What is bulimia nervosa?

Bulimia usually affects a slightly older age group, often women in their early to mid-twenties who also have been overweight as children. It will affect 3 out of every 100 women at some time in their lives. Like anorexics, people with bulimia suffer from an exaggerated fear of becoming fat, however, unlike people with anorexia bulimics usually manage to keep their weight within normal limits.

They can do this because, although they try to lose weight by making themselves sick or taking laxatives, they also “binge eat”. This involves eating, in a very short time, large quantities of fattening foods that they would not normally allow themselves. For example, people with bulimia might get through numerous packets of biscuits, several boxes of chocolates and a number of cakes in two hours or less. Afterwards they will make themselves sick, and feel very guilty and depressed.

This bingeing and vomiting may raise or lower their weight by up to 10 Ib within a very short period of time. It is extremely uncomfortable, but for many it becomes a vicious circle that they cannot break out of. Their chaotic pattern of eating comes to dominate their lives.

There are two types of bulimia:

  • A purging type (person regularly engages in purging behaviour, e. g. self-induced vomiting or misuse of laxatives, diuretics or enemas)

  • A non-purging type (person uses other inappropriate compensatory behaviours, such as fasting or excessive exercise, rather than self-induced vomiting or misuse of laxatives, diuretics or enemas)

People with bulimia are often high-functioning and perfectionists, but can also be dependant, helpless or shy. They tend to feel out of control, inadequate and worthless. Bulimia is characterised by high levels of shame, self-loathing and embarrassment. Bulimia is also associated with a high level of comorbidity in connection with depression, anxiety disorders, alcoholism and substance abuse. Also linked to bulimia are borderline or narcissistic disorders, obsessive-compulsive, avoidant, and dependent personality disorders, as well as issues with affect and impulse regulation.

The effects of bulimia are less apparent than the effects of anorexia. A person with bulimia can maintain a normal weight for their height and they may outwardly give the impression of coping well with life’s challenges. They may put off seeking help and support because they are frightened of the reaction they might get if they disclose what they are doing. Shame and the fear of rejection become powerful barriers to change. Being able to come out of isolation may take time.

What are the signs of bulimia nervosa?

People with bulimia typically start their days eating very little and stick to very low calorie meals during the day. This might end in binges at the end of the day, where they consume a large amount of high calorie foods (carbohydrates and fats). Bingeing and purging is done secretly, and bingeing only stops when people are uncomfortable full or are interrupted, leaving them feeling guilty and anxious. Bingeing episodes may be followed by days of strict dieting. People with bulimia often eat normally in the presence of others.

A warning sign for someone to suffer from bulimia may be that the person disappears to the bathroom after meals. They may also secretly hoard food. People with bulimia may be very emotional and suffer from irritability and mood swings. They may have problems dealing with social situations and in their interaction with others.

What are the physical symptoms of bulimia nervosa?

People with bulimia often have a variety of complaints, many of which may be a direct result either of their eating behaviour or of attempts to counter overeating such as vomiting or taking laxatives. These may include tiredness, muscle weakness, feeling faint or dizzy, abdominal pains, sore throats, diarrhoea or constipation. Many people with bulimia experience swelling of the salivary glands, possibly due either to bingeing or to vomiting, which enhances their feeling of being fat.

People who vomit frequently, and have done so for several years, are likely to have dental problems, in particular erosion of tooth enamel of the upper teeth. People with bulimia are likely to suffer from dehydration as a result of vomiting or taking laxatives, which may partly explain feelings of dizziness, weakness and being light-headed. As a rebound effect, when they do allow themselves to eat and drink, they may experience fluid retention, which itself adds to the feelings of being fat and the belief that purging is necessary as a means of combating overeating.

Purging behaviour can lead to electrolyte imbalances caused by loss of essential minerals such as potassium, sodium, calcium, magnesium and chloride. These are reversed when purging stops, but can result in minor symptoms such as muscle weakness, and, at worst and rarely, can have serious medical consequences such as cardiac arrhythmias, even cardiac arrest or renal failure. In rare cases, bingeing itself can lead to acute gastric dilatation, even rupture; vomiting can cause tearing or rupture of the oesophagus.

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