EATING DISORDER MANUSCRIPT

Overview

Eating disorders are serious health conditions that affect both your physical and mental
health. These conditions include problems in how you think about food, eating, weight
and shape, and in your eating behaviors. These symptoms can affect your health, your
emotions and your ability to function in important areas of life.

Eating disorders are characterized by severe and persistent disturbance in eating

behaviors and associated distressing thoughts and emotions. They can be very serious
conditions affecting physical, psychological and social function.

If not treated effectively, eating disorders can become long-term problems and, in some
cases, can cause death. The most common eating disorders are anorexia, bulimia and
binge-eating disorder.

Most eating disorders involve focusing too much on weight, body shape and food. This
can lead to dangerous eating behaviors. These behaviors can seriously affect the ability
to get the nutrition your body needs. Eating disorders can harm the heart, digestive
system, bones, teeth and mouth. They can lead to other diseases. They're also linked
with depression, anxiety, self-harm, and suicidal thoughts and behaviors.

Types of Eating Disorders

Anorexia Nervosa

 Anorexia nervosa is characterized by self-starvation and weight loss resulting in

low weight for height and age. Anorexia has the highest mortality of any
psychiatric diagnosis other than opioid use disorder and can be a very serious
condition. Body mass index or BMI, a measure of weight for height, is typically
under 18.5 in an adult individual with anorexia nervosa.
 Dieting behavior in anorexia nervosa is driven by an intense fear of gaining
weight or becoming fat. Although some individuals with anorexia will say they
want and are trying to gain weight, their behavior is not consistent with this intent.
For example, they may only eat small amounts of low-calorie foods and exercise
excessively. Some persons with anorexia nervosa also intermittently binge eat
and or purge by vomiting or laxative misuse.1

There are two subtypes of anorexia nervosa:

 Restricting type, in which individuals lose weight primarily by dieting, fasting or

excessively exercising.
 Binge-eating/purging type in which persons also engage in intermittent binge
eating and/or purging behaviors.

Restricting type
People with this type of anorexia nervosa restrict the amount and type of food they eat.

This can include:

 counting calories
 skipping meals
 limiting or avoiding certain food groups (such as carbohydrates)
 following obsessive rules, such as only eating foods of a certain colour

These behaviours may be accompanied by too much exercise.

Binge eating/purging type

People with this type of anorexia place severe restrictions on the food they eat and they
also purge. Purging behaviours include vomiting (being sick) or misusing laxatives,
diuretics or enemas.

Some people may also binge eat — eat a large amount of food and feel out of control.

some of the following symptoms may develop related to starvation or purging behaviors:

 Menstrual periods cease

 Dizziness or fainting from dehydration
 Brittle hair/nails
 Cold intolerance
 muscle weakness and wasting
 Heartburn and reflux (in those who vomit)
 Severe constipation, bloating and fullness after meals
 Stress fractures from compulsive exercise as well as bone loss resulting in
osteopenia or osteoporosis (thinning of the bones)
 Depression, irritability, anxiety, poor concentration and fatigue

 What causes Anorexia?

 For this reason, the exact cause of anorexia is unknown, but research suggests
that there are certain factors that may be involved in developing anorexia include:
 Genetics:
 Explanation: Research suggests that approximately 50% to 80% of the risk of
developing an eating disorder is genetic. People with first-degree relatives
(siblings or parents) with an eating disorder are 10 times more likely to develop
an eating disorder, which suggests a genetic link.
 Trauma:
 Explanation: Many experts believe that eating disorders, including anorexia, are
caused by people attempting to cope with overwhelming feelings and painful
emotions by limiting food. Physical abuse or sexual assault, for example, can
contribute to some people developing an eating disorder.
 Environment and culture:
  Explanation: Cultures that idealize a particular body type — usually “thin” bodies
— can place unnecessary pressure on people to achieve unrealistic body
standards. Popular culture and images in media and advertising often link
thinness to popularity, success, beauty and happiness. This may contribute to
someone developing anorexia.
 Peer pressure:
 Explanation: Particularly for children and adolescents, peer pressure can be a
very powerful force. Experiencing teasing, bullying or ridiculing because of
appearance or weight can contribute to the development of anorexia.

Serious medical complications can be life threatening and include heart rhythm
abnormalities especially in those patients who vomit or use laxatives, kidney problems
or seizures.

