Bulimia

Bulimia is an eating disorder – but one that is not necessarily easy to spot in one’s own child. Other eating disorders are more visible. For instance, pills almost anyone can recognize obesity – a condition in which the sufferer is significantly overweight. People can also often recognize cases of anorexia nervosa – the condition in which a person is severely under his or her ideal weight (and may therefore look painfully skinny and boney). However, it is not possible to identify someone with Bulimia Nervosa just by looking. The sufferer of this eating disorder may be a perfectly normal weight. It is not the WEIGHT that is disordered in this condition, but rather the way in which the person maintains that weight.  A bulimic (one who suffers from bulimia nervosa) eats way too many calories in one sitting (for example, a number of grilled cheese sandwiches, a full tub of ice cream, a box of crackers, a bag of chips and a plate of waffles). This episode of overeating is called “bingeing.” It is normally followed by feelings of panic (about gaining too much weight), shame and guilt and an intense effort to “undo” the eating behavior by engaging in excessive exercise or using laxatives to empty the gut, or inducing vomiting for the same purpose. Episodes of bingeing and purging (over-eating and then “undoing” the calories somehow) can sometimes occur many times a day. On average, people with Bulimia binge 12 times a week, consuming as much as 11,500 calories. Foods rich in processed sugar and fat, such as pastry, ice cream, bread and donuts are the most common objects of binges.

Bulimia Nervosa is more common than Anorexia, and affects girls more than boys.

Signs of Bulimia
Although parents can’t tell from LOOKING at their child that the youngster is suffering from bulimia, they may be able to discern a problem by observing their child’s behavior. Those suffering from bulimia usually feel a lack of control when it comes to eating. While most of us stop eating when we feel full, those with bulimia keep on eating to the point of feeling pain.  This inability to control their eating can be very embarrassing and typically bulimics try to hide their binging and purging.  Some typical symptoms that may indicate bulimia are:

  • Wanting to eat alone
  • Eating very little in public
  • Frequent trips to the bathroom after meals
  • Disappearance of food
  • Hidden stashes of junk food
  • Eating large amounts of food without putting on weight
  • Excessive exercising
  • Using laxatives, enemas or diuretics

People with bulimia may also have physical symptoms caused by purging.  These include:

  • Puffy cheeks caused by repeated vomiting
  • Discoloured teeth caused by exposure to stomach acid when throwing up
  • Frequent fluctuations in weight
  • Calluses or scars on knuckles and hands caused by putting fingers down the throat to induce vomiting

An Impulse-Control Issue
Are sufferers of Bulimia Nervosa aware that their eating pattern is dysfunctional? Yes. However, they have difficulty controlling themselves; the act of binging and purging is a compulsion. In fact, many Bulimics report that they only stop a cycle of binging or purging when they feel physical pain. Otherwise, they can’t help themselves. They have a compulsion that is too strong for them to overcome, much like an addicts relationship to his substance.

Bulimia Nervosa has been linked to emotional stress as well as body image issues. Low self-esteem, a history of abuse, a difficult life transition, traumatic experiences and other stresses have been found to be higher in those suffering from Bulimia. In addition, there is a higher rate of bulimia in those who are drawn to a body-conscious hobby or profession like modeling, ballet, gymnastics or physical fitness training. It is not clear whether the activity and peer pressure found in the activity actually induces bulimia or whether those with bulimic tendencies (obsession about body image) may choose those activities to begin with.

A Serious Health Threat
Bulimia is a serious health issue. Chronic bingeing and purging can cause serious gastro-intestinal diseases. The purging (in the form of vomiting, laxatives, and diuretics) can lead to electrolyte imbalances, usually in the form of low potassium levels. Low potassium results in symptoms such as lethargy, confusion, irregular heartbeat, and cardiac and kidney dysfunction. In severe cases it can even cause death. Other effects of bulimia may include:

  • Weight gain
  • Constipation caused by chronic laxative use
  • Abdominal pain and bloating
  • Tooth decay
  • Chronic sore throat and hoarseness
  • Broken blood vessels in the eyes
  • Weakness and dizziness
  • Loss of menstrual periods
  • Acid reflux

Risk Factors
Bulimia generally begins in adolescence and 90 – 95% of those with the disease are women.  There is no single cause for bulimia but low self-esteem and poor body image are often contributing factors.  Some of the more common risk factors for bulimia are:

  • Dieting – people who diet on a regular basis are more likely to develop an eating disorder than those who don’t.
  • Involvement in professions/activities that emphasize weight control – the pressure placed on gymnasts, dancers, models, actors, and other athletes to maintain a certain weight can lead to the development of eating disorders.
  • Low self esteem – this can be a result of abuse, depression, a critical home environment, and a desire for perfection.
  • Poor body image – young women are often influenced by our culture’s glorification of thinness and beauty.
  • Major life changes – bulimia is sometimes a reaction to stress, which can accompany a major life change.  Examples of major life changes may be; moving away from home, puberty, divorce, and the break-up of relationships.
  • Biological factors – since eating disorders run in families there is likely a genetic component.  In addition, research indicates that low serotonin levels play a role in bulimia.

Treatment for Bulimia
Treatment for Bulimia should be a combination of a medical and a psychological program. At times, an in-patient weight management program needs to be implemented alongside counseling in order to address the two critical aspects of the illness. Most often, however, bulimia is effectively treated on an out-patient basis. People do heal from this disorder. They may have relapses occasionally but when they learn effective stress-management techniques they can usually prevent relapses over the long-run. Seeking counseling and using self-help strategies are both important for long term recovery.

Psychotherapy is the main form of treatment for bulimia.  Specifically, cognitive behavioural therapy is often used to break the binge-and-purge cycle and change unhealthy thought patterns.

Medication such as anti-depressants may also be used.  These help to reduce binge eating and treat the depression that is often a part of bulimia.

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