Bulimia

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

Symptoms include:

• 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

• Heart problems

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)

• Diarrhoea 

• Bloating and painful cramps

• Dehydration  headaches

• 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

  • N.B. IMPORTANT:  Laxative use 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

• Uncontrollable urge to eat

• Obsession with food/dieting

• Life may revolve around shopping, eating and purging behaviour – affecting social and work life

• Secretive behaviours

• 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