What is Bulimia Nervosa?
Bulimia (also known as bulimia nervosa) is an eating disorder characterized by frequent episodes of binge eating followed by frantic efforts to avoid gaining weight. It's important to note that episodes of binge eating don't necessarily involve purging (via vomiting, enemas or diuretics) but can followed instead by fasting, exercising to excess, or going on crash diets.
The Binge and Purge Cycle of Bulimia Nervosa:
Dieting triggers the cycle of binging and purging in an individual with bulimia. Unfortunately, the more rigidly food intake is controlled, the more likely it is that the individual will become even more occupied with food. Self-starvation elicits powerful cravings within the body.
As the tension, feelings of deprivation and hunger build, the compulsion to eat becomes far too powerful to resist, and a forbidden food is eaten, thereby breaking a dietary rule. Bulimics suffer an "all or nothing" mindset, so a simple slip is perceived as a total failure.
A single slip becomes an all-out food binge.
The relief of binging shortly gives way to feelings of guilt, shame and self-loathing. Purging is a way of making up for the control that is lost when binging.
Purging and the subsequent dieting, however, merely reinforce binge eating.
The binge/purge cycle is a vicious circle.
Does Purging Prevent Weight Gain?
Unfortunately, purging isn't an effective way of eliminating the calories ingested through a binge-eating session. Vomiting after eating only eliminates half of the calories consumed - usually much less. Caloric absorption begins when the food hits the mouth.
Laxatives get rid of about 10% of consumed calories and diuretics do nothing. Weighing less after using a diuretic is only due to water loss, not actual weight loss.
Diagnosis of Bulimia Nervosa:
The onset for bulimia nervosa is often between the ages 13 and 20 years old - and in many cases, occurring in previously overweight individuals. Bulimia can be difficult to detect as those with bulimia are often of an average weight or slightly overweight.
The diagnostic criteria per the Diagnostic and Statistical Manual of Mental Disorders is as follows:
A) Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
B.) Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
C.) The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
D.) Self-evaluation is unduly influenced by body shape and weight.
E.) The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Subtypes of Bulimia Nervosa:
Purging Type: during the current episode of bulimia nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Nonpurging Type: during the current episode of bulimia nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.
Signs and Symptoms of Bulimia:
Binge Eating Symptoms:
- Inability to control eating - cannot stop eating, eating until physically uncomfortable.
- Eating large amounts of food without an appreciable weight gain.
- Secret eating - eating after everyone else is in bed. Taking unexpected food runs. Eating in privacy.
- Alternating between overeating and fasting.
- Food disappears - tons of empty candy wrappers or food in the garbage.
- Hidden stashes of junk food.
- Visiting bathroom after every meal - may run water to disguise sounds of vomiting.
- Use of diuretics, enemas, and laxatives after eating.
- Vomit smells on the person or in the bathroom.
- Extreme exercising, usually after meals.
Physical Symptoms of Bulimia:
- Large puffy cheeks caused by repeated vomiting.
- Calluses or scars on the hands from sticking fingers down throat to cause vomiting.
- Normal or slightly overweight.
- Yellow, ragged, or clear teeth from stomach acid exposure.
Effects of Bulimia:
The most dangerous side effect of bulimia is dehydration due to purging. Vomiting, laxative, and diuretic abuse can also cause massive electrolyte imbalances.
What Causes Bulimia?
There is no single known cause for bulimia - there are many contributing factors. People with eating disorders, in general, have trouble managing emotions in a healthy way. Eating may be an emotional release for those who suffer from bulimia, so it's not surprising to find out that the binge and purge cycle begins when feeling angry, depressed, stressed, or anxious.
Below are the major risk factors for bulimia:
- Poor Body Image - unrealistic portrayals of women in the media can create a feeling of body dissatisfaction, especially in younger women.
- History of Trauma or Abuse - those who have bulimia have a higher than average instance of sexual abuse as well as those with parents who have a substance abuse problem or mental illness.
- Low Self-Esteem - those who consider themselves worthless, useless, and ugly are at greater risks for bulimia. This can be exacerbated by depression, perfectionism, childhood abuse, and an overly-critical home environment.
- Major Life Stressors - bulimia is often triggered by stressful changes or transitions, like puberty, relationship breakups, or changing schools.
- Appearance-Oriented Professions - those who are under the pressure to have a perfect body (actors, models, dancers), are at a greater risk for developing bulimia or other eating disorders.
Am I Bulimic?
If you are questioning whether or not you are bulimic, ask yourself the following questions. The more questions you answer with yes, the more likely it is that you have bulimia or another eating disorder.
Are you obsessed with your body and weight?
Does food and dieting rule your life?
Do you ever eat until you feel physically ill?
Are you afraid that if you start eating, you won't stop?
