Changing lifestyles, confusion over body image and issues with over-weight, and the bid to shed it as fast as possible, have led to a rise in the cases of eating disorders like bulimia. There are those who go on an excessive exercise and fasting spree to shed the added weight, while others are seen inducing vomiting or using laxatives to get rid of the weight. Dr I. Bharat Kumar Reddy, senior consultant pyschiatrist at Apollo Hospitals explains that both types are harmful and life-threatening and call for a lot of counselling and family support. The disease had to do more with the state of mind when looking at one’s body and that of those around them, he explains, as he answers some FAQs on the subject.

Why is bulimia on the rise?
Eating disorders per se were Western disorders. However due to changes in lifestyle, increased stress, cultural changes due to Western influence there is an identity crisis and confusion. The idea of beauty is defined by its shape and the presentation of looks which are accepted and applauded by the society in general. Due to this reason we are seeing women (mostly) becoming paranoid with their weight issues and there is a frantic state of mind where the weight is always a concern. This is one of the major reasons for the rise of eating disorders like bulimia.





Why do young teenagers binge eat and then induce vomiting thinking that they will put on weight?
It is the concept of ‘thin is beautiful’ that gets hammered into young minds that makes them psychologically vulnerable. Ironically, we are now seeing that more middle-aged women are competing to look thin. There is very little consideration given to hormonal changes and respect to the ageing body. These are resulting in confusion, depression and also low self-esteem in many of those who are on the overweight side. While obesity is a medical issue, it has to be treated and dealt with in a different light. But being fit and healthy is different from being fat and unhealthy. One type does not fit all is not being understood in our society.

How will this affect the digestive system in the short and long run?
In the short run it causes heartburn, inflamed oesophagus, and burping. In long run it causes indigestion, gastritis, Malory Weiss tear, hiatus hernia, and, in those who have not sought medical help, there are cases of sudden death. Women suffer from this disorder 15 times more than men.

How does this disorder impact the immune system?
Induced vomiting and using of laxatives affects the gut lining. Due to this reason there is mal-absorption of food as food absorption is affected at macro and micro levels. This in turn leads to water-electrolyte imbalance. The continuous nature of this disorder suppresses the immune system and makes the body susceptible to diseases. It has been found that viral fevers in these types of patients are more debilitating than they would have otherwise been.

Does it lead to acidic reaction in the body and the oesophagus as the food is rolled out?
Forced vomiting is found to cause acidic reaction in the stomach and oesophagus. The problem of acid reflux in these patients is also very high.

How can this disorder be treated? Does treatment ensure that it does not occur again?
Treatment is always tailor-made for each individual. The pharmaco-therapy part includes use of anti depressants, anxiolytics and sometimes low dose anti psychotics. Over the long term, behavioural therapy, psychotherapy, psycho-education and family therapy help.

Does the patient also require psychological counselling?
Yes the patient needs counselling in most cases. Behavioural counselling therapy is required for a long period of time in the first episode and also after relapse. This is a major part of the treatment apart from medication. The support of family members in these patients has to be very strong. Often it has been found that the patients believe that they are perfectly fine but the family has to check on them regularly. This is because there is relapse and that would mean that they must opt for medical and mental advice again.