Eating disorders

What is bulimia nervosa?

There are similarities between anorexia and bulimia. As with the majority of eating disorders, bulimics suffer from low self-esteem and distorted body image. Anorexia and bulimia also appear to be linked to clinical depression. In some cases, the eating disorder leads to depression while in others, depression leads to the eating disorder.

How are bulimia and anorexia similar?
How are they different?

Like anorexia nervosa, bulimia nervosa is a chronic, sometimes life-threatening eating disorder in which sufferers frequently engage in purging. Bulimia nervosa has a 15 percent mortality rate and those fortunate enough to survive this illness often suffer health complications and physical disorders the rest of their lives. As in anorexia, bulimia affects the internal organs. It weakens the heart and lowers bone density. The skin may become sunken, dry, and sallow. Continued vomiting can lead to the eventual erosion of tooth enamel. Other dangers of bulimia include rupture of the stomach and choking.

Bulimia differs from anorexia in one very important aspect. It isn't purging alone bur rather, it is the cycle of binging and purging that makes a person bulimic rather than anorexic. Purging can involve the use of laxatives or self-induced vomiting. Some bulimics choose to engage in inappropriate compensatory behaviors instead—compulsive exercise, for example.¹

Bulimics wish to be thin at all costs. Many feel inherently flawed inside and at a loss to overcome their weaknesses and therefore strive to be perfect (thin) on the outside. Some bulimics view their illness as a means to assert control over food choices and food intake when they have seemingly lost control over other environmental factors and painful struggles such as emotional, physical or sexual abuse. Even if unable to control what enters their body through eating, bulimics believe they can assert control over what leaves the body. It is at this point that bulimia emerges.²

What is the "bulimic cycle"?

Those suffering with bulimia seek out binge and purge episodes. They will frequently binge, eating large quantities of food in a relatively short span of time. They will then purge using laxatives and/or diuretics and they will make themselves vomit. These behaviors are self-imposed punishments brought on by guilt and shame—emotions directly linked to how bulimics feel about themselves or about a particular event or series of events in their lives. Binging and purging are seen by bulimics as alternatives to lashing out and releasing pent up feelings of anger, depression, stress, or anxiety.³

The frequency of the binging and purging cycle varies from patient to patient. Some bulimics suffer an episode every few months while others may binge and purge several times a day.

What are the signs and symptoms of bulimia?

Most bulimics recognize that they have an eating disorder. Some do not view it as a problem while others fear and loathe the bulimic cycle that rules their lives. Bulimics may eat socially and exhibit bulimic behaviors in private. These behaviors and symptoms include:

Refusing to eat after a specific time of day Denying hunger Persistent concern with weight or distorted body image Lying about what they have eaten or claiming they have already eaten Shoplifting, hiding, hording or stashing food for later binges Sudden disappearance of food Periods of fasting Recurring episodes of rapid food consumption followed by feelings of extreme guilt

Feeling of lacking control over eating behavior Purging through the use of self-induced vomiting, laxatives, diet pills and diuretics Misuse of laxatives, diuretics and diet pills Regularly engaging in strict diets and/or exercise programs Obsessive or excessive exercise Withdrawal from social situations involving food Absence of at least three consecutive menstrual periods where they are normally expected to occur

Who's at special risk for bulimia?

Although there is no one factor that triggers bulimia, environmental factors such as family dynamics, sexual abuse, peer pressure and societal pressure are all known to be contributing factors. Those most likely to develop bulimia are those in their 20s. They may have already suffered with anorexia or they may go on to develop anorexia nervosa.⁴

Bulimia can be more difficult than anorexia to diagnose because bulimics tend not to lose weight as dramatically. The disorder may exist for many years before it is detected. Bulimics' chronic lack of self-confidence is often well hidden. Many bulimics are highly intelligent and outgoing, and many may work in occupations that require them to have high levels of productive energy, confidence and an outgoing, self-assured manner.⁵

Early intervention and treatment of bulimia can help avoid many of the health complications mentioned above. Strict monitoring is necessary during and after recovery. Treatment takes a great deal of time and patience. Bulimics struggle with themselves and their illness. Those caring for them need to exercise patience and compassion.

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1. Bulimia Nervosa. Something Fishy Website on Eating Disorders.
2. What is Bulimia Nervosa? PageWise, Inc. (2002)
3. What is Bulimia Nervosa? PageWise, Inc. (2002)
4. Bulimia Nervosa. Eating Disorders Association. (2004)
5. Bulimia Nervosa. Eating Disorders Association. (2004)