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Bulimia Nervosa

Its very common, for people to turn to the fridge when feeling lonely or bored or stressed. However, when you suffer from bulimia, the now-and-then impulse to overeat is more like a compulsion. Instead of eating sensibly to make up for it, you may punish yourself by purging, fasting, or exercising to get rid of the calories.

This vicious cycle of binging and purging takes a toll on the body, and it’s even harder on emotional well-being. This cycle can be broken. Effective bulimia treatment and support can help you develop a healthier relationship with food and overcome feelings of anxiety, guilt, and shame.

What is bulimia?

Bulimia nervosa is an eating disorder characterised by frequent episodes of binge eating, followed by frantic efforts to avoid gaining weight. When you’re struggling with bulimia, life can become a battle . You don’t want to binge—you know you’ll feel guilty and ashamed afterwards—but time and time again you give into the urge to do so. After it ends, panic sets in and you turn to drastic measures to “undo” the binge, such as inducing vomiting, or going for a run. All the while, you feel increasingly out of control.


Do I have bulimia nervosa?

Ask yourself the following questions. The more “yes” answers, the more likely you are suffering from bulimia or another eating disorder.

  bullet Are you obsessed with your body and your weight?
  bullet Does food and dieting dominate your life?
  bullet Are you afraid that when you start eating, you won’t be able to stop?
  bullet Do you ever eat until you feel sick?
  bullet Do you feel guilty, ashamed, or depressed after you eat?
  bullet Do you vomit or take laxatives to control your weight?


The binge and purge cycle


Dieting triggers bulimia’s destructive cycle of binging and purging. The irony is that the more strict and rigid the diet, the more likely it is that you’ll become preoccupied, even obsessed, with food. When you starve yourself, your body responds with powerful cravings—it’s way of asking for needed nutrition. As the tension, hunger, and feelings of deprivation build, the compulsion to eat becomes too powerful to resist: a “forbidden” food is eaten; a dietary rule is broken. With an all-or-nothing mindset, you feel any diet slip-up is a total failure. After having a bite chocolate, you might think, “I’ve already blown It, so I might as well go all out.” Unfortunately, the relief that binging brings is extremely short-lived. Soon after, guilt and self-loathing set in. And so you purge to make up for binging and regain control. Purging only reinforces binge eating. Though you may tell yourself, as you launch into a new diet, that this is the last time, in the back of your mind there’s a voice telling you that you can always make yourself sick or use laxatives if you lose control again.


Purging does NOT prevent weight gain

Purging isn’t effective at getting rid of calories, which is why most people suffering with bulimia end up gaining weight over time. Vomiting immediately after eating will only eliminate 50% of the calories consumed at best—and usually much less. This is because calorie absorption begins the moment you put food in the mouth. Laxatives and diuretics are even less effective. Laxatives get rid of only 10% of the calories eaten, and diuretics do nothing at all. You may weigh less after taking them, but that lower number on the scale is due to water loss, not true weight loss.


Signs and symptoms of bulimia

  bullet Lack of control over eating – Inability to stop eating. Eating until the point of physical discomfort and pain.
  bullet Secrecy surrounding eating – Going to the kitchen after everyone else has gone to bed. Going out alone on unexpected food runs. Wanting to eat in privacy.
  bullet Eating unusually large amounts of food with no obvious change in weight.
  bullet Disappearance of food, numerous empty wrappers or food containers in bin, or hidden stashes of junk food.
  bullet Alternating between overeating and fasting – Rarely eats normal meals. It’s all-or-nothing when it comes to food
  bullet Going to the bathroom after meals – Frequently disappears after meals or takes a trip to the bathroom to throw up. May run the water to disguise sounds of vomiting.
  bullet Using laxatives, diuretics, or enemas after eating. May also take diet pills to curb appetite or use the sauna to “sweat out” water weight.
  bullet Smell of vomit – The bathroom or the person may smell like vomit. They may try to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.
  bullet Excessive exercising – Works out strenuously, especially after eating. Typical activities include high-intensity calorie burners such as running or aerobics.
  bullet Calluses or scars on the knuckles or hands from sticking fingers down the throat to induce vomiting.
  bullet Puffy “chipmunk” cheeks caused by repeated vomiting.
  bullet Discoloured teeth from exposure to stomach acid when throwing up. May look yellow, ragged, or clear.
  bullet Not underweight – Men and women with bulimia are usually normal weight or slightly overweight. Being underweight while purging might indicate a purging type of anorexia.
  bullet Frequent fluctuations in weight – Weight may fluctuate more due to alternating episodes of bingeing and purging.


