All About Bulimia Nervosa

The week of February 22-26 is National Eating Disorder Awareness Week and a great time to learn more about eating disorders.  I thought I would share some facts about bulimia and a little of my own experience with the disorder.

My Story

My childhood was stressful at times and I became a natural "worry wart". In all the anxiety, food just seemed to pull me back into a better place.  In my teens, I read the book "When Food is Love" and I promptly highlighted anything that reminded me of my situation and behavior.  I remember the book being a rainbow of fluorescent yellow, blue and pink highlighted sentences.  I continued to overeat and comforted myself with food throughout my 20's.  

I went through a difficult divorce in my early 30's after 5 years in an abusive marriage.  I continued to rely on food, but something changed.  I moved from overeating to eating large volumes of food in a short period of time.  I would then obsess about how much I just ate with an overwhelming feeling of guilt and shame.  Eventually, I began a relentless cycle of obsessing about food, binging and then acting on the compulsion to feel better by forcing myself to throw up what I had just binged.

What is bulimia?

Bulimia (bulimia nervosa) is an eating disorder and a serious health problem.  In fact, some cases are severe enough to be life threatening.  People with bulimia have recurrent episodes of eating more at one time than most other people would.  To help with perspective, a person binging will eat much more food than is in a meal, often several thousand calories.

You can click here to read more about the binge-purge cycle, including triggers and how it emotionally, physically and socially impacts quality of life.

What is purging?

The definition of binging is fairly straightforward, but purging is a little more complicated.   Purging is an unhealthy way of getting rid of the calories binged to avoid weight gain. It's common to only think of forced vomiting as the way bulimics rid their bodies of a purge.   However, the following methods are also used to purge:

• Excessive exercise
• Misuse of laxatives (pills, enemas etc.)
• Misuse of diuretics
• Strict dieting

Bulimia Statistics

Bulimia affects individuals of any gender, ethnicity, age or socioeconomic status.  However, it most often occurs in females, teens and young adults.   Here is the lifetime prevalence of bulimia in the U.S.:

• Women 1.5% (approximately 4.7 million females)
• Men 0.5% (approximately 1.5 million males)

What are the causes of bulimia?

Causes of eating disorders usually come from a number of different factors, each building upon the others.  Here are some of the factors that may increase the risk of bulimia.

Biological Factors

There is a genetic link, and your risk may be greater if you have a sibling, parent or child with a history of an eating disorder.  There is also evidence that being overweight during adolescent or teen years may also increase risk.

Psychological/Emotional Factors

Psychological and emotional issues can contribute to eating disorders.  These may include:

• Depression
• Anxiety disorders
• Past trauma
• Environmental stress
• Negative self-image
• Substance abuse
• Being overweight as a child

Dieting

You may be at higher risk for an eating disorder if you routinely diet.  Even though bulimics binge, many also severely restrict calories between binge-purge episodes.  This is a vicious cycle- restrict, binge-purge, restrict, binge-purge......

Society Pressure

We are constantly bombarded with images and attitudes of society's desire for thinness.  In some people, the pressure to be thin plays a part in developing an eating disorder.

Visit the National Association for Eating Disorders Risk Factors webpage for a detailed list of risk factors.

You can also read about weight stigma and its impact on body image here. 

What are the signs of bulimia?

Everyone experiences bulimia differently, however, there are some common behaviors that raise a red flag.  These may include:

• Weighs frequently
• Distorted image of their body