Do you feel guilty, ashamed, or depressed after you eat?
Do you vomit or take laxatives to keep your weight under control?
Steps to Recovering from Bulimia Nervosa:
Admit that there is a problem. After spending so long believing that if one were simply thin enough, life would be better, the first step to recovering from bulimia nervosa is admitting that the relationship you have with food is distorted and out of control.
Talk to someone. It may be shameful and scary to admit what you've been going through - especially since the bulimia has been a secret for so long. But you are not alone - you are never alone. Find a good listener and admit that you struggle with bulimia nervosa.
Avoid Triggers. Steer clear of people, places, and activities that trigger the temptation to binge or purge. Maybe it's fashion magazine or friends who obsess about food or cooking shows. But until you've gone through treatment, avoid these triggers.
Find Professional Help. The advice of trained eating disorder specialists can help to regain health, develop healthy eating patterns, learn to eat properly, and develop healthy attitudes about food and your body image.
Treatment of Bulimia Nervosa:
Therapy is a key aspect in proper treatment of bulimia nervosa as much of the disorder is caused by poor body image and low self-esteem. Therapists can help reduce feelings of shame and isolation caused by bulimia nervosa.
Cognitive-Behavioral Therapy is the type of therapy often used to treat bulimia nervosa. CBT identifies the unhealthy eating patterns and negative thoughts that fuel them and teaches the individual how to appropriately change their patterns of thought. Treatment will likely contain the following elements:
- Learning to break the binge and purge cycle and restoring normal eating patterns. This may be taught by monitoring eating habits, avoiding triggers, discovering healthy ways to handle stress, and fighting the urge to purge.
- Replacing unhealthy thoughts about food and patterns of eating with healthy thoughts and patterns. Unhealthy attitudes about stress, body image, weight, and food will be challenged and replaced with more healthy ones.
- Working through emotional issues. The underlying emotional issues at the heart of bulimia nervosa (anxiety, depression, low self-esteem, isolation, and loneliness) will be explored and worked through.
If Someone You Love Has Bulimia Nervosa:
The most important thing you can do if suspect that your friend, family member or loved one has bulimia nervosa is to talk to them. Perhaps he or she will deny that there is a problem, but the simple act of asking and opening up the topic for later conversation is very, very important - your loved one's life is at stake.
Remember that you cannot force a person with an eating disorder to change, nor can you walk through recovery for them. But you can help by being a solid, compassionate support system.
Avoid scare tactics, guilt trips, insults and rude patronizing comments. As bulimia is caused (and triggered by) stress and other emotional issues, negativity will only make the disorder worse.
Set a good example of healthy eating habits, exercise, and body image. Avoid making any sort of negative comments about your own body or anyone else's.
Accept that you do, in fact, have limitations. You cannot fix an eating disorder for someone else, no matter how much you might like to.
Take care of yourself. Know when to walk away, talk to a counselor, and manage your own stress.
What is Pro-Mia?
Pro-Mia stands for "pro-bulimia" and is often used interchangeably with "pro-ana," and refers to websites that are gaining popularity among young people to gain support and ally with others who have bulimia nervosa. These websites are often written by young women who depict an eating disorder as something to be proud of, offer tips and tricks for purging, and advice for how to manage the side effects of bulimia.
Pro-Mia websites glamorize eating disorders and provide readers with photo galleries of "thinspiration" - photos of extremely thin women to provide inspiration for those who have eating disorders to continue the eating disorder cycle.
Eating disorder websites have spoken out against the dangers of pro-ana and pro-mia websites as being unhealthy and glamorizing a very serious illness.
Hotlines for Bulimia Nervosa:
The ANAD Helpline 630-577-1330
NEDA Helpline - 800-931-2237
Additional Bulimia Nervosa Resources:
Eating Disorder Treatment Finder – Searchable directory of eating disorder treatment providers, including doctors, therapists, dieticians, and support groups. (The Something Fishy Website on Eating Disorders)
National Association of Anorexia Nervosa and Associated Disorders - Treatment information, eating disorders bookstore, articles and helplines for those suffering eating disorders.
National Eating Disorders Association - A non-profit organization dedicated to supporting individuals and families affected by eating disorders. They campaign for prevention, improved access to quality treatment, and increased research funding to better understand and treat eating disorders. They also work with partners and volunteers to develop programs and tools to help everyone who seeks assistance.
Academy for Eating Disorders - Global professional association committed to leadership in eating disorders research, education, treatment, and prevention.
Body Image Gallery - A site where women can see what real women look like – what we really look like. Most women have spent so many years looking at themselves in mirrors that we can no longer see what’s really there. The My Body Gallery project’s goal is to help women objectively see what we look like and come to some acceptance that we are all beautiful.