 Module 213, Bulimana Vosa, Bulimana Vosa is another type of eating disorder in which the person is eat a lot and after that purge it out. So basically the client feel the need to eat and when he is starting to eat he got the fear of being getting obsessed and after that he vomit it out. So if we look at it, Bulimana Vosa that is like anorexia navosa but that is not completely in line with that. How we are saying that it is not completely in line with that and sheared some of its symptom is in the way that the anorexia navosa has fear of gaining weight, Bulimana Vosa also has fear of gaining weight, but the difference is that the Bulimana Vosa is eating a lot of the individual. After eating a lot, after bench eating it is purging, that is, it is vomiting out. And the weight in it will be in the normal range, that is, the BMI that is in between 18-30. But the anorexia navosa in it, the weight of the client is less than 2 that can also be purging and bench eating can be developed. So if you explicitly define Bulimana Vosa, then what will happen is that it will be bench eating, that is, it will eat more and after that it will immediately try not to gain weight. And when it tries not to gain weight, then it will use different strategies for that, in which it can be purging, now what will it do in that, that it will vomit, except to vomit, it will do excessive exercises, it will take lexatives, so in this way it tries to overcome that. If we look at its symptoms of Bulimana Vosa, then you can understand this thing that most of the time it eats a lot at a time, and eats so much that they feel themselves uncontrollable. Basically, the client eats food in a significant amount, for example, if there are 4-5 things on its table, then it will eat all of it, and that uncontrollable impulse will be for taking that food. So when it eats that food, then what will happen is that it will have a lot of guilt feeling, shame and the feeling of anxiety will start to induce it. Along with this, the feeling of havingness can also be developed in it. Secondly, in these people, that perception is in the reference of their body weight and shape. Basically, when they take a lot of food, the guilt, shame or the feeling of anxiety will develop. To encounter these feelings, what do they do, they purge the food, what will they do, they will vomit, they will take lexatives, and at a certain time they try to take gag reflexes also. So with the help of that, when they vomit, they feel themselves, their calories that have gone into the body, they have vomited out, and after that, at some time, their excessive taking of food, to neutralize it, they do excessive exercises. When we say word of excessive exercise, it means that for example, in one day, they will start doing 500 set ups. Okay, or when they start running, they will start running for 2 to 3 hours. So this sort of behavior is observed by them. Along with that, the pre-occupation of their body, with weight and shape, is very high. Okay, when they are self-image, they are very distorted, they don't like them. They always said that, I am fat, I am ugly, so these kinds of statements are in their mind. Okay, so when there is a client of Bulima Narvosa in front of you, then you have to differentiate them from Anorexia Narvosa, number one, that their weight is in the normal limit. Okay. And along with that, you have to see that their body is not very thin. At a certain time, the people who are obese, Bulima Narvosa is also found out, okay. But the Anorexia Narvosa, the thinness of the body will be there, and along with that, their body weight will be below BMI. So you have to keep this in mind, but we also know that the Anorexia Narvosa can develop a binge type with it. That is, the client is not taking food intake, but if he is taking food intake, then he is purging, but along with that, his weight is reducing. If the weight is reducing, then Anorexia Narvosa is there, if the weight is not reducing, and the normal weight criteria is coming, then that is Bulima Narvosa. After that, we see that Bulima Narvosa, what will be its physical effect on the body? Okay. So due to eating disorder, the brain will definitely have a lot of effects on it, which can be depression, fear of gaining weight, anxiety, dizziness, shame, anxiety, shame and low self-esteem. Then it has been observed that their cheeks are either sore or swollen, because they are like some time they are trying to do the vomit out. So when they put their fingers in the mouth to do the vomiting, then due to that, their cheeks start having problems. Similarly, we have seen in the mouth that cavities can be a certain time gum disease, so such sensitivity develops in the mouth. Similarly, if you look at the throat, usually it is sore, irritable, sometimes they vomit so much that certain time the blood is also observed. After that, because for example, if they insert their fingers, then it may be possible that the throat gets injured. Similarly, the muscles are fatigued. Then the stomach can be ulcerated, or it can be ruptured, or it can have pain. Why? Because they are taking so many lexatives, so due to that, the problem of the stomach can start. The skin becomes very dry, why can it be dry? Because the water intake is not that much, the skin starts having problems. The blood has been observed that anemia happens to these children. The heart also has irregular heartbeat. It has come to see the weakness, that is, the muscles start fluctuating. The body fluids are reduced. Magnesium, potassium, sodium have problems in them. They have a low level. The functions of the intestine are also disturbed. Constipation can be done, irregular bowel movements can be done. Diarrhea can be done. Such complaints are present in their history. Similarly, the hormones are disturbed, and in the case of females, periods can be irregular or absent. So basically, if we talk about bulimia nervosa in the eating disorder, then that is not only limited to the psychological effect on the body, rather it also affects the body physically too. Thank you.