Treatment for anorexia nervosa involves helping those affected normalize their eating
and weight control behaviors and restore their weight. Medical evaluation and treatment
of any co-occurring psychiatric or medical conditions is an important component of the
treatment plan. The nutritional plan should focus on helping individuals counter anxiety
about eating and practice consuming a wide and balanced range of foods of different
calorie densities across regularly spaced meals. For adolescents, the and emerging
adults, most effective treatments involve helping parents to support and monitor their
child's meals. Addressing body dissatisfaction is also important but this often takes
longer to correct than weight and eating behavior.

Bulimia Nervosa

Bulimia nervosa is an eating disorder that causes you to eat large amounts of food at
one time (binge) and then get rid of it (purge). The physical, behavioral and emotional
symptoms vary. The exact cause of bulimia is unknown — it may be a combination of
genetic factors and learned behaviors. Education and symptom awareness may prevent
bulimia.

Bulimia nervosa, also called bulimia, is an eating disorder. Eating disorders are mental
health conditions that can be potentially life-threatening. If you have an eating disorder,
you may have an obsession with food and weight. This obsession can harm your
physical and emotional well-being.

Bulimia nervosa can be defined as a pattern of eating characterized by:

1. Consuming an unusually large amount of food in a short period of time (binge

eating).
2. Getting rid of the food (purging). Purging may involve making yourself throw up
(vomiting) or taking laxatives. Laxatives are medications that speed up the
movement of food through your body.
Other characteristics of bulimia nervosa may include:

 Misuse of water pills (diuretics) or diet pills.

 Eating very little or not at all (fasting).
 Excessively exercising.
 Hiding food to binge and purge later.

People with bulimia are usually at a normal, healthy weight. But they judge themselves
harshly based on their view of their body shape and/or weight. They usually have self-
esteem issues closely linked to their body image.

Bulimia can lead to rare but potentially fatal complications including esophageal tears,
gastric rupture, and dangerous cardiac arrhythmias. Medical monitoring in cases of
severe bulimia nervosa is important to identify and treat any possible complications.

Outpatient cognitive behavioral therapy for bulimia nervosa is the treatment with the
strongest evidence. It helps patients normalize their eating behavior and manage
thoughts and feelings that perpetuate the disorder. Antidepressants (e.g. fluoxetine) can
also be helpful in decreasing urges to binge and vomit. Eating disorder focused family
based treatment which involves providing caregivers with information on how to assist
an adolescent or young adult to normalize their eating pattern may also be helpful in the
treatment of young people with bulimia nervosa.

What causes Bulimia?

The exact cause of bulimia nervosa isn’t known. But researchers think it may be a
combination of:

Genetics and learned behaviors.

 Explanation: If you have a relative that has or had an eating disorder, you're at a
higher risk of developing one yourself.

Popular culture and the media

 Explanation: This put pressure on people to have a certain body type. These
outside influences can affect your body image and self-esteem. Popular culture
and images in media and advertising often link thinness to popularity, success,
beauty and happiness.

Feeling stressed, upset or out of control

 Explanation: When you may have trouble managing your emotions in a healthy
way and use eating as an emotional release which can all to bulimia.

What’s the difference between bulimia nervosa and anorexia nervosa?

People with bulimia nervosa usually have a normal weight. They engage in a cycle of
binging and purging. People with anorexia nervosa are usually underweight. They
engage in self-starvation, extreme diets and extreme exercise to lose weight. People
with anorexia nervosa think they’re fat even though they’re very thin. They may get so
thin they look sick.

Pica

Pica is an eating disorder in which a person repeatedly eats things that are not food with
no nutritional value. The behavior persists over at least one month and is severe
enough to warrant clinical attention.

Typical substances ingested vary with age and availability and might include paper,
paint chips, soap, cloth, hair, string, chalk, metal, pebbles, charcoal or coal, or clay.
Individuals with pica do not typically have an aversion to food in general.

The behavior is inappropriate to the developmental level of the individual and is not part
of a culturally supported practice. Pica may first occur in childhood, adolescence, or
adulthood, although childhood onset is most common. It is not diagnosed in children
under age 2. Putting small objects into their mouth is a normal part of development for
children under 2. Pica often occurs along with autism spectrum disorder and intellectual
disability, but can occur in otherwise typically developing children.

A person diagnosed with pica is at risk for potential intestinal blockages or toxic effects
of substances consumed (e.g. lead in paint chips).

Treatment for pica involves testing for nutritional deficiencies and addressing them if
needed. Behavior interventions used to treat pica may include redirecting the individual
from the nonfood items and rewarding them for setting aside or avoiding nonfood items.

