Bulimia nervosa is a complex condition of binging and purging that turns a biological necessity into a destructive force. Well over six million people in the U.S. experience this disorder. Though there is plenty of research describing bulimia as a primarily psychological disorder, evidence suggests that the relationship may have multiple factors. Science still has a lot to learn about how the disorder affects all aspects of health and the myriad ways it manifests.
Frequent vomiting not only damages the enamel, color, and shape of teeth but also the soft palate in a couple of ways. First, it becomes red and scratched by the persistent exposure to stomach acid and fingers or fingernails during the purging process. Additionally, those with bulimia may develop temporomandibular joint or TMJ disorders, which includes painful, degenerative arthritis of the jaw hinges. TMJ makes it hurt to chew and may lead to chronic headaches in addition to neck and shoulder pain.
Follicle-stimulating hormone, FSH, stimulates the growth of an egg-producing follicle during ovulation. Bulimia compromises this process because people with the disorder have lower estrogen levels, which throws their bodies into metabolic imbalance. Fertility lowers because of the body's imbalanced estrogen levels leading to lower FSH and luteinizing hormone (LH), another chemical whose rise triggers ovulation.
The flipside of having lower estrogen levels is that many patients with bulimia present with higher testosterone levels, which could be a catalyst for the binge-purge cycle. Scientists believe that too much testosterone causes cravings for nutritionally dense food loaded with sugar and fat, as well as constant hunger. This leads those with bulimia to binge on those foods, feel guilty, and purge, only to eventually succumb to those cravings again. This theory lends credence to the belief that some forms of bulimia may be the result of a metabolic disorder, not just psychology.
While many researchers have investigated the psychology and neurobiology behind bulimia, a molecular cause could also explain the disorder. Doctors have isolated the ClpB protein produced by E. coli as a possible culprit behind bulimia and other eating disorders. This bacteria protein seems to have a significant influence on food intake and emotions, such as anxiety, in people with eating disorders, although more research is needed to understand its role in the disorder.
Separation anxiety disorder causes individuals to experience anxiety when separated from home or loved ones, and overanxious disorder is the tendency of children to excessively worry or become anxious. Both disorders, which have genetic links, were highlighted in a 2005 study as a common association between juvenile twin girls who developed eating disorders. While multiple factors determine the manifestation of an eating disorder, anxiety and depression disorders in childhood could raise the risk of developing bulimia in later adolescence.
Approximately half of women with bulimia do not have periods, which makes getting pregnant difficult. When they do get pregnant, they have higher risks of miscarriage, stillbirth, and fetal death. One of the reasons why these women develop pregnancy complications is because the laxatives and diuretics many women with bulimia continue to take deprive the fetus of necessary nutrients and fluids. The result is poor fetal development and abnormalities.
Anorectal complications are clinically associated with bulimia. Because of the continuous laxative use, those with bulimia can experience the rectum wall pushing through the anus. Rectal prolapse is an uncommon, painful condition that could also occur because of the repeated intra-abdominal pressure exerted during forced vomiting. Untreated rectal prolapse can lead to a leaky or damaged rectum, and treatment usually requires surgery.
While stopping bulimia is the objective, it is important to wean the body off any laxatives or diurectics the individual is consuming rather than stop suddenly because the latter can be dangerous. Pseudo Bartter syndrome is a complication from stopping cold turkey, and its most dangerous side effect is hypokalemia or low potassium, which creates a potassium electrolyte imbalance that could trigger a sudden cardiac event.
The majority of people with bulimia are women, but in the U.S., between 1.5 and two million men deal with the disorder as well. Research indicates male athletes who participate in weight-dependent sports are more likely to develop bulimia, and it often remains undetected. The psychology is partly cultural, and they may engage in other types of purging behavior, such as excessive exercise and chronic macronutrient manipulation, in addition to or in place of regular purging behavior.
In rare instances, purging can have fatal consequences. Chronic dehydration from regular purging [and] causes a drop in water content in the blood, thickening it. The heart has to work harder to pump thicker blood, causing the organ to become distended while heart rate and blood pressure climb to dangerous levels. All of this puts the heart at risk of deadly arrhythmias.
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