By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Bulimia Nervosa a relapsing eating disease.
Bulimia Nervosa is included in the eating disorder category along with Anorexia Nervosa but it is very different from the other eating disorders. Anorexia progresses like a vice, starving the sufferer until their weight reaches a critical potentially fatal low. Bulimia runs its course in episodes of extreme eating and efforts to undo the overeating and lose the weight until it finally does its damage.
If you didn’t hear the person with Bulimia talking about food, should you only hear the emotional component, it would be hard to distinguish Bulimia from the binge drinking form of alcoholism.
Episodes of binging and the resulting guilt can be triggered by many of the same things that trigger addictive binges. Poor relationships and conflicts with others, the feeling of deprivation from excessively strict diets, or feeling out of control all can trigger the binges.
Binge eaters describe these overwhelming obsessive-compulsive urges as emotional eating. Emotional eaters who do not purge develop Binge Eating Disorder. Those who start compensating develop Bulimia.
Most people who develop Bulimia start off at normal or even a little overweight. They are likely to be a little older than the beginning person with Anorexia, perhaps late teens or even early twenties. There may be a period of moderate to strict dieting before the Bulimia strikes.
When they diet they have increasingly intense urges to eat. The tension continues to grow until the individual can’t stand it any longer, then like the alcoholic, the binge is on. At this point, the “just don’t think about it” approach does not work and may make things worse. In a previous post “Don’t think about Elephants.” I described why the “just not thinking about things” approach does not work and what else can be done in this circumstance.
Binge drinking is defined as 4-5 drinks on a single drinking occasion, enough to get intoxicated. Binge eating is described as eating far more than a normal person during a single food intake episode lasting two hours or less. Bulimics crave food and then when they give in and eat it is not a little, but a lot of food consumed in a short amount of time. This overconsumption results in guilt and regret.
These episodes increase in frequency. Typically the person with Bulimia will have two or more episodes of loss of control, binge eating and then efforts to purge the food every week for at least three months. The guilt over the episode increases the risk they will binge again.
Often the food of choice is ice cream or cake though no one food type is the choice of all people with Bulimia. They will eat until they reach the over-full point, become uncomfortable or even painfully full.
The Bulimic then tries to undo the excess calories by deliberate vomiting or other compensatory behaviors. This is not a disease of gradual overeating and excess weight gain. Bulimia may result in sudden swings in weight, both increases, and decreases. The damage comes not from the weight gain or loss but from the radical behaviors used to undo the binge episode.
The emphasis is on the person’s use of “inappropriate” methods to undo the overeating. Someone with Bulimia may vomit so often that the enamel in the teeth is destroyed. They may develop calluses on the knuckles from repeated efforts to force the vomiting.
There can be damage to the throat and esophagus. A great many medical problems develop over time but may go unnoticed as the person’s weight swings up and down rather than moving to an extreme.
Bulimia is more common than Anorexia with up to three percent of women developing Bulimia during their lifetime.
These episodes of binge eating and the resulting efforts to undo the overeating are generally done in secret. The sufferer tries to be inconspicuous and may withdraw from family and friends damaging their relationships.
Self-esteem for the person with Bulimia is dependent on body shape and weight. They often develop intense depression after a period of bingeing and purging. Some have undiagnosed depression before the Bulimia, but Bulimia can also cause depression and anxiety.
Bulimia Nervosa like Anorexia Nervosa is treatable but both require specialized treatment by someone knowledgeable and experienced in treating eating disorders.
Bulimia is not associated with a high risk of suicide or death from medical complications, though some who have suffered from Bulimia can become severely depressed and have thoughts of self-harm.
Bulimia Nervosa is an illness not a case of vain or selfish behavior. If you want to be helpful to someone with this disorder listen to what they have to say in an open and non-judgmental way.
If you have Bulimia, get help now. If you know someone who has this problem encourage them to seek professional help.
Other posts about eating disorders and the new DSM-V proposals will be found at:
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