Bulimia Nervosa

Bulimia Nervosa, often referred to as bulimia, is a serious eating disorder characterized by a destructive and recurring pattern of binging, eating large amounts of food in a short period of time, followed by inappropriate behaviors to prevent weight gain. Those who suffer from bulimia nervosa commonly live in a world of shame, secrecy, and self-disgust.

Binges most often occur in private and are accompanied by a sense of lack of control, According to the Diagnostic Statistical Manual, this sense of lack of control is defined by a feeling that one cannot stop eating or control what or how much one is eating. In addition, with the all or nothing thinking of bulimics, any slip-up is a total failure. So, since they failed anyway, why not go and engage in an all-out binge. But if there is any enjoyment or even a sense of disconnect before or during the binge, it is quickly replaced with feelings of guilt, shame, disgust, and self-loathing. Once the binge episode ends, the purging behaviors begin. The Diagnostic Statistical Manual describes these behaviors as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting, and /or excessive exercise. Fasting may often take place the day following a binge.

The period of time between a binge and purge is connected with high anxiety, intense desperation, and extreme feelings of guilt and shame. They may purge in a desperate attempt to burn off the calories following a binge, because they feel overwhelmed in coping with their emotions, or/and a means to punish themselves. Yet, because they have so much shame after a binge, purging becomes a relief. It may be shameful to be in the cycle of binging and purging, but in the moment is seems far less shameful than it is to eat too much and actually let it digest. The preoccupation before the binge even takes place, the whole act of a binge-and-purge episode, and then becoming consumed with feelings and thoughts following is extremely time consuming. There is so little time to be productive and in all just becomes insidious to the core.

Those suffering from bulimia are with usually within a normal weight range and may even look relatively healthy. They may even hide their symptoms pretty well most of the time. But, don’t be fooled, that does not mean the symptoms are not there. And as the disease progresses, the signs do become more apparent and bulimia nervosa takes over a person’s life. It compromises her body, uses up her time and money, limits her peer relationships, and narrows her emotions to those that support the disorder itself. Bulimia nervosa has a profound effect on the body and can have severe, even life threatening medical complications. Listed below is a list of these signs and symptoms and medical complications.

Binge eating signs and symptoms:

  • Lack of control over eating
  • Secrecy surrounding eating (i.e. going out alone on unexpected food runs or going to the kitchen after everyone is asleep.)
  • Alternating between eating unusually large amount of food to fasting
  • Disappearance of food (i.e. hidden stashes of junk food, empty wrappers)
  • Hoarding food

Purging signs and symptoms:

  • Going to the bathroom or leaving for a period of time after eating
  • Disguising sounds so no one can hear the vomiting (i.e. running the faucet)
  • Smell of vomit on breath or the smell of mouthwash or mints
  • Using laxatives, diuretics, or enemas after eating. Also may be utilizing diet pills
  • Excessive exercise, despite weather, illness, or injury, especially following eating
  • Swollen salivary glands and/or puffy “chipmunk” cheeks
  • Calluses on the back of the hands and knuckles from self-induced vomiting
  • Discoloration or staining of the teeth due to stomach acid
  • Chronic sore throat or hoarseness
  • Broken blood vessels in the eyes
  • Frequent fluctuations in weight

Emotional signs and symptoms of bulimia nervosa:

  • Distorted negative body image
  • Preoccupation with shape, weight, dieting, and control of food to the point that it interrupts in daily functioning and is primary concern
  • Feeling like you can’t stop or control your eating behavior
  • Withdrawal from usual friends and activities
  • Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions
  • Depression
  • Anxiety

Medical Complications and Consequences of Bulimia Nervosa:

According the National Eating Disorder Association, the recurrent binge-and-purge cycles can damage the entire digestive system and purge behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.

  • 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 behaviors
  • Possible tear and even rupture of the esophagus or stomach
  • Blood in vomit, acid reflux and ulcers
  • Chronic irregular bowel movements and constipation as a result of laxative abuse
  • Tooth decay and staining from stomach acids released during frequent vomiting
  • Irregular or absent period
  • Gum disease
  • Abrasions and scarring of the knuckles

If you or someone you know may be suffering from an eating disorder, or presenting warning signs of concern, please use the resource page or contact Erica Ives, MFT, CEDS for help.