The desire to eat is not only driven by hunger, but also by the emotional state and psychological stress. Binge eating, which is different to anorexia where one does not eat enough food, is another common eating disorder. This eating disorder is becoming more prevalent with the increase of interest in weight loss, as in Western countries, and in a rise in socioeconomic status as in Korea.
Eating disorders, including both bulimia and anorexia, mostly occur in young women, particularly in adolescents.
Binge eating ― bulimia
Patients with bulimia tend to binge because they cannot control their desire to eat. After eating, they will “purge” in an effort to lose weight. Sometimes they will eat the food rapidly without even chewing properly, or hide from others when they are eating. These behaviors occur at least twice a week for more than three months in a bulimia diagnosis. These patients will immediately regret eating afterward, so will make efforts to lose weight by inducing vomiting, using laxatives or diuretics, or becoming obsessed with exercising.
These patients also are conscious of their weight because they often think that they are overweight. Most bulimic patients tend to maintain a normal body weight despite repeated episodes of binge eating, but some may be underweight, or slightly overweight.
Causes and complications
Induced, repeated vomiting or use of diuretics can cause an electrolyte imbalance, hypokalemia or hyponatremic alkalosis. In a small number of patients, repeated vomiting can lead to tearing of the esophagus or the stomach. These patients often also tend to suffer from depression, personality disorders, problems controlling their impulses, or medication misuse. On the other hand, anorexic patients go on extreme diets to lose weight, and develop hair loss, hypothermia and dry skin due to their limited food intake. They may also develop kidney or heart problems due to an electrolyte imbalance.
Bulimia is thought to be related to problems with the neurotransmitters, including serotonin, norepinephrine and endorphins. In fact, the use of medications that correct these neurotransmitters can improve the symptoms. Bulimic patients often are goal-driven and frequently have anger-management issues, causing relationship issues with others. They often have mixed feelings (love and hate) toward those close to them, and have psychological stress when separated from them, which is thought to contribute to their bulimic symptoms. Many patients also have depression and may have a family history of depression. Therefore eating disorders are thought to be closely related to mood disorders such as depression.
One way of treating bulimia is pharmacologically ― using selective serotonin reuptake inhibitor antidepressants. However, some patients may not respond to pharmacological treatment. Other psychotherapies such as cognitive behavioral therapy that aims to correct abnormal behaviors, or combined CBT and pharmacological treatment can be used. If symptoms are severe, a short hospitalization may be required. Nutrition and diet education is also important for these patients. They should be provided with appropriate education on having a balanced diet. It is also beneficial to educate the patient’s families and housemates on nutrition and eating behaviors.
By Jeon Hong-jin
The author is a psychiatrist at Samsung Medical Center in Seoul who also lectures at Sungkyunkwan University’s school of medicine. ― Ed.