimia. Things that can contribute to low self-esteem include depression, perfectionism, childhood abuse, and a critical home environment.
History of trauma or abuse: Women with bulimia appear to have a higher incidence of sexual abuse. People with bulimia are also more likely than average to have parents with a substance abuse problem or psychological disorder.
Major life changes: Bulimia is often triggered by stressful changes or transitions, such as the physical changes of puberty, going away to college, or the breakup of a relationship. Binging and purging may be a negative way to cope with the stress.
Appearance-oriented professions or activities: People who face tremendous image pressure are vulnerable to developing bulemia. Those at risk include ballet dancers, models, gymnasts, wrestlers, runners, and actors.
If your loved one has bulimia: Offer compassion and support. Keep in mind that the person may get defensive or angry. But if he or she does open up, listen without judgment and make sure the person knows you care.
Avoid insults, scare tactics, guilt trips, and patronizing comments. Since bulemia is often caused and exacerbated by stress, low self-esteem, and shame, negativity will only make it worse.
Set a good example for healthy eating, exercising, and body image. Do not make negative comments about your own body or anyone else’s.
Accept your limits. As a parent or friend, there isn’t a lot you can do to “fix” your loved one’s bulimia. The person with bulemia must make the decision to move forward.
Take care of yourself. Know when to seek advice for yourself from a counselor or health professional. Dealing with an eating disorder is stressful, and it will help if you have your own support system in place.
How Does Medical Marijuana Help With Bulemia?
Recent studies have revealed disturbances in endocannabinoid signaling in eating disorders. Especially in elevated levels of the endocannabinoid anandamide.
It has been proposed that disturbances in the neural circuitries regulating appetite, food intake and energy balance, including leptin and the endocannabinoid system, play a crucial role in the pathophysiology of eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN). (Monteleone etal.,2004; Holtkamp etal.,2006
The new information: The study looked at 134 patients with anorexia nervosa, 180 patients with bulemia nervosa, and 148 healthy individuals, and was looking for two specific mutations in endocannabinoid genes, a mutation in the gene coding for cannabinoid receptor 1, and a mutation in the gene coding for FAAH (fatty acid amide hydrolase), which is the enzyme in our bodies that degrades cannabinoids. It was found that compared to the healthy individuals, anorexic and bulemic patients were significantly more likely to have mutations in cannabinoid receptor 1 gene or mutations in the FAAH gene. Additionally, compared to the healthy individuals, it was much more likely that anorexic patients had mutations in both genes.
What this means:
This experiment tells us that there may in fact be a genetic predisposition to anorexia nervosa and bulemia nervosa. Additionally, cannabinoids may be used in the treatment of these two eating disorders as the genetic mutations cause a decreased sensitivity to them.
Cannabinoids are generally known to be cannabinoid receptor agonists. When a cannabinoid receptor agonist binds to a cannabinoid receptor a response is triggered. This response is known as a signalling pathway.
cannabinoid receptors in bulemia nervosa and physiological alterations in gut peptides that may sustain disordered eating behavior. More preferably the inverse agonism of the CB1 and/or the CB2 cannabinoid receptor acts to suppress appetite
The studies show that endocannabinoids have a place in the treatment of bulemia and anorexia nervosa. CBD whole plant extract to the study animals at both 15 and 50 mg/kg/day had a marked effect on overall bodyweight gain. Both groups, equally for males and females, showed a greater than ten percent decrease in bodyweight over the study period in comparison to the controls.
The studies show that CBD has properties that suppress appetite .
Best Strains: Those with higher levels of CBD. Or whole plant extracts. (75% Sativa x 25%Indica)
Queen Mother x NYDiesel to produce ‘Juanita’s Tears’ ‘Juanita la Lagrimosa’ extremely high CBD levels
International Review of Psychiatry, April 2009; 21(2): 163–171 Avraham, Y., Ben Menachem, A., Okun, A., Zlotarav, O.,
Abel, N., Mechoulam, R., & Berry, E.M. (2005). Effects of
the endocannabinoid noladin ether on body weight, food
consumption, locomotor activity, and cognitive index in mice.
Brain Research Bulletin, 65, 117–123.
Beal, J. E., Olson, R., Laubenstein, L., Morales, J. O.,
Bellman, P., Yangco, B., Lefkowitz, L., Plasse, T.F., &
Shepard, K.V. (1995). Dronabinol as a treatment for anorexia
associated with weight loss in patients with AIDS. Journal of
Pain Symptom Management, 10, 89–97.
Berger, A., Crozier, G., Bisogno, T., Cavaliere, P., Innis, S., &
Di Marzo, V. (2001). Anandamide and diet: Inclusion of
dietary arachidonate and docosahexaenoate leads to increased
brain levels of the corresponding N-acylethanolamines in
piglets. Proceedings of the National academy of Sciences USA,
Berridge, K. C. (2007). Brain reward systems for food incentives
hedonics in normal appetite and eating disorders. In T.
C. Kirkham & S. J. Cooper (Eds.), Appetite and body weight:
Integrative systems and the development of anti-obesity drugs.
Burlington, MA: Academic Press.
Blundell, J. E., Jebb, S. A., Stubbs, R. J. Gross, H., Ebert, M.H.,
Faden, V.B., Goldberg, S.C., Kaye, W.H., Caine, E.D.,
Hawks, R., and Zinberg, N. (1983). A double-blind trial of
delta 9-tetrahydrocannabinol in primary anorexia nervosa.