•Pica can cause other conditions or issues, which have their own sets of symptoms.
Other conditions that can happen because of pica include:

 Anemia (low iron).

 Ascariasis (roundworm infection).
 Constipation.
 Electrolyte imbalance.
 Irregular heart rhythms (arrhythmias).
 Lead poisoning.
 Small intestine and large intestine obstruction/blockage.

A nurse should employ different management techniques such as: •promoting a safe
environment by removing non-edible items
•impeding access to harmful substances •providing patient education regarding healthy
and harmful substances for consumption.

•Bulimia nervosa can be hard to spot. People with the condition often binge and purge
privately. But empty food wrappers and laxative packaging can be warning signs of
bulimia.

What causes Pica?

Experts don’t know exactly why pica happens. However, researchers know certain
factors increase the risk of developing it.

Cultural or learned behaviors.

Explanation: Certain types of pica are common, socially accepted behaviors in certain
cultures and religions. A religious example of this is the practice of eating dirt at El
Santuario de Chimayó, a Roman Catholic shrine in New Mexico, USA. A cultural
example of this commonly happens in cities in the country of South Africa, where it’s a
common practice among young women.

Stress or anxiety.

Explanation: Pica might be an outlet or coping mechanism for people with these issues.

Negative conditions during childhood.

Explanation: Pica is more common in children living in low socioeconomic situations

(such as poverty), but why this happens is unknown.

Nutritional deficiencies.

Explanation: People who show signs of pica often have mineral or other deficiencies in
their diet. Iron (anemia), calcium and zinc deficiencies are some of the most common
reasons people show these signs.

Mental health conditions.

Explanation: These include conditions they had at birth because of disruptions in how
they developed in the womb and genetic disorders they inherited from their parents.

Other behavioral and emotional symptoms of bulimia nervosa include:

 Frequent visits to the bathroom, particularly after meals.

 Excessive exercising.
 Preoccupation with body image.
 Intense fear of gaining weight.
 Depression, anxiety or substance abuse.
  Feeling out of control.
 Feeling guilty or shameful about eating.
 Withdrawing socially from friends and family.

PREVALENCE:

Eating disorders affect several million people at any given time, most often women
between the ages of 12 and 35.

•According to global data, the lifetime occurrence of anorexia nervosa is between 0.3%
to 1.5% in females and 0.1% to 0.5% in males.

•Based on information from the National Eating Disorders Association, research

indicates that the prevalence of bulimia nervosa varies among different populations. It is
estimated that between 1.1% and 4.6% of females and 0.1% to 0.5% of males will
develop bulimia nervosa at some point in their lives.

•The Handbook of Clinical Child Psychology currently estimates that prevalence rates
of pica range from 4%-26% among institutionalized populations

There are several types of eating disorders.

Laboratory Examination

Labs and Tests

While there is no one specific lab test to confirm an eating disorder diagnosis, there are
some tests your healthcare provider may request to check your overall health.

Ruling Out Underlying Conditions

Your healthcare provider will want to make sure you don’t have an underlying health
condition triggering your eating disorder or something caused by an eating disorder.

Lab Work

Your healthcare provider will likely want a blood test to check your complete blood count
(CBC), along with your:

Electrolytes

Electrolytes are electrically charged minerals that help control the amount of fluids and
the balance of acids and bases in your body. They also help control muscle and nerve
activity, heart rhythm, and other important functions. An electrolyte panel, also known as
a serum electrolyte test, is a blood test that measures levels of the body's main
electrolytes:
Sodium, which helps control the amount of fluid in the body. It also helps your nerves
and muscles work properly.

Chloride, which also helps control the amount of fluid in the body. In addition, it helps
maintain healthy blood volume and blood pressure.

Potassium, which helps your heart and muscles work properly.

Bicarbonate, which helps maintain the body's acid and base balance. It also plays an
important role in moving carbon dioxide through the bloodstream.

Abnormal levels of any of these electrolytes can be a sign of a serious health problem,
including kidney disease, high blood pressure, and a life-threatening irregularity in heart
rhythm.

Other names: serum electrolyte test, lytes, sodium (Na), potassium (K), chloride (Cl),
carbon dioxide (CO2)

What is it used for?

An electrolyte panel is often part of a routine blood screening or a comprehensive

metabolic panel. The test may also be used to find out if your body has a fluid
imbalance or an imbalance in acid and base levels. Electrolytes are usually measured
together. But sometimes they are tested individually. Separate testing may be done if a
provider suspects a problem with a specific electrolyte.

Liver function

Liver function tests are blood tests used to help find the cause of your symptoms and
monitor liver disease or damage. The tests measure the levels of certain enzymes and
proteins in your blood.

Some of these tests measure how well the liver is performing its regular functions of
producing protein and clearing bilirubin, a blood waste product. Other liver function tests
measure enzymes that liver cells release in response to damage or disease.

Kidney function

Kidney function tests are urine or blood tests that evaluate how well your kidneys are
working. Most of these tests measure glomerular filtration rate (GFR). GFR assesses
how efficiently your kidneys clear waste from your system.

What are the types of kidney function tests?

Your healthcare provider may order one or a few different types of kidney function tests.
You may have blood tests for kidney function, such as:

Blood urea nitrogen (BUN) measures nitrogen (made from protein breakdown) in your
blood.

Estimated GFR (eGFR) calculates filtration rates based on your protein levels, age,
gender, size and race.

Serum creatinine looks for the buildup of creatinine, a waste product from muscle tissue
breakdown.

Your healthcare provider may also use 24-hour urine tests, including:

Microalbuminuria looks for a specific protein called albumin.

Urinalysis evaluates your urine for blood, proteins and function.

Thyroid function

These labs are essential to check your overall health.

Thyroid Function

Checking the thyroid is important since it affects so many parts of the body and can
cause you to lose or gain weight quickly. It’s also possible your thyroid function is being
impacted by an eating disorder, creating a bigger problem.2

The results from these tests will help your healthcare provider determine if you have:

Anemia

Dehydration

Malnutrition

Electrolyte abnormalities

X-ray

In some cases, your healthcare provider might request an X-ray because eating
disorders are a factor for low bone density.

If this is the case, it is easier for you to break a bone or possibly have osteoporosis.
Electrocardiogram (ECG)

Many people with an eating disorder will have an electrocardiogram (ECG) done to
check the rhythm of their heart.

Someone with an eating disorder is at high risk for having a heart that doesn’t beat with
a regular rhythm.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with eating disorders may
include:

1. Promoting Adequate Nutrition

Patients with anorexia and bulimia nervosa may use laxatives to control their weight,
leading to inadequate nutrient absorption and less than body requirements. Inadequate
food intake in anorexia nervosa can also result in nutrient deficiencies and imbalanced
nutrition. Both conditions can have significant physical and emotional consequences
that require professional treatment.

For Bulimia Nervosa:

Identify the patient’s elimination patterns.

To prevent self-induced vomiting.

Assess her suicide potential.

Among patients with bulimia nervosa, warning signs include having more co-morbid
psychiatric symptoms and reporting a history of sexual abuse.

Outline the risks of laxative, emetic, and diuretic abuse for the patient.

Bulimic patients may include abuse laxatives, emetics, and diuretics.

Supervise the patient during mealtimes and for a specified period after meals (usually
one hour).

Prevents vomiting during or after eating.

For Anorexia Nervosa:

Supervise the patient during mealtimes and for a specified period after meals (usually
one hour).

To ensure compliance with the dietary treatment program. For a hospitalized patient
with anorexia, food is considered a medication.

Liquids are more acceptable than solids.

Fluids eliminate the need to choose between foods – something the patient with
anorexia may find difficult.

Expect weight gain of about 1 lb (0.5 kg) per week.

To see the effectiveness of the treatment regimen.

If edema or bloating occurs after the patient has returned to normal eating behavior,
reassure her that this phenomenon is temporary.

She may fear that she’s becoming fat and stop complying with the plan of treatment.

Assessment and Diagnostic Findings

The following diagnostic tests and assessment cues are commonly used for patients
suspected of eating disorders:

Physical and mental status evaluation. Individuals’ physiological condition, including

weight, vital signs, and potential physical complications, as well as their psychological
well-being, assessing factors like body image, mood disturbances, and cognitive
distortions related to eating and food.

Complete blood count (CBC). The hemoglobin levels are typically normal, although
elevations are observed in states of dehydration; the white blood cell count (WBC) is
typically low due to increased margination, and thrombocytopenia is also observed.

