Bulimia Nervosa

Bulimia is a serious, potentially life-threatening eating disorder characterized by a cycle of binge eating followed by purging. Bulimia includes eating large amounts of food—more than most people would eat in one meal—in short periods of time, then getting rid of the food calories through vomiting, laxative abuse or over-exercising.

Bulimia has three primary symptoms:

  • Regular intake of large amounts of food accompanied by a sense of loss of control over eating behaviour
  • Regular use of inappropriate compensatory behaviours such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise
  • Extreme concern with body weight and shape

Bulimia nervosa most often begins in late adolescence or young adulthood, affecting one to two percent of women. The majority of people who have bulimia are women—about 80 percent.[1] It is possible that there are more men with bulimia and that they may be less likely to seek treatment.

Men and women involved in sports, dance, modeling or other activities that emphasize thinness represent a high-risk group to develop bulimia. Many people who struggle with bulimia recognize that their behaviours are unusual and perhaps dangerous to their health.

A person with bulimia may also fast or exercise to lose weight, is often at a normal weight and may ultimately gain weight. A continuous cycle of bingeing and purging slows down the body’s metabolism. During a binge, the body absorbs fat and calories, thereby increasing the likelihood of gaining weight.

The binge-purge cycle often begins at transition points of independence (such as changing high school, leaving for college, moving away from home) when stress is high and there may be no other outlets for emotional conflict and tension.

Eating disorder specialists believe that the chance for recovery increases the earlier bulimia nervosa is detected. Therefore, it is important to be aware of some of the warning signs.

The warnings signs of bulimia are:

  • Evidence of binge eating, including disappearance of large amount of foods in short periods of time or the existence of wrappers and containers indicating the consumption of large amounts of food
  • Evidence of purging behaviours, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers of packages of laxatives or diuretics
  • Excessive, rigid exercise regimen despite weather, fatigue, illness or injury—the need to burn off calories taken in
  • Unusual swelling of the cheeks and jaw
  • Calluses on the back of the hands and knuckles from induced vomiting
  • Discoloration or staining of the teeth
  • Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions
  • Withdrawal from usual friends and activities
  • In general, behaviours and attitudes indicating that weight loss, dieting and control of food are becoming primary concerns

Complications that lead to death are less common in bulimia than in some other eating disorders but if treatment is not pursued, bulimia can become a lifelong progressive disorder in which more and more of a person’s daily activities and thoughts are oriented around food.

Treatment

Treatment for bulimia is similar to that of anorexia nervosa and should be specific to the needs of the individual. Treatment may occur in an inpatient program, and in individual or group psychotherapy. Medication has been shown to lessen the number of binge episodes and reduce the depression associated with bulimia. Therapists may use a number of approaches that include cognitive behavioral interventions, family therapy, psychodynamic or expressive art therapies.

 

Additional features of bulimia nervosa:

  • Repeated episodes of binge eating (rapid consumption of a large amount of food in short period of time), sometimes with purging
  • Feeling out of control during a binge and eating beyond the point of comfortable fullness
  • Purging after a binge (typically by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise or fasting)
  • Frequent dieting or fasting
  • Use of laxatives and diuretics
  • Strict exercise program to prevent weight gain
  • Persistent over concern with body shape and weight
  • Preoccupation with and constant concern about food and/or weight
  • Severe self criticism
  • Self worth determined by weight
  • Frequent bathroom visits after meals
  • Dietary restriction when eating in public
  • Impulsivity (with alcohol, spending, decision making, relationships)

 

Health consequences of bulimia nervosa:

  • Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviours.
  • Inflammation and possible rupture of the esophagus from frequent vomiting.
  • Tooth decay and staining from stomach acids released during frequent vomiting
  • Chronic irregular bowel movements and constipation as a result of laxative abuse
  • Gastric rupture is an uncommon but possible side effect of binge eating
  • Difficulty concentrating on tasks, mood swings due to chemical imbalance
  • Swollen glands, puffiness in the cheeks, or broken blood vessels under the eyes
  • Chest pain, muscle cramps, fatigue

If you think you may have an eating disorder, contact our office to find out more about services available in the Ottawa Community.


[1] Gidwani, G.P. and Rome, E.S. (1997). Eating Disorders. Clinical Obstetrics and Gynecology, 40(3), 601-615.

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