Journal of Clinical Psychopharmacology, 3, 165–171.
Bodnar, R. J. (2004). Endogenous opioids and feeding behavior:
A 30-year historical perspective. Peptides, 25, 697–725.
Chen, R., Huang, R., Shen, C., Chen, C.P., MacNeil, D.J., &
Fong, T.M. (2004). Synergistic effects of cannabinoid inverse
agonist AM251 and opioid antagonist nalmefene on food intake
in mice. Brain Research and Brain Research Reviews, 999,
Chopra, I.C., & Chopra, R.N. (1957). The use of the cannabis
drugs in India. Bulletin on Narcotics, 9, 4–29.
Christensen, R., Kristensen, P. K., Bartels, E. M., Bliddal, H., &
Astrup, A. (2007). Efficacy and safety of the weight-loss drug
rimonabant: A meta-analysis of randomised trials. Lancet, 370,
Colombo, G., Agabio, R., Diaz, G., Lobina, C., Reali, R., &
Gessa, G.L. (1998). Appetite suppression and weight loss after
the cannabinoid antagonist SR 141716. Life Science, 63,
Cooper, S. J., & Kirkham, T. C. (1993). Opioid mechanisms in
the control of food consumption and taste preferences. In
A. Herz, H. Akil & E. J. Simon (Eds.), Handbook of
Experimental Pharmacology, Vol. 104, part II. Berlin: SpringerVerlag.
Cota, D., Marsicano, G., Tschop, M., Grubler, Y.,
Flachskamm, C., Schubert, M. et al. (2003). The endogenous
cannabinoid system affects energy balance via central orexigenic
drive and peripheral lipogenesis. Journal of Clinical Investigation,
Di Marzo, V., Sepe, N., De Petrocellis, L., Berger, A.,
Crozier, G., Fride, E., & Mechoulam, R. (1998). Trick or
treat from food endocannabinoids? Nature, 396(6712),
Di Marzo, V., & Matias, I. (2005). Endocannabinoid control of
food intake and energy balance. Nature Neuroscience, 8,
Di Marzo, V. (2008). The endocannabinoid system in obesity and
type 2 diabetes. Diabetologia, 51, 1356–1367.
Di Patrizio, N. V., & Simansky, K. J. (2008). Activating
parabrachial cannabinoid CB1 receptors selectively stimulate
feeding of palatable foods in rats. Journal of Neuroscience, 28,
Drewnowski, A., Krahn, D. D., Demitrack, M. A., Nairn, K., &
Gosnell, B.A. (1992). Taste responses and preferences for
sweet high-fat foods: Evidence for opioid involvement.
Physiology & Behavior, 51, 371–379.
Fride, E. (2008). Multiple roles for the endocannabinoid system
during the earliest stages of life: Pre- and postnatal development. Journal of Neuroendocrinology, 20(Suppl.1), S75–81.
Fride, E., Bregman, T., & Kirkham, T.C. (2005).
Endocannabinoids and food intake: Newborn suckling and
appetite regulation in adulthood. Experimental Biology and
Medicine (Maywood), 230(4), 225–234.
Gaoni, Y., & Mechoulam, R. (1971). The isolation and structure
of delta-1-tetrahydrocannabinol and other neutral cannabinoids
from hashish. Journal of the American Chemistry Society, 93,
Gallate, J., & McGregor, I. (1999). The motivation for beer
in rats: Effects of ritanserin, naloxone and SR 141716.
Psychopharmacology, 142, 302–308.
Gallate, J., Saharov, T., Mallet, P., & McGregor, I.S. (1999).
Increased motivation for beer in rats following administration of
a cannabinoid CB1 receptor agonist. European Journal of
Pharmacology, 370, 233–240.
Gazzerro, P., Caruso, M. G., Notarnicola, M., Misciagna, G.,
Guerra, V., Laezza, C., & Bifulco, M. (2007). Association
between cannabinoid type-1 receptor polymorphism and body
mass index in a southern Italian population. International
Journal of Obesity (London), 31(6), 908–912.
Gomez, R., Navarro, M., Ferrer, B., Trigo, J.M., Bilbao, A.,
Del Arco, I., Cippitelli, A., Nava, F., Piomelli, D., & Rodriguez
de Fonseca, F. (2002). A peripheral mechanism for CB1
cannabinoid receptor-dependent modulation of feeding.
Journal of Neuroscience, 22, 9612–9617.
Gross, H., Ebert, M.H., Faden, V.B., Goldberg, S.C.,
Kaye, W.H., Caine, E.D., Hawks, R., & Zinberg, N. (1983).
A double-blind trial of delta 9-tetrahydrocannabinol in primary
anorexia nervosa. Journal of Clinical Psychopharmacology, 3,
Haney, M., Rabkin, J., Gunderson, E., & Foltin, R. W. (2005).
Dronabinol and marijuana in HIVþ marijuana smokers: Acute
effects on caloric intake and mood. Psychopharmacology
(Berlin), 181, 170–178.
Hao, S., Avraham, Y., Mechoulam, R., & Berry, E.M. (2000).
Low dose anandamide affects food intake, cognitive function,
neurotransmitter and corticosterone levels in diet-restricted
mice. European Journal of Pharmacology, 392, 147–156.
Harrold, J., Elliott, C., King, P., Widowson, P.S., & Williams, G.
(2002). Down-regulation of cannabinoid-1 (CB-1) receptors in
specific extrahypothalamic regions of rats with dietary obesity: