About Bulimia Nervosa and Treatment

Bulimia Overview
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Bulimia nervosa is an eating disorder characterized by frequent episodes of binging and purging in an attempt to lose weight. Individuals with bulimia typically consume large amounts of food and then induce vomiting to rid their bodies of the calories. Other forms of “purging” may include excessive exercise or abuse of laxatives, diuretics or enemas. The eating disorder affects up to 4 percent of women, mostly teenage girls, though a growing number of men and older women are suffering from this illness as well.

While binging, individuals may consume thousands of calories in as little as one hour. A binge is typically followed by intense feelings of guilt, shame and disgust and an overwhelming desire to purge. Purging reinforces the desire to binge, and binging reinforces the desire to purge, which propels someone with bulimia into the binge-purge cycle. Those suffering from bulimia are excessively concerned with weight and body shape, often using eating disorder behaviors to cope with painful feelings, stress, depression or low self-esteem. The emotional cycle of bulimia typically follows a pattern:

  • Loss of self-control by consuming large amounts of food (up to 20,000 calories at a time)
  • A temporary sense of calm
  • Feelings of shame and self-hatred
  • Purging to cope with difficult feelings

Although most people who purge do so in order to lose weight, those suffering with bulimia typically remain the same weight or may even gain weight over time, making the eating disorder difficult to identify and diagnose.  This is because the various purging methods eliminate only 10 to 50 percent of the calories consumed. There is also a great deal of secrecy and denial among bulimics.

Bulimia puts lives at risk. Health complications may include:

  • Dehydration
  • Electrolyte imbalances
  • Fatigue
  • Irregular heartbeat
  • Kidney damage
  • Broken blood vessels in the eyes
  • Abdominal pain
  • Swelling of hands and feet
  • Chronic sore throat
  • Swollen glands in the cheeks
  • Tooth decay
  • Ulcers or acid reflux
  • Ruptured stomach or esophagus
  • Constipation
  • Loss of menstrual periods

Symptoms of Bulimia

Most people struggling with bulimia go to extremes to hide their eating disorder. In addition to feeling ashamed of their binge eating behavior, they work to conceal their purging behavior. If you suspect that you or someone you care about is suffering from bulimia, keep an eye out for the following symptoms and warning signs:

  • Preoccupation with weight and body shape
  • Poor body image or low self-esteem
  • Consuming large quantities of food in a short period of time
  • Disappearing to the bathroom after meals (to purge)
  • Opened boxes of laxatives, diuretics or other medication
  • Excessive exercise
  • Periods of fasting
  • Depressed mood
  • Swollen cheeks
  • Irregular menstrual cycle
  • Bloating and abdominal pain
  • Weakness
  • Inability to control food intake
  • Eating until uncomfortably full
  • Feeling guilty, ashamed or depressed after binge eating
  • Vomiting, using laxatives, diuretics or enemas, or exercising excessively to control weight
  • All-or-nothing thinking (for example, having a bite of an unhealthy food leads to a full-blown binge)
  • Secrecy surrounding eating
  • Visiting “pro-mia” websites that promote bulimia

How to Help a Loved One with Bulimia

Because people suffering with bulimia are often skilled at hiding their eating disorder, a problem can be hard to detect. Loved ones may suspect that something is wrong, but don’t know the specific signs of bulimia. A loved one may need treatment for bulimia if they:

  • Eat large amounts of food without a significant change in weight
  • Want to eat in private
  • Leave empty food containers in the trash or have hidden food stashes
  • Alternate between eating large meals and fasting
  • Frequently go to the bathroom after meals
  • Run the water while in the bathroom
  • Exercise strenuously especially after eating
  • Physical symptoms such as frequent fluctuations in weight, calluses on the hands, puffy cheeks or discolored teeth

If you notice any of these signs, offer your loved one as much support and encouragement as you can. The most important help you can provide is calling a doctor, counselor or bulimia treatment program.

Bulimia is a serious mental illness that can worsen dramatically over time. Some people with bulimia eventually develop anorexia, and many others struggle with other mental health disorders such as depression or anxiety.

Causes of Bulimia

When someone is suffering from an eating disorder, it’s natural to want answers. Scientists don’t know definitively what causes bulimia, but most agree that the eating disorder stems from:

  • Genetics — Scientists are exploring the impact of certain genes on the development of bulimia and other eating disorders. Having a sibling or parent with an eating disorder makes people more vulnerable to bulimia.
  • Dieting — Strict diets can cause people to think obsessively about food and experience food cravings as a result of starving the body. Rigid rules and loss of control are common precursors to bulimia.
  • Low Self-Esteem — People who have a negative self-perception or poor body image tend to be at greater risk for bulimia and other eating disorders.
  • Personality — Those who have difficulty coping with stress, anger, sadness and other emotions in a healthy way may use bulimia as an unhealthy coping mechanism.
  • Social Pressure — American culture sends powerful messages that success requires achieving certain ideals of thinness and beauty. This can lead to dissatisfaction with one’s body and extreme attempts to change one’s appearance.
  • Environment — A history of trauma or abuse or an unhealthy home environment can contribute to bulimia.
  • Stress — Major life changes, both positive and negative, can trigger bulimia.
  • Body-Focused Professions and Activities — Males and females in body-centered careers and activities are more vulnerable to bulimia. Examples include wrestlers, athletes, actors, models and ballet dancers.
  • Brain Chemistry — It is possible that certain chemicals in the brain, such as serotonin, may play a role in bulimia.
  • Psychological Issues — People with eating disorders often struggle with other emotional and psychological issues, such as anger, impulsivity, unhealthy relationships and perfectionism.

Bulimia Nervosa Treatment

Bulimia affects one of the most important relationships in life: the relationship with self. Bulimia treatment requires a comprehensive approach in which a team of professionals works together to heal your mind, body and spirit. Most often, bulimia treatment occurs in a residential eating disorder program or eating disorder clinic, though hospitalization may be required in severe cases.

The goals of bulimia treatment typically include developing a healthier relationship with food, improving coping skills and nurturing a stronger sense of self. Co-occurring disorders such as anxiety and depression will also be addressed.

The goal of bulimia treatment is to put an end to eating disorder behaviors, address any underlying emotional or psychological issues, and help the individual develop a healthier set of coping skills. Some of the best bulimia treatment programs offer the following interventions:

  • Cognitive-Behavioral Therapy
  • Dialectical Behavior Therapy
  • Nutrition Therapy
  • Culinary Therapy
  • Medication
  • Individual, group and family therapy
  • Restaurant and grocery store outings
  • Medical care and medication management

Whether you’re just beginning down a dangerous path or you’ve struggled with bulimia for years, treatment is the key to a new way of life. Breaking the binge-purge cycle requires a shift in mindset, but with the right support system in place you can achieve lifelong eating disorder recovery.