Effects of bulimia

When you are living with bulimia, you are putting your body and even your life at risk. The most dangerous side effect of bulimia is dehydration due to purging. Vomiting, laxatives, and diuretics can cause electrolyte imbalances in the body, most commonly in the form of, low potassium levels. Low potassium levels trigger a wide range of symptoms ranging from lethargy and cloudy thinking to irregular heartbeat and death. Chronically low levels of potassium can also result in kidney failure.

Other common medical complications and adverse effects of bulimia include:

  bullet Weight gain bullet Weakness and dizziness
  bullet Abdominal pain, bloating bullet Tooth decay and mouth sores
  bullet Swelling of the hands and feet bullet Acid reflux or ulcers
  bullet Chronic sore throat, hoarseness bullet Ruptured stomach or oesophagus
  bullet Broken blood vessels in the eyes bullet Loss of menstrual periods
  bullet Swollen cheeks and salivary glands bullet Chronic constipation from laxative abuse


Bulimia causes and risk factors

There is no single cause of bulimia. While low self-esteem and concerns about weight and body image play major roles, there are many other contributing causes. In most cases, people suffering with bulimia—and eating disorders in general—have trouble managing emotions in a healthy way. Eating can be an emotional release so it’s not surprising that people binge and purge when feeling angry, depressed, stressed, or anxious.

One thing is certain. Bulimia is a complex emotional issue. Major causes and risk factors for bulimia include:

  bullet Poor body image: Our culture’s emphasis on thinness and beauty can lead to body dissatisfaction, particularly in young women bombarded with media images of an unrealistic physical ideal.
  bullet Low self-esteem: People who think of themselves as useless, worthless, and unattractive are at risk for bulimia. Things that can contribute to low self-esteem include depression, perfectionism, childhood abuse, and a critical home environment.
  bullet History of trauma or abuse: Women with bulimia appear to have a higher incidence of sexual abuse. People with bulimia are also more likely than average to have parents with a substance abuse problem or psychological disorder.
  bullet Major life changes: Bulimia is often triggered by stressful changes or transitions, such as the physical changes of puberty, going away to college, or the breakup of a relationship. Binging and purging may be a negative way to cope with the stress.
  bullet Appearance-oriented professions or activities: People who face tremendous image pressure are vulnerable to developing bulimia. Those at risk include ballet dancers, models, gymnasts, wrestlers, runners, and actors.


Getting help for bulimia

It can feel scary to have Bulimia, and knowing that you are harming your body. Knowing that you are harming your body just adds to the fear. However, change is possible. Regardless of how long you’ve struggled with bulimia, you can learn to break the binge and purge cycle and develop a healthier attitude toward food and your body.

Taking steps toward recovery is tough. It’s common to feel ambivalent about giving up your binging and purging, even though it’s harmful. If you are even thinking of getting help for bulimia, you are taking a big step forward.


Steps to bulimia recovery

  bullet Admit you have a problem. Up until now, you’ve been invested in the idea that life will be better—that you’ll finally feel good—if you lose more weight and control what you eat. The first step in bulimia recovery is admitting that your relationship to food is distorted and out of control.
  bullet Talk to someone. It can be hard to talk about what you’re going through, especially if you’ve kept your bulimia a secret for a long time. You may be ashamed, ambivalent, or afraid of what others will think. But it’s important to understand that you’re not alone. Find a good listener—someone who will support you as you try to get better.
  bullet Stay away from people, places, and activities that trigger the temptation to binge or purge. You may need to avoid looking at fashion or fitness magazines, spend less time with friends who constantly diet and talk about losing weight, and stay away from weight loss web sites and “pro-mia” sites that promote bulimia. You may also need to be careful when it comes to meal planning and cooking magazines and shows.
  bullet Seek professional help. The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.


The importance of deciding not to diet

Treatment for bulimia is much more likely to succeed when you stop dieting. Once you stop trying to restrict calories and follow strict dietary rules, you will no longer be overwhelmed with cravings and thoughts of foods. By eating normally, you can break the binge-and-purge cycle and still reach a healthy, attractive weight.


