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The Crown’s latest season deals with an eating disorder; know about it here

Currently streaming on Netflix, The Crown‘s fourth season has been garnering a lot of attention, more than any of its previous seasons. The show, based on the inner life and world of the British royal family, explores the life of the late Princess Diana in Season 4, and what may have led to her fallout with the family and most importantly, her husband Prince Charles. While a section of the audience is convinced that the show, created by Peter Morgan, is authentic, others believe it has unnecessarily vilified the royal family.

Among other things, the latest season also explores Diana’s struggle with bulimia, which is an eating disorder. Previously, The Independent had mentioned that Left Bank Pictures — the production company working on The Crown — had said in a statement: “The producers worked closely with [eating disorder charity] ‘Beat’ to ensure that their portrayal of Princess Diana’s bulimia in season four was both accurate to the disorder and sensitively handled.”

And while there is a lot of misinformation out there that could be triggering for a lot of people,  reached out to a doctor to shed light on the condition — what causes it, and how it can be treated.

“Bulimia (often called Bulimia Nervosa) is an eating disorder, in which a person has regular episodes of eating large amounts of food (binge-eating), during which they feel a loss of control. To get rid of calories and prevent weight gain, people with bulimia then use different methods. For example, they may regularly self-induce vomiting or misuse laxatives, weight-loss supplements, consume diuretics or enemas after binging. Or they may opt for other ways to shed excess calories and prevent weight gain. This would include excessive fasting, scheduled dieting or excessive exercise,” explains Dr Chandrashekhar Tulsigiri, Director-Intensive Care, Fortis Hiranandani Hospital Vashi.

Who does bulimia affect?

Dr Tulsigiri says teenage girls and young women usually experience Bulimia Nervosa.

“They usually know their eating and purging patterns are abnormal. This set of people also feel upset or shaken about their episodes. It has been noted women are nine times more likely to suffer from Bulimia Nervosa than men. While the exact cause/trigger is not known, it is known to be more common among people who have someone in the family with the same condition. Certain factors that are understood to be contributing are societal and cultural stress, peer pressure, body image issues and poor self-esteem,” he says.

ALSO READ | The Crown’s new season will explore Princess Diana’s struggle with bulimia

The triggers

The onset of Bulimia Nervosa is often during adolescence, between 13-20 years of age, says the doctor, adding that it is, therefore, often described as a developmental disorder. Other than a genetic predisposition, there may be one or more triggers. Some of them are:

* Psychiatric disorders: Depression, anxiety, bipolar disorders, obsessive-compulsive disorders (OCD), social phobia, substance abuse disorder, predispose a person for binge-eating. Abnormal levels of many hormones, notably serotonin, have been shown to be responsible for some disordered eating behaviours. Particularly, neurotransmitters endorphins and enkephalins are responsible for binges, he says.

* Social factors: Societal pressure plays a detrimental role in the development of bulimia in young girls. These pressures come from parents and siblings, media, peers, etc.

* Psychological factors: Sensation seeking may cause some individuals to gorge for the pleasure of eating. Bulimics have a compulsion to eat that resembles an addiction. Bulimia can be triggered because of environmental stress such as family dysfunction or traumatic stressful life events such as divorce, or the death of a loved one.

The signs and symptoms

People with bulimia are often at a normal weight, but they may see themselves as being overweight, and even ‘fat’. And because the person’s weight is normal, other people may also not notice this eating disorder, the doctor remarks.

Symptoms that people can see:

* Eating large amounts of food or buying food that gets consumed right away.
* Exercising excessively, even to the point of fatigue.
* Rushing to the bathroom right after having their meals.
* Buying large amounts of laxatives, emetics or diuretics, which disappear in no time.

“When examined, a person with bulimia will usually show a gum infection. They may also have worn-out teeth, which really is a result of vomit acid. A thorough examination would also reveal ruptured or damaged blood vessels in the eyes from excessive straining during vomiting,” says Dr Tulsigiri.

ALSO READ | Netflix’s ‘To The Bone’ offers a dialogue around eating disorders

The treatment

“A bulimia treatment plan is tailored to every individual’s needs. Various treatment approaches that your physician may choose to use separately or in combination will include psychotherapy, medication, nutrition education and hospitalisation.”

– People with bulimia rarely have to go to the hospital, unless they have anorexia, suffer from major depression, or need medicines to help them stop purging. Most often, a staggered approach is used to treat bulimia. The treatment plan is built on how severe the bulimia is, and the person’s response to the treatment. Support groups may be helpful for mild bulimia without other health problems.

– Counseling sessions, such as talk therapy and nutritional therapy, are the first step of treatment for a patient that does not respond to support groups.

– Medicines that also treat depression, known as selective Serotonin-Reuptake Inhibitors (SSRIs) are often used in treatment. Combining talk therapy with SSRIs may help, if talk therapy alone does not work, the doctor explains.

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