A person with bulimia has not made a “lifestyle choice”, they are actually very unwell and need help.
The reasons for developing Bulimia will differ from person to person; known causes include genetic predisposition and a combination of environmental, social and cultural factors.
Bulimia is characterised by repeated episodes of binge eating followed by compensatory behaviour. In addition, people with bulimia place an excessive emphasis on body shape or weight in their self-evaluation. This can lead to the person’s sense of self-esteem and self-worth being wholly defined by the way they look.
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 are the warning signs of Bulimia?
Having awareness about Bulimia and its warning signs and symptoms can make a marked difference to the severity and duration of the illness. Seeking help at the first warning sign is much more effective than waiting until the illness is in full swing. If you or someone you know is exhibiting some or a combination of these signs it is vital to seek help and support as soon as possible.
The warning signs of Bulimia can be physical, psychological and behavioral. It is possible for someone with Bulimia to display a combination of these symptoms.
Physical signs:
- Frequent changes in weight (loss or gains)
- Signs of damage due to vomiting including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath
- Feeling bloated, constipated or developing intolerances to food
- Loss of or disturbance of menstrual periods in girls and women
- Fainting or dizziness
- Feeling tired and not sleeping well
Psychological Signs:
- Preoccupation with eating, food, body shape and weight
- Sensitivity to comments relating to food, weight, body shape or exercise
- Low self-esteem and feelings of shame, self-loathing or guilt, particularly after eating
- Having a distorted body image (e.g. seeing themselves as overweight even if they are in a healthy weight range for their age and height)
- Obsession with food and need for control
- Depression, anxiety or irritability
- Extreme body dissatisfaction
Behavioral Signs
- Evidence of binge eating (e.g. disappearance or hoarding of food)
- Vomiting or using laxatives, enemas, appetite suppressants or diuretics
- Eating in private and avoiding meals with other people
- Anti-social behaviour, spending more and more time alone
- Repetitive or obsessive behaviours relating to body shape and weight (e.g. weighing themselves repeatedly, looking in the mirror obsessively and pinching waist or wrists)
- Secretive behaviour around food (e.g. saying they have eaten when they haven’t, hiding uneaten food in their rooms)
- Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)
- Dieting behaviour (e.g. fasting, counting calories/kilojoules, avoiding food groups such as fats and carbohydrates)
- Frequent trips to the bathroom during or shortly after meals which could be evidence of vomiting or laxative use
- Erratic behaviour (e.g. spending large amounts of money on food)
- Self harm, substance abuse or suicide attempts
What are the risks associated with Bulimia?
The risks associated with Bulimia are severe. People with Bulimia may experience:
- Chronic sore throat, indigestion, heartburn and reflux
- Inflammation and rupture of the esophagus and stomach from frequent vomiting
- Stomach and intestinal ulcers
- Chronic irregular bowel movements, constipation and/or diarrhea due to deliberate misuse of laxatives
- Osteoporosis– a condition that leads to bones becoming fragile and easily fractured
- Loss of or disturbance of menstrual periods in girls and women
- Increased risk of infertility in men and women
- Irregular or slow heart beat which can lead to an increased risk of heart failure
Treatment
What Is the Treatment for Bulimia?
The primary treatment for bulimia often combines psychotherapy,antidepressants, and nutritional counseling. It is helpful to find a psychologist or psychiatrist experienced in dealing with eating disorders. The same is true for nutritional counseling, whether the patient sees the family doctor or another health professional.
Clinics that specialize in eating disorders can often provide psychiatrists, psychotherapists, and nutritionists. All therapists involved should work in close cooperation with one another.
Therapies to be considered for the treatment of Bulimia Nervosa include:
- Psychological Treatments
- Evidence-based self-help programs
- Cognitive behavioral therapy for Bulimia Nervosa
- Interpersonal psychotherapy
- Maudsley family-based treatment (for children and adolescents)
- Dialectical behaviour therapy
- Guided imagery
- Crisis intervention
- Stress management