Therapy for bulimia

Because poor body image and low self-esteem lie at the heart of bulimia, therapy is an important part of recovery. It’s common to feel isolated and shamed by your bingeing and purging, and therapists can help with these feelings.

The treatment of choice for bulimia is cognitive-behavioural therapy. Cognitive-behavioural therapy (CBT) targets the unhealthy eating behaviours of bulimia and the unrealistic, negative thoughts that fuel them.

  bullet Breaking the binge-and-purge cycle – The first phase of bulimia treatment focuses on stopping the vicious cycle of bingeing and purging and restoring normal eating patterns. You learn to monitor your eating habits, avoid situations that trigger binges, solve problems with stress in ways that don’t involve food, eat regularly to reduce food cravings, and fight the urge to purge.
  bullet Changing unhealthy thoughts and patterns – The second phase of bulimia treatment focuses on identifying and changing dysfunctional beliefs about weight, dieting, and body shape. You explore attitudes about eating, and rethink the idea that self-worth is based on weight.
  bullet Solving emotional issues – The final phase of bulimia treatment involves targeting emotional issues that caused the eating disorder. Therapy may focus on relationship issues, underlying anxiety and depression, low self-esteem, and feelings of isolation and loneliness.


Psychotherapy have been shown to be effective in Bulimia Nervosa. However, for many people they benefit from a range of different therapies depending on the causes of their eating problem. Therapies that might be discussed with you include; dialectical behaviour therapy; mindfulness approaches; E.M.D.R.; CBT; Interpersonal Psychotherapy (IPT) family therapy etc
.


Cognitive Behavioural Therapy (CBT)

This is usually done with an individual therapist, with a self-help book, in group sessions, or with a CD Rom. CBT helps you to look at your thoughts and feelings in detail. You may need to keep a diary of your eating habits to help find out what triggers your binges. You can then work out better ways of thinking about, and dealing with, these situations or feelings.
 
 
Eating advice

This helps you to get back to regular eating, so you can maintain a steady weight without starving or vomiting. The dietetian will help you work out a food plan that’s right for you, and support you to develop strategies for overcoming your difficulties around foods and situations.

To download a general advice / meal plans click here.


Medication

Even if you are not depressed, high doses of antidepressants such as Fluoxetine (Prozac) can reduce the urge to binge eat. This can reduce your symptoms in 2-3 weeks, and provide a “kick start” to psychotherapy. Unfortunately, without the other forms of help, the benefits wear off after a while.
 

How effective is the treatment?

About half of sufferers recover, reducing their bingeing and purging by at least half. This is not a complete cure, but will let you get back some control of your life, with less interference from the eating problem.

The outcome is worse if you also have problems with drugs, alcohol or harming yourself.
CBT and IPT work just as effectively over a year, although CBT seems to start to work a bit sooner.

There is some evidence that a combination of medication and psychotherapy is more effective than either treatment on its own.

Recovery usually takes place slowly over a few months or many years.


Self Help Advice

beat (formerly the Eating Disorders Association)

Helpline: 0845 634 1414 (Mon- Fri, 10:30-8.30pm, and Saturday 1.00- 4:30pm.
beat youth helpline: 0845 634 7650 (Mon- Fri, 4.00-6.30pm and Saturday: 1.00-4:30 pm).

beat is an organisation that campaigns, that challenges the stigma faced by people with eating disorders and that gives people the help and support they need.

Eating Disorder Hope

American website offering information, eating disorder treatment options, recovery tools and resources to those suffering from eating disorders, their treatment providers and loved ones.

NHS Direct

Tel: 0845 4647 (24hr)
Advice from a nurse on all health topics.
Online CBT resources
Overcoming Bulimia
www.overcomingbulimiaonline.co.uk


Further Reading

Understanding your Eating. Julia Buckroyd
Binge no More. Nash
Bulimia Nervosa and Binge eating: A guide to recovery by P. J. Cooper and Christopher Fairbairn (Constable and Robinson).
Overcoming binge eating by Christopher Fairburn (Guildford Press).
Getting better BITE by BITE: A survival kit for sufferers of bulimia nervosa and binge eating disorders by Janet Treasure and Ulrike Schmidt (Hove Psychology Press).


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