All about Bulimia Nervosa
Bulimia nervosa often called bulimia is a disorder which disrupts the ability to maintain a `normal’ eating pattern. Someone with bulimia nervosa becomes increasingly unable to relate normally to food and instead develops a dependency on a chaotic cycle of bingeing and purging. Typically they alternate between the frantic activity of binge-eating and the subsequent state of panic and the need to get rid of what has just been eaten. People with bulimia nervosa either make themselves vomit or use laxatives or diuretics – or all of these – to purge themselves of the food they have consumed. Others do not purge in this way, but instead have a period of excessive fasting or exercise to compensate for their over-eating.
Bulimia Nervosa has three primary symptoms:
• Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior.
• Regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise.
• Extreme concern with body weight and shape.
What is binge eating?
Binge eating disorder (BED) has an independent diagnosis and is characterized by frequent and persistent episodes of binge eating, accompanied by a loss of control and marked distress in the absence of regular compensatory behaviors that are characteristic of bulimia. The binge episodes take place quickly, without the physical necessity to eat, and alone, due to the individual’s feeling of shame regarding their own behavior.
Binge eating involves two key features:
• Eating a very large amount of food within a relatively short period of time (e.g. within two hours)
• Feeling a sense of loss of control while eating (e.g. feeling unable to stop yourself from eating)
What are compensatory behaviours?
Compensatory behaviours are used as a way of trying to control weight after binge eating episodes. They include:
• Misusing laxatives or diuretics
• Excessive exercise
• Use of any drugs, illicit, prescription and/or ‘over the counter’ inappropriately for weight control
A person with Bulimia can become lost in a dangerous cycle of eating out of control and attempts to compensate which can lead to feelings of shame, guilt and disgust. These behaviours can become more compulsive and uncontrollable over time, and lead to an obsession with food, thoughts about eating (or not eating), weight loss, dieting and body image.
These behaviours are often concealed and people with Bulimia can go to great lengths to keep their eating and exercise habits secret. As a result, Bulimia can often go undetected for a long period of time.
Many people with Bulimia experience weight fluctuations and do not lose weight; they can remain in the normal weight range, be slightly underweight, or may even gain weight.
What causes bulimia nervosa?
There is a lot of confusion about eating disorders. Many people still think of them as `slimmer’s diseases’. While it is true that both anorexia and bulimia nervosa can develop from a strict diet, the reasons for a diet turning into an eating disorder go far beyond the desire to be slim.
Some people attribute eating disorders to media and fashion. It has become fashionable in the developed western culture to be slim. This is not possible for everyone as we are naturally all different shapes and sizes. Many people who do not conform to the ideals presented by the fashion industry or the media feel that they need to diet. For some people this may not present a problem while for others it can lead them to develop an eating disorder. The media can also compound problems for people who already have eating problems as it is very difficult to get better while you are being presented with images of desirable thin models. People with bulimia nervosa very often feel that they can only ever be happy or successful if they can become more like these images.
Many people living with bulimia nervosa can remember very clearly the first time they made themselves sick or took a large dose of laxatives. They may now look back on this as the beginning of a destructive illness, but at the time it often felt like a huge release. Bulimia nervosa can be the physical way of dealing with emotions which are otherwise very difficult to express. Some people who develop this condition have been abused as children – either physically, sexually or mentally or may have been in difficult family or sexual relationships. Others may not be able to pinpoint a cause and will not have experienced any of the above difficulties, but still need an outlet for their emotions.
At first, bulimia nervosa can feel like a way of having control over your life -suddenly it seems as if there is a way of eating whatever foods you like and not putting on weight. In reality the opposite is true. When bulimia nervosa takes hold it completely destroys your ability to control what you are eating. All of your energy and emotions become tied up in your relationship with food and feelings about your body. This can have the effect of suppressing other emotional difficulties as you simply do not have the energy to deal with anything other than the bulimia nervosa, but it is clearly a very destructive coping strategy.
Warning Signs of Bulimia Nervosa:
· Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food.
· Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
· Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury, the compulsive need to “burn off” calories taken in.
· Unusual swelling of the cheeks or jaw area.
· Calluses on the back of the hands and knuckles from self-induced vomiting.
· Discoloration or staining of the teeth.
· Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.
· Withdrawal from usual friends and activities.
· In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
· Continued exercise despite injury; overuse injuries.
Health Consequences of Bulimia Nervosa
Bulimia nervosa can be extremely harmful to the body. The recurrent binge-and-purge cycles can damage the entire digestive system and purging behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Some of the health consequences of bulimia nervosa include:
· Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.
· Inflammation and possible rupture of the esophagus from frequent vomiting.
· Tooth decay and staining from stomach acids released during frequent vomiting.
· Chronic irregular bowel movements and constipation as a result of laxative abuse.
· Gastric rupture is an uncommon but possible side effect of binge eating
What can I do if I have bulimia nervosa?
It is possible to recover from Bulimia, even if you have been living with the illness for many years. The path to recovery can be very challenging. People with Bulimia can become entangled in a vicious cycle of eating and exercise behaviours that can impact their ability to think clearly and make decisions. However, with the right team and a high level of personal commitment, recovery is an achievable goal. Treatments for Bulimia are available; seek help from a professional with specialised knowledge in eating disorders.