Bulimia Nervosa and Epilepsy

By:  Catherine Joachin

Photo Credit: www.depositphotos.com

What is bulimia nervosa?

Bulimia nervosa is an eating disorder characterized by uncontrollable episodes of binge eating followed by periods of purging (Mayo Clinic, 2024). Purging refers to the act of forcefully expelling food from the body through self-induced vomiting or the misuse of laxatives and other medications in an attempt to avoid weight gain (Johns Hopkins Medicine., n.d.). Non-purging behaviors such as fasting and excessive exercise to limit calories may also indicate bulimia (Johns Hopkins Medicine., n.d.).

Symptoms and Causes

Like other eating disorders, bulimia nervosa is rooted in a harmful obsession with food and weight and can impair emotional and physical well-being (Cleveland Clinic, 2024). A commonly reported symptom of bulimia involves experiencing a loss of control over eating behavior while bingeing, where consuming excessively large amounts of food in a short period of time can make people feel like they cannot stop eating (Mayo Clinic, 2024).

Other behavioral and emotional symptoms associated with bulimia include anxiety, depression, social withdrawal, substance abuse, a propensity towards extreme mood swings, and a dissatisfaction over body shape and weight, which can negatively impact perception of self-worth (Cleveland Clinic, 2024; Mayo Clinic, 2024). Additionally, bingeing, purging, and other eating rituals are often performed in secret out of shame or guilt about eating (Cleveland Clinic, 2024).

Physical signs that someone might be experiencing bulimia include:

  • Unusual weariness
  • Muscle weakness
  • Dehydration
  • Irregular menstruations or lack of periods
  • Bloodshot eyes
  • Gastrointestinal problems
  • Damaged teeth or gums. These can be caused by tooth enamel erosion from vomiting.
  • Swollen cheeks and jaw
  • Sores, scrapes, or calluses on the knuckles (also a sign of repeated self-induced vomiting).
  • Sore, inflamed throat

(Cleveland Clinic, 2024; Johns Hopkins Medicine., n.d.; Mayo Clinic, 2024).

While girls are more likely to develop this condition in their teenage years, bulimia can affect anyone regardless of age and gender (Johns Hopkins Medicine., n.d.). Moreover, people with a family history of eating disorders, illness, and mental health issues are more likely to experience bulimia (Johns Hopkins Medicine., n.d.). The exact cause of this condition is unknown; however, a combination of genes and societal pressures seems to play a role in the development of bulimia nervosa as well as other eating disorders (Mayo Clinic, 2024).

Bulimia may lead to severe health complications, some of which can be life-threatening.

  • Stomach rupture
  • Heart failure
  • Tooth decay and gum disease
  • Kidney failure
  • Intestinal damage
  • Inflamed esophagus
  • Mental health problems (e.g., bipolar disorder, personality disorder, substance misuse)
  • Poor nutrition
  • Suicidal behavior

(Johns Hopkins Medicine., n.d.; Mayo Clinic, 2024).

Prevention and diagnosis

Encouraging discussions on nutrition and healthy body image, addressing mental health concerns, and seeking treatment for early signs of unhealthy eating patterns may help prevent the development of bulimia and further complications (Mayo Clinic, 2024).

In order to receive appropriate care, patients need to be open about eating habits and physical and mental symptoms (Mayo Clinic, 2024). Healthcare providers may administer a physical exam, request a mental evaluation, and run blood and urine tests to determine the underlying causes of symptoms (Cleveland Clinic, 2024). For a diagnosis to qualify as bulimia nervosa, someone has to have experienced bingeing-purging cycles at least once a week for three months (Mayo Clinic, 2024). More frequent episodes indicate a more severe condition (Mayo Clinic, 2024).

Treatment

Treatment options include antidepressant medication, nutritional counselling, and psychotherapy, notably enhanced cognitive behavioral therapy (CBT-E), family-based treatment (FBT), or dialectical behavioral therapy, which elicit a reduction of symptoms in people with bulimia (Mayo Clinic, 2024). In the United States, fluoxetine (Prozac) is currently the only FDA-approved antidepressant to treat bulimia (Mayo Clinic, 2024). Drug administration produces more effective results when combined with talk therapy (Mayo Clinic, 2024). Healthcare providers may also refer patients to a dietitian to address nutritional problems and help them along their recovery (Johns Hopkins Medicine., n.d.). Severe cases may require patients to be treated in a hospital (Mayo Clinic, 2024).

How does bulimia affect the lives of people with epilepsy?

Very little research has been done on the relationship between eating disorders and epilepsy. Research shows that teenagers with epilepsy were more likely to develop symptoms associated with an eating disorder (Kolstad et al., 2018; Latzer et al., 2023). Latzer et al. (2023) found that while anorexia nervosa was determined to be the most prevalent eating disorder in this cohort, a dual diagnosis of epilepsy and eating disorder was associated with important psychiatric conditions such as depression, anxiety, and suicidality, with a stronger concurrence than in isolated diagnoses of epilepsy and eating disorder.

Studies have also demonstrated the clinical importance of anticonvulsant medication in treating certain non-epilepsy disorders, namely neurological and psychiatric conditions (Landmark, 2008). However, one drug, topiramate, is associated with weight loss and an ability to suppress one’s appetite, alluding to its potential implications in the treatment of a dual epilepsy and ED diagnosis. In a case study by Knable (2001), topiramate therapy led to the complete cessation of disordered eating in a patient with comorbid partial complex epilepsy and bulimia nervosa, highlighting the drug’s pharmacological potential.

References

Cleveland Clinic. (2024). Bulimia nervosa. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9795-bulimia-nervosa#prevention

Johns Hopkins Medicine. (n.d.). Bulimia Nervosa. https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/bulimia-nervosa

Mayo Clinic. (2024). Bulimia nervosa – Diagnosis and treatment – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/bulimia/diagnosis-treatment/drc-20353621

Mayo Clinic. (2024). Bulimia nervosa – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615

Landmark, C. J. (2008). Antiepileptic Drugs in Non-Epilepsy Disorders: Relations between Mechanisms of Action and Clinical Efficacy. CNS Drugs, 22(1), 27–47. https://doi.org/10.2165/00023210-200822010-00003

Knable, M. B. (2001). Topiramate for Bulimia Nervosa in Epilepsy. The American Journal of Psychiatry, 158(2), 322-a-323. https://doi.org/10.1176/appi.ajp.158.2.322-a

Kolstad, E., Bjørk, M., Gilhus, N. E., Alfstad, K., Clench-Aas, J., & Lossius, M. (2018). Young people with epilepsy have an increased risk of eating disorder and poor quality diet. Epilepsia Open, 3(1), 40–45. https://doi.org/10.1002/epi4.12089

Tokatly Latzer, I., Richmond, T. K., Zhang, B., & Pearl, P. L. (2023). Eating disorders occur at high rates in adolescents with epilepsy and are associated with psychiatric comorbidities and suicidality. Epilepsia (Copenhagen), 64(11), 2982–2992. https://doi.org/10.1111/epi.17759