Understanding Bulimia
Bulimia Nervosa is a type of eating disorder characterised by episodes of binge eating followed by compensatory behaviours, which are intended to prevent weight gain.
During an episode of binging, the person will eat an unusually large amount of food in a short period of time with a sense of loss of control of the food intake. The binge will generally take place in private and binge on that person’s ‘forbidden’ foods (usually high in fat and sugar). The foods typically involved in a binge are biscuits, chocolate, crisps, bowls of cereal, large amounts of toast with butter, chips, cakes, tubs of ice cream etc. Eating continues until the urge to eat is gone, tension is reduced, physical satiation is reached, often to the point of pain, or the person is interrupted.
The person will then engage in compensatory behaviours due to feeling intense feelings of guilt and shame. Compensatory behaviours are intended to prevent weight gain following a binge eating episode. These compensatory behaviours include self-induced vomiting, dieting, fasting, restricting, over-exercise, misuse of laxatives, diuretics, and or other medications.?
Bulimia Nervosa is a serious mental illness that can cause a range of physical health complications of which some can be life threatening.?
Those who struggle with an eating disorder may not look like they are affected by one on the outside as they may maintain an average weight and compensatory behaviours are carried out in secret (due to the feelings of guilt and shame), making the eating disorder difficult to detect and provides a barrier to the individual seeking treatment and support.?
What does Bulimia Nervosa do?
Bulimia is often used as a way of dealing with underlying personal, emotional and psychological difficulties.
Some individuals find that Bulimia helps them to function by numbing their emotions, provides a distraction, a sense of accomplishment and feelings of control.
What can cause the development of Bulimia?
There are a range of factors that can play a role in the development of this eating disorder such as genetics, societal influences, pre-existing anxiety, or depression.
We generally see Bulimia develop in late adolescence, primarily in females however males can be affected by Bulimia also.?
Those with Bulimia place extreme importance on their body shape and weight in determining their self-worth.
Signs and symptoms of Bulimia Nervosa:
Physical signs:
- Frequent changes in weight, loss or gains
- Signs of damage due to vomiting, including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath
- Feeling bloated, constipated
- Disturbance of menstrual periods in women
- Fainting or dizziness
- Feeling tired and not sleeping well
Psychological signs:
- Preoccupation with eating, food, body shape and weight
- Sensitivity to comments relating to food, weight, body shape or exercise
- Low self-esteem and feelings of self-loathing, shame or guilt, particularly after eating
- Distorted body image
- Obsession with food and need for control
- Depression, anxiety or irritability
- Body dissatisfaction
Behavioural signs:
- Evidence of eating large amounts of food
- Vomiting or using laxatives, enemas, appetite suppressants, or diuretics
- Eating in private and avoiding meals with other people
- Anti-social behaviour, spending more and more time alone
- Repetitive or obsessive behaviours relating to body shape and weight
- Secretive behaviour around food
- Dieting behaviour
- Erratic behaviour
- Self-harm, substance abuse, or suicide attempts
Treatment Options:
Bulimia Nervosa is a treatable illness and there is a lot of evidence about the treatments that work. The sooner someone gets help, the better.
Research suggests that a range of psychological therapies such as Cognitive Behaviour Therapy (CBT) and (CBT-E), Dialectical Behaviour Therapy (DBT), and Interpersonal Therapy (IPT) are the most effective.
Ongoing medical monitoring by a GP and nutrition support with a Dietitian is also important.
For adults, CBT has been shown to be the most effective for the treatment of Bulimia Nervosa. ‘Guided self-help’ has also been shown to be effective.
Hospital-based treatment may be required if the symptoms are very severe or if there are any medical complications that need immediate treatment.
If you find that you identify with the thoughts, feelings, and behaviours of Bulimia, it is important to seek support to understand what these behaviours are doing for you and how we might be able to do things differently to keep you healthy and work towards the quality of life that you deserve.
Author: Aleah Haffenden, B Soc Wk, Grad Cert Suicide Prevention, AMHSW.
Aleah Haffenden is an Accredited Mental Health Social Worker, working primarily with young people (aged 15 and up). She takes a client-focused approach, using a mix of Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT), tailored to their specific needs.