Information on Bulimia Nervosa:

Literally 'hunger of an ox'. The person with bulimia nervosa will binge to cope with uncomfortable feelings, feel out of control and then make themselves sick, take laxatives, starve or exercise in an attempt to get rid of the calories they have taken in, setting up a cycle of overeating and compensating behaviour. They have an intense fear of weight gain, although they are likely to maintain a 'normal' body weight. This behaviour seems like the answer to a problem - how to eat and not gain weight, but … taking laxatives does not help weight loss. They remove water and waste from the lower bowel and may cause permanent damage. Also vomiting is not useful as it causes rebound fluid retention and other physical and psychological problems.

Diagnostic criteria:

  • Recurrent episodes of binge eating. A binge is characterised by: Eating a larger amount of food than normal during a short period of time (within 2 hours) Feeling a lack of control over eating during the binge episode.
  • Regular methods of preventing weight gain which may include self induced vomiting, taking laxatives or diuretics, compulsive over-exercise or strict dieting.
  • A minimum of two binge eating episodes per week for at least three months.
  • Persistent over-concern with body shape and weight. N.B. Bingeing produces a drug-like state, relieving negative mood. Once the body is in a state of "starvation chemistry", it is likely bingeing will occur as soon as a "trigger" food is eaten. This is a physiological reaction driven by the need for nutrients which are required to maintain the body in a healthy state.

Symptoms of bulimia nervosa:

  • Weight yo-yo's, but is in the normal weight range.
  • Imbalance of minerals in blood (low potassium and calcium). Vital substances are lost when vomiting - may affect the heart.
  • Kidney problems - dehydration may result if vomiting or using laxatives.
  • Guilt and shame about behaviour they cannot control.

Consequences of vomiting include:

  • Swollen salivary glands (looks like little hamster cheeks).
  • Sore throat and sores on mouth due to acid vomit.
  • Calluses on hands (from impact with teeth) if the person is putting their fingers down their throat to induce vomiting.
  • Loss of stomach acid causes bloating in stomach.
  • Rebound oedema (water retention) may result if the person is taking in large amounts of carbohydrate during binges.
  • Smooth teeth. Acid vomit removes enamel from teeth. [To minimise this damage and preserve the enamel as much as possible, rinse the mouth with bicarb (sodium bicarbonate solution) or water after vomiting to neutralise the acid. Do not brush the teeth with toothpaste as this will further remove tooth enamel.]
  • Pressure on the diaphragm to induce vomiting may rupture small blood vessels.

Consequences of laxative misuse:

(Laxatives may be the stimulant type like senna, osmotic-type like lactulose, or fibre type which produce bulk. The latter two are safer, but as tolerance to the laxative develops, increasingly high doses of laxatives are likely to be used.)
  • Laxatives may cause bloating due to loss of gut flora.
  • Laxatives are liked as they give a feeling of emptying.
  • If laxatives are used, less minerals will be absorbed.
  • Constant use of laxatives may result in loss of natural bowel action and spastic colon. N.B. Although abuse of laxatives is damaging, they should be reduced gradually or else rebound constipation and fluid retention may result with feelings of bloatedness.

Some observable signs:

  • Excessive food intake with no apparent weight gain.
  • Disappearing to the bathroom after meals.
  • Spending long periods of time in the bathroom.
  • Putting air fresheners in the bathroom, finding messy toilets.
  • Isolation, especially after meals.
  • Buying large quantities of food, hoarding food.
  • Finding empty food wrappers, crisp packets etc.
  • Food from the kitchen, larder, fridge etc disappearing.
  • Eating in secret.
  • Eating at night.
  • Dark circles and puffiness under eyes.
  • Chipmunk-like swellings at face/neck.
  • Callouses on knuckles (where teeth hit the hand if fingers are put down the throat to provoke vomiting.
  • Smooth teeth, due to erosion of tooth enamel by acid of vomit.
  • Sore throat and sores on mouth.
  • Severe mood swings - hyperactivity, depression, irritability.
  • Personality change - moody and irritable.
  • Weight fluctuations, but in the normal weight range.
  • Shortage of money (spent on food for binges).
  • Anxious to get people out of the way / out of the kitchen.