Blood chemistries. Hyponatremia (reflects excess water intake or the inappropriate

secretion of antidiuretic hormone), hypokalemia (results from diuretic or laxative use),
hypoglycemia (results from the lack of glucose precursors in the diet or low glycogen
stores; low blood glucose may also be due to impaired insulin clearance), elevated
blood urea nitrogen (renal function is generally normal except in patients with
dehydration, in whom the BUN level may be elevated), Hypokalemic hypochloremic
metabolic alkalosis (observed with vomiting), acidosis (observed in cases of laxative
abuse).

Liver function tests. Liver function test results are minimally elevated, but levels
encountered in patients with active hepatitis are not observed; albumin and protein
levels are usually normal, because although the amount of food intake is restricted, it
usually contains high-quality proteins.

Medical Management

Medical management focuses on weight restoration, nutritional rehabilitation,

rehydration, and correction of electrolyte imbalances.

Nutritional rehabilitation and weight restoration. Clients receive nutritionally balanced

meals and snacks that gradually increase caloric intake to a normal level for size, age,
and activity.

Family-based therapy. Individuals with anorexia nervosa may respond best to family-
based treatment, also known as the Maudsley method, an established therapeutic
modality for achieving and maintaining remission from anorexia nervosa.

The goals of the Maudsley method act as three treatment phases. They are:

 Helping the person regain any weight they need to.

 Helping the person learn new eating habits.
 Establishing a secure sense of self.

Cognitive behavioral therapy (CBT). CBT is an evidence-based, effective treatment for

bulimia nervosa (BN); behavioral approaches to avoiding undesirable eating habits are
used, including diary keeping; behavioral analyses of the antecedents, behaviors, and
consequences (so-called ABCs) associated with binge eating and purging episodes;
and exposure to food paired with progressive response prevention regarding binge
eating and purging.

In CBT, you’ll work with your therapist to identify the thinking patterns that cause your
distress. This is an important step in managing overwhelming emotions and unhelpful
behaviors. Though many people think therapy is just chatting with a doctor, CBT is
actually very structured and tailored to each person.

Interpersonal psychotherapy. Interpersonal psychotherapy (IPT) addresses specific

issues in the interpersonal arena that create the context for and stimulate dynamic
tensions that spur the patient’s symptoms; these generally encompass such processes
as grief, role transitions, role conflicts or disputes, and interpersonal deficits.

IPT is designed to help you manage acute mood symptoms and improve interpersonal
skills.

This type of therapy is based on a medical model of depression. This means that clinical
depression is viewed as a biological predisposition, and interpersonal challenges are
thought of as triggers.
In this sense, IPT stresses that depression and other mood disorders are never your
“fault.” Instead, it’s believed that you might have an inherited or biological tendency to
experience these symptoms.

Stressful life events, like interpersonal conflict, may activate them.

Dialectical behavior therapy (DBT)

DBT is a type of CBT originally developed for borderline personality disorder. It’s now
also used to treat eating disorders and some other mental health conditions like
depression and PTSD.

“Dialectical” in DBT refers to the combining of two opposites. In therapy, this means you
learn to integrate acceptance and change.

One older study found that DBT helped teens with anorexia reduce their eating disorder
symptoms.

Acceptance and commitment therapy (ACT)

ACT was designed to increase mental flexibility using acceptance and mindfulness
strategies, along with commitment and behavior-changing strategies.

ACT uses six core values:

 acceptance
 cognitive defusion (learning to manage uncomfortable thoughts and feelings)
 present-moment awareness
 self-as-context (knowledge that people aren’t their thoughts and feelings)
 values
 committed action

Though research on ACT for anorexia is ongoing, studies have found that ACT helps
people manage behaviors related to eating disorders. But more research is needed to
verify the long-term effects of ACT on anorexia.

Nursing Management for Eating Disorders

Nursing care for a client with an eating disorder includes the following:

Nursing Assessment

Although anorexia and bulimia have several differences, many similarities are found
when assessing.
History. Family members often describe clients with anorexia nervosa as perfectionists
with above-average intelligence, achievement-oriented, dependable, eager to please,
and seeking approval before their condition began; clients with bulimia, however, often
have a history of impulsive behavior such as substance abuse, shoplifting, as well as
anxiety, depression, and personality disorders.

General appearance and motor behavior. Clients with anorexia appear slow, lethargic,
and fatigued; they may be emaciated depending on the amount of weight loss; clients
with bulimia may be underweight or overweight but are generally close to expected
body weight for age and size.

Mood and affect. Clients with eating disorders have labile moods that usually
correspond to their eating or dieting behaviors.

Thought processes and content. Clients with eating disorders spend most of their time
thinking about dieting, food, and food-related behavior.

