People suffering from bulimia nervosa are caught up in a cycle of overeating/bingeing and then purging to prevent any gain in weight. They feel out of control of their eating, and their purging behaviour adds to their sense of personal shame and distress. Some use compensating behaviours in addition to or instead of purging, e.g. over-exercising or restricting food.
Purging is typically achieved by self-induced vomiting or taking laxatives or diuretics. This behaviour seems like the answer to a problem - how to eat and not gain weight, but it mainly causes fluid loss in fact, rather than calorie loss, and it damages the body.
Sufferers of bulimia have an intense fear of becoming overweight, and usually keep within the normal body weight ranges, though their weight may fluctuate. This means that bulimia can be kept hidden, unlike anorexia.
Bulimia can develop out of anorexia, and some sufferers do follow a cycle of strict dieting and then a binge-purge.
The diagnostic criteria used by the NHS:
Recurrent episodes of binge eating. A binge is eating a very large amount of food during a short period of time (under 2 hours), and feeling a lack of control over eating during the binge episode
Regular inappropriate methods of preventing weight gain, e.g. by self-induced vomiting, taking laxatives or diuretics, compulsive over-exercise or strict dieting
On average one binge eating episode and one purging episode per week for at least three months
Excessive judgment of own body shape and weight
Weight can vary up and down , but is in the normal weight range
Excessive food intake in a short period of time followed by purging
Obsessive thoughts about food and eating; over-critical views of their weight and body shape
Fear of being overweight
Binges triggered by stress, anger, hunger, anxiety, depression, loneliness, low self-esteem
Guilt, shame, disgust and secrecy about behaviours they cannot control
Constipation and bloating - stomach pains
Menstrual periods stop or irregular
Damaging consequences of vomiting include:
Damaged, over-sensitive, yellowish teeth as acidic vomit removes enamel from teeth
N.B. IMPORTANT: To minimise this damage and preserve the enamel as much as possible, rinse the mouth thoroughly with bicarb (sodium bicarbonate mixed in water) or water or milk after vomiting in order to neutralise the acid.
Do not brush the teeth with toothpaste as this will remove more tooth enamel.
Calluses on hands (from impact with teeth, if putting their fingers down their throat to induce vomiting)
Bad breath and chronic sore/damaged throat
Dry skin and hair and brittle nails
Swollen face, neck and throat glands (look like hamster /chipmunk cheeks)
Serious imbalances in body chemistry – causes problems such as tiredness, abnormal heart rhythms, and muscle spasms through to heart attacks and kidney failure
Damaging consequences of laxative misuse include:
Over time, laxative use increases to high doses as tolerance to the laxative develops.
Bowel muscles damaged leading to permanent constipation (or even surgery and a colostomy bag)
Bloating and painful cramps
Dry skin and hair and brittle nails
Serious imbalances in body chemistry – causes problems such as tiredness, abnormal heart rhythms, kidney damage and muscle spasms
Excessive food intake with no apparent weight gain
Uncontrollable urge to eat
Obsession with food/dieting
Life may revolve around shopping, eating and purging behaviour – affecting social and work life
Disappearing to the bathroom after meals
Spending long periods of time in the bathroom
Putting air fresheners in the bathroom, leaving 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; money taken to buy food
Eating in secret, eating at night
Chipmunk-like swellings at face/neck
Calluses on knuckles
Smooth yellowish teeth
Sore throats and bad breath
Shortage of money (spent on food for binges)
Anxious to get people out of the way / out of the kitchen
Self-harm, misuse of alcohol
Mood swings – anxious, tense, depression, irritability; low self-esteem at home vs. confidence elsewhere