Bulimia nervosa

Bulimia nervosa is a form of eating disorder. People with bulimia are often unable to regulate their food intake.

Bulimia nervosa is characterised by a repetitive cycle of binge eating and purging. Bingeing is the part of the cycle when a bulimia sufferer eats food compulsively, without restraint. People tend to binge on unhealthy foods with a high fat and sugar content.

After a binge, bulimic people will often feel overwhelmingly guilty or disgusted by their behaviour. This feeling of remorse and self-loathing will result in a purge. Purging is the part of the cycle when the sufferer will attempt to avoid weight gain by ridding the digestive system of recently consumed food. The most common methods used to get rid of digesting food include:

  • forcedly vomiting
  • excessively exercising
  • taking laxatives and diuretics.

People suffering from bulimia tend to feel constantly anxious and paranoid about their weight. These anxieties often manifest as a result of social pressures to look a certain way, or to be a certain weight - usually advocated by the media and endorsed by celebrities.

It is widely believed that bulimia stems from underlying emotional or psychological problems such as low self-esteem, low confidence, depression, stress and anxiety.  

Who can develop bulimia?

It is thought that 1 in 50 women will suffer from bulimia at some point in there lives1. There is, however, a wide misconception that bulimia only affects women.

For every 10 female bulimics, there is one man also suffering from the condition. Bulimia in men is most commonly triggered by specific athletic occupations such as body building, horseracing or running. Many athletes feel a pressure to reach a certain fat or muscle percentage, or to fit into a particular weight category for their sport. There is also an increasing number of men who, like women, are influenced by media images of the ‘aspirational’ body shape.

Although bulimia is far more prevalent in young woman in their late teens or early twenties, it can in fact affect anyone, at any age. Bulimia has been known to affect children, but cases like this are extremely rare.  

There are certain uncontrolled factors that can increase the likelihood of developing bulimia. These include:

  • Living in a Western society - extreme exposure to conflicting messages in media advertising (on one hand encouraging instant gratification and tempting us to indulge, and on the other - telling us we should be thin), can lead to feelings of confusion and inadequacy.
  • Having type 1 diabetes can increase the risk of developing bulimia.
  • Women who start their periods at a young age may be more at risk risk.
  • If you have had anorexia in the past, you may develop bulimia.
  • If you have a family history of eating disorders you are four times more likely to develop bulimia- this can either be due to genetics, or it might be due to copied behaviour. Children can be influenced by parents who place high value on appearances, or who tend to criticise their children.

Symptoms of bulimia

People suffering from bulimia are often obsessed with what they eat and how they look. They may harbour an intense fear of gaining weight or looking fat, and often have a distorted perception of their what their bodies really look like. Most bulimics are average in weight for their height and build, but many wrongly believe that they are too fat.

There are usually few physical symptoms of bulimia, however, there are some typical behavioural patterns associated with the condition.

If you think that you could be bulimic, you may wish to ask yourself the following questions:

  • Do I eat even when I am not hungry?
  • Do I continue to eat even after I am full?
  • Do I eat very quickly and suddenly?
  • Do I often escape to private places to eat my food away from other people?
  • Do I feel ashamed or embarrassed by what I eat?
  • Do I think or worry about food a lot?
  • Do I ever make myself sick after eating?
  • Do I secretly hoard food?
  • Am I obsessed with exercise?
  • Have I become secretive and unwilling to socialise?
  • Do I ever self-harm?
  • Do I go through a binge-purge cycle at least twice a week?

If you answered yes to one or more of the above questions, it may be advisable to book an appointment with your GP. Some physical symptoms of bulimia may include:

  • fluctuating weight
  • bloated feeling or a feeling of fullness
  • indigestion
  • tiredness
  • weakness
  • abdominal pains
  • irregular periods (if you are female)
  • constipation or diarrhoea
  • sore throat from vomiting
  • scarred, cut or grazed knuckles from forcing fingers down throat to induce vomiting.

Living with bulimia

Because bulimia isn’t an infection or a disease, it cannot simply be cured with a trip to the hospital or with a course of antibiotics. Bulimia is something sufferers have to live with and try to deal with continuously.

For bulimic individuals, the relationship between emotion and food is extremely complex. This unusual connection is often triggered by underlying psychological conditions that can take many years to recognise and address.

Underlying causes of bulimia

  • Low self-esteem - Sometimes eating disorders can be caused by feelings of inadequacy. Some people feel that if they lose weight, they will be accepted and liked by other people. For them, losing weight is a way of gaining self-worth.
  • Depression - People who feel sad or unhappy on a regular basis may find that binge eating distracts or momentarily comforts them. Straight after eating the feelings can return - often accompanied by additional guilt and repulsion. This precedes the purging stage of the cycle.
  • Stress - Bulimia can be triggered by stressful or traumatic life events such as an abusive childhood, rape, witnessing crime or losing a loved one. Trauma can often make us feel like we’re out of control of our lives. This feeling of helplessness can lead to other emotional states- such as anxiety or stress. Bulimic people find that binge eating provides temporary emotional comfort during times of stress.
  • Anger - People who have problems expressing intense emotions, such as anger, tend to channel them through compulsive habits like binge-eating and purging.

Diagnosing bulimia

Admitting to the problem and seeking help is the biggest and most important step a bulimic can take towards recovery. It can be difficult to admit to something that may, in many cases, have been kept a secret for years. Sometimes it can take a change of living situation, such as a new relationship or new house mates, to trigger the decision to tackle bulimia. This could be due to other people noticing and commenting on your eating habits.

If you think that you have bulimia, it is advisable to book an appointment with your GP. Your GP will ask questions about your eating habits. It may be a good idea to keep a food diary for a few weeks so you can provide enough information for them to build a solid picture of your condition.

Depending on the severity of your bulimia, the GP may decide to refer you for specialist support. In this case, they may refer you either to a psychiatrist, a psychologist, or dietitian.

Complications of bulimia

In some cases, bulimia can be life-threatening. The binge-purge cycle is extremely dangerous and can have a detrimental effect on many different parts of the body- from the digestive to the reproductive system. 

Some possible complications include:

  • Dental problems - Excessive vomiting causes stomach acid to corrode tooth enamel, leading to tooth decay, bad breath and sore throat.
  • Damaged skin and hair - Because nutrients are manually flushed out via induced vomiting or laxative/diuretic use, they don’t have time to absorb into the bloodstream. This results in deficiencies which causes skin to become dry and hair to become thin, dry and brittle.
  • Swollen glands - Induced vomiting can cause the salivary glands to swell, making the face appear puffy and rounder that usual.
  • Bowel issues - Misuse of laxatives can cause damage to the bowel muscles. This can result in permanent constipation.
  • Chemical imbalances - Purging leads to malnutrition. Malnutrition can cause chemical imbalances in the body which result in tiredness, abnormal heart rhythms, kidney damage, weakness, muscle spasms and fits.
  • Heart problems - Long-term effects of bulimia often result in an increased risk of heart problems.

Treatment for bulimia

There are a number of different treatments available to help alleviate the symptoms of bulimia. These are administered according to the severity or cause of the condition.

Psychological treatment can include:

  • Cognitive behavioural therapy (CBT) - Explores the relationships between patterns of thinking and patterns of behaviour. This form of therapy aims to examine emotions in detail in order to devise new ways of tackling difficult situations without resorting to food.
  • Interpersonal therapy (IPT) - This form of therapy aims to tackle problems relating to personal relationships with the idea of reducing the need to comfort eat. Patients are more likely to be referred to this form of treatment if they have recently suffered the loss of loved ones or experienced a big change in their lives.

Medical treatment can also be prescribed. SSRIs are a form of anti-depressant that boosts serotonin levels (happy hormones) in the bloodstream, reducing the need for comfort eating and purging. Taking SSRIs can cause many side effects and complications. The long term effects of SSRIs are as yet unknown. If you would like to find out more about SSRIs, it is advisable to breech the subject with your GP.

Recovery from bulimia

Recovering from bulimia can often be a long, arduous experience demanding huge commitment from the patient. If you have bulimia, there are a number of things you can do to aid your treatment and make a successful recovery. These include:

Change your eating habits

Consult a nutritionist to learn about healthy, low-calorie foods that can sooth your cravings without making you gain weight. If you enjoy a healthy, balanced diet with enough of the necessary nutrients, you should be able to stave off hunger pangs and resist the urge to binge.

The key to eating a healthy, balanced diet is to not deprive yourself of a certain food groups (such as fats or carbohydrates). Below are a number of simple nutritional facts from the BBCwebsite that you could use as guidelines to eating healthily and staying full:

1. 1/3 of your diet should consist of starchy carbohydrates. Carbohydrate is the body's predominant source of energy. It is generally advisable to choose 'unrefined carbohydrates' like wholegrain, which is rich in fibre and thought to help protect against diabetes, heart disease and some cancers.

2. 1/3 of your diet should consist of fruit and vegetables. The government recommends we aim to eat 5 portions of fruit and vegetables every day. These can either be incorporated into main meals or into snacks. Eating healthy snacks throughout the day can help relieve hunger pangs and reduce the risk of a binge.

3. The remaining 1/3 of your diet should consist of dairy and protein. This can include milk, cream, cheese, meat, fish, nuts, beans and eggs.

4. Avoid saturated fats from processed foods- these are high in cholesterol and increase the risk of fatty build-up in the arteries leading to cardiovascular disease.

Change the way you think about food

People suffering from eating disorders often associate food with emotions. For instance, if they feel particularly down or stressed they may resort to eating large amounts of high calorie food for temporary distraction or relief.

Certain forms of therapy may be able to help you change the way you think about food. After you finish your course of therapy, it is important to continue applying your techniques so you don't slip back into old habits.

Becoming educated about food can go some way towards controlling your compulsions.

A nutritionist will be able to teach you about the nutritional benefits of certain foods. You can use this knowledge to gain control over what you eat. Exploring new foods, trying new recipes and spending time preparing meals could in some cases help to develop a positive relationship with food.

A combination of therapy and self-help could see you well on the way to recovery. Getting to the core of the cause is important, as is changing your approach to food and adjusting your habits accordingly.

How can a nutritionist help with bulimia?

The road to recovering from bulimia is long. It can take a lot of effort and dedication on behalf of the sufferer. A nutritionist can offer a branch of support even after the initial treatment (medication, therapy) has finished. Bulimia can return at any moment, especially during times of stress or trauma. Nutritionists are food experts. They know what kinds of food can help stave off the hunger pangs and sugar cravings that often preempt a binge.

They can try to help you develop a positive relationship with food. The more you learn about the complexity of nutrition and the power of certain vitamin and mineral balances, the closer you will come to understanding the impact bulimia has on your body and moods.

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