Self-concept. Low self-esteem is prominent in clients with eating disorders.

Pharmacologic Treatment

There’s no such thing as “anorexia medication.” In fact, the American Psychological

Association doesn’t recommend medication as the main treatment for anorexia
symptoms. But depending on your symptoms, medication could be part of your
treatment plan.

In some cases, antidepressants such as fluoxetine (Prozac) could help prevent

anorexia from coming back when you’re in recovery. Antidepressants can also help with
symptoms of depression or obsessive-compulsive disorder (OCD), which may come
with anorexia.

Some medications used for schizophrenia and mood disorders could also help with
anorexia. For example, evidence suggests that olanzapine (Zyprexa) may help people
with anorexia regain weight that’s healthy for them.

In addition, medications used to manage the medical complications of anorexia — such

as anemia, constipation, and osteoporosis — may be prescribed based on your needs.

Some medications aren’t recommended for people with anorexia. One of these is
bupropion (Wellbutrin), which is often used for depression and smoking cessation.
Wellbutrin is linkedTrusted Source to a higher risk of seizures for people with anorexia.

Fluoxetine

Fluoxetine, sold under the brand name Prozac, among others, is an antidepressant of
the selective serotonin reuptake inhibitor (SSRI) class. It is used for the treatment of
major depressive disorder, obsessive–compulsive disorder (OCD), anxiety, bulimia
nervosa, panic disorder, and premenstrual dysphoric disorder. It is also approved for
treatment of major depressive disorder in adolescents.
Olanzapine

Atypical antipsychotic used for the treatment of acute mania, schizophrenia, and other
psychotic disorders in adults
Olanzapine (sold under the trade name Zyprexa among others) is an atypical
antipsychotic primarily used to treat schizophrenia and bipolar disorder. For
schizophrenia, it can be used for both new-onset disease and long-term maintenance. It
is taken by mouth or by injection into a muscle.
PATHOPHYSIOLOGY
BULIMIA

Pathophysiology of Bulimia Nervosa: A Complex Interplay of Factors

Bulimia nervosa is a serious eating disorder characterized by recurrent episodes of

binge eating followed by inappropriate compensatory behaviors like self-induced
vomiting, laxative misuse, or excessive exercise. While the exact cause remains
unknown, understanding the pathophysiology, or the biological processes involved,
can offer valuable insights into this complex condition.
Key areas of focus:
1. Gastrointestinal System:
 Binge eating: During binges, large amounts of food overwhelm the digestive
system, leading to hormonal imbalances and altered gut motility. This can
contribute to feelings of fullness, discomfort, and bloating, further perpetuating
the binge-purge cycle.
 Purging behaviors: Self-induced vomiting can cause esophageal tears, dental
erosion, and electrolyte imbalances, particularly potassium deficiency, leading to
cardiac complications. Laxative misuse disrupts fluid and electrolyte balance,
causing dehydration and potential organ damage.
2. Neurotransmitters:
 Dopamine: Binge eating releases dopamine, a pleasure-inducing
neurotransmitter, creating a "reward" system that reinforces the behavior.
 However, over time, dopamine sensitivity decreases, necessitating larger binges
to achieve the same effect.
 Serotonin: Dysregulation of serotonin, involved in mood and appetite regulation,
contributes to impulsivity, anxiety, and cravings, potentially triggering binges as a
coping mechanism.
3. Brain Circuits:
 Reward system: Altered activity in the brain's reward circuitry makes individuals
more susceptible to seeking pleasure through food and less responsive to natural
satiety cues, leading to bingeing.
 Stress response: The stress response system, involving the hypothalamus and
amygdala, may be overactive in people with bulimia, leading to increased cortisol
levels and emotional eating.
4. Genetic Predisposition:
 Twin and family studies suggest a genetic component to bulimia, though specific
genes have not been pinpointed. Genetic vulnerability interacts with
environmental factors like stressful life events or cultural pressures to increase
susceptibility.
It's important to remember:
 The pathophysiology of bulimia is complex and multifaceted, involving a
combination of biological, psychological, and social factors.
 No single factor is solely responsible for the development or maintenance of the
disorder.
 Understanding the pathophysiology is crucial for developing effective treatment
strategies that address the biological, psychological, and social aspects of
bulimia nervosa.
If you or someone you know is struggling with bulimia nervosa, please seek
professional help from a qualified healthcare provider or mental health professional.
Early intervention and evidence-based treatment can significantly improve outcomes
and quality of life.