Bulimia

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Bulimia nervosa, commonly called bulimia, is a potentially life-threatening eating disorder. Those with bulimia eat excessive amounts of food, then rid their bodies of the food by vomiting, using laxatives, or over-exercising. They often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. If you or someone you know is suffering from bulimia, understanding more about it can help you cope.

This section contains information about what bulimia is, its symptoms, and how it can be diagnosed. Because bulimia is related to self-image and is not just about food, it can be difficult to overcome. With effective treatment, it’s possible for a person with bulimia to rebuild his or her self-image, adopt healthier eating patterns and reverse serious health complications.

For those who suspect a friend or family member has bulimia, it can be tough to know what to do. The Tips for Helping Someone With Bulimia page can give you some guidance to help you support your loved one.

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Warning signs and symptoms of bulimia include:

  • An obsessive attitude towards food and eating
  • A distorted and overcritical attitude to body weight and shape
  • Binge eating, usually in secret
  • Vomiting after bingeing
  • Frequent visits to the bathroom after eating to throw up
  • Abuse of laxatives, diuretics and diet pills after eating
  • Compulsive exercise and need to burn off calories taken in, even in bad weather or when injured or fatigued
  • Swollen and puffy cheeks, caused by repeated vomiting
  • Broken blood vessels in the eyes
  • Calluses or scrapes on the knuckles (if using fingers to induce vomiting)
  • Teeth that may look yellow or clear, from exposure to stomach acid when throwing up
  • Frequent fluctuations in weight
  • Withdrawal from usual friends and activities

According to the OOffice on Women’s Health , many people with bulimia are also battling with other mental health conditions, including depression, anxiety or substance abuse problems.

The chance for recovery increases the earlier bulimia nervosa is detected. Therefore, if you or a loved one is suffering from bulimia, seek professional help right away.

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Bulimia nervosa, commonly called bulimia, is a potentially life-threatening eating disorder. Those with bulimia eat excessive amounts of food, then rid their bodies of the food by vomiting, using laxatives, or over-exercising. Often acting in secrecy, they feel guilty as they binge, yet relieved of those negative emotions once their stomachs are empty again. This cycle usually repeats several times a week.

Bulimia can be categorised in two ways:

  • Purging bulimia: This is when an individual regularly induces vomiting or misuses laxatives, diuretics or enemas after bingeing
  • Nonpurging bulimia: This is when other methods are used to rid the body of calories and prevent weight gain, such as fasting, crash dieting or excessive exercise

Many physical conditions result from the purging aspect of the illness, including electrolyte imbalances, gastrointestinal problems, and oral and tooth-related problems.

Unlike anorexia, people with bulimia can fall within the normal range for their age and weight. But like people with anorexia, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Because it's related to self-image and is not just about food, bulimia can be difficult to overcome. But effective treatment can help someone with bulimia improve their self-image, adopt healthier eating patterns and reverse serious complications.

What causes bulimia?

There is no single known cause of bulimia, but there are some factors that play a major part. Many people with eating disorders suffer from low self-esteem, feelings of helplessness, and intense dissatisfaction with the way they look. In most cases, people with bulimia also have trouble managing emotions in a healthy way therefore turn to bingeing and purging when feeling angry, depressed, stressed, or anxious. Life experiences may also trigger eating disorders. This can include being bullied about the way they look, or experiencing traumas such as rape or the death of a loved one.

Who is affected by bulimia?

As with all eating disorders, women are much more likely to develop bulimia than men. However, it is becoming increasingly common in boys and men also. According to the National Health Service , bulimia can occur at any age but mainly affects women aged between 16 and 40. Bulimia nervosa can affect children, but this is extremely rare.

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If you have symptoms of bulimia and are concerned that you may have an eating disorder, the first step is to recognise that you may have a problem and visit your doctor. During your appointment, your doctor will typically perform:

  • A complete physical exam
  • Blood and urine tests
  • A psychological evaluation, including a discussion of your eating habits and attitude toward food

While there is no international guideline for diagnosing bulimia, these tests help doctors determine if you have bulimia or another eating disorder, such as anorexia or binge eating disorder. At this point, your doctor will also decide whether to refer you for help from a specialist mental health team. This could include specialist counsellors, psychiatrists, psychologists, nurses, dietitians and other healthcare professionals.

The course of your treatment depends on how serious your condition is and the best way to manage it. Your doctor may even recommend a self-help program to start your recovery before referring you for specialist treatment.

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Someone with bulimia can get better by learning healthy eating patterns and how to cope with their thoughts and feelings. Treatment for bulimia uses a combination of options, which include psychotherapy, nutritional advice and medications.

  • Psychotherapy: Two types of psychotherapy have been shown to be effective for bulimia. These are:
    • Cognitive Behavioural Therapy (CBT): This is the most common type of psychological treatment for bulimia. It involves talking to a therapist and looking at your emotions in detail to work out new ways of thinking about situations, feelings and food. You may need to keep a diary of your eating habits to help find out what triggers your binge eating.
    • Interpersonal Therapy (IPT): As with CBT, interpersonal therapy is usually done with an individual therapist, but concentrates more on your relationships with other people than your problems with food. You are more likely to be referred for this type of psychological treatment if you have recently lost a loved one or have experienced a big change in your life, such as moving overseas. The aim of IPT is to help you rebuild supportive relationships that can meet your emotional needs better than eating.
  • Nutritional advice: If you're underweight due to bulimia, the first goal of treatment will be to get you back to regular eating so you can maintain a steady weight. Dietitians and other health care providers can design an eating plan to help you achieve a healthy weight, normal eating habits and good nutrition.
  • Medication: Even if you are not depressed, antidepressants such as Fluoxetine (Prozac) can reduce the urge to binge eat. Taking medication will often begin to reduce your symptoms in two to three weeks, and is sometimes used to provide a “kick start” to psychotherapy. Unfortunately, without other forms of treatment, the benefits tend to wear off after a while.

Recovery usually takes place slowly over a few months or many years. According to the Royal College of Psychiatrists , evidence suggests that a combination of medication and psychotherapy is the most effective way to overcome this disorder.

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It can be tough to know what to do if you suspect a friend or family member has bulimia. The best thing you can do is to talk to the person about your concerns, as bulimia has serious physical and emotional consequences and should never be ignored. While your loved one may get defensive and deny bingeing and purging, there’s a chance that he or she will welcome the opportunity to open up about the struggle. Here are some suggestions for supporting your loved one:

  • Speak out about your concerns: Be honest and tell your loved one about your worries about his or her eating or exercising habits. Keep in mind that the person may get defensive or angry. But if he or she does open up, let them express their feelings, listen without judgment and make sure the person knows you care.
  • Ask your loved one what you can do to help: For example, offer to keep certain trigger foods out of the house or ask if your teenager would like you to plan family activities after meals to reduce the temptation to purge.
  • Suggest they talk to a professional: It can help your loved one to talk to a professional who knows about eating issues. Offer to help them find a counsellor or doctor and make an appointment, and offer to go with him or her to the appointment.
  • Avoid conflicts: If your friend or family member won't admit that he or she has a problem, don't push. Since bulimia is often caused and exacerbated by stress, low self-esteem and shame – negativity will only make it worse. Instead, assure them that you’re always there to listen if they want to talk.
  • Avoid placing blame: Don't make comments like, "If you'd just stop, then things would be fine!" Patronising comments and guilt trips usually exacerbate the situation. Instead, say things like, “I'm worried about you because you won't eat breakfast or lunch”.
  • Set a good example: Set a good example for healthy eating, exercising, and body image by not making negative comments about your own body or anyone else’s.
  • Schedule regular family mealtimes: Eating at routine times is important to help reduce binge eating.
  • Accept your limits: As a parent or friend, it’s not in your hands to fix your loved one’s bulimia. The person with bulimia must make the decision to seek treatment themselves.
  • Take care of yourself: Eating disorders are stressful and affect the whole family, so you need to take care of yourself too. Know when to seek advice for yourself from a counsellor or health professional, as it helps to have your own support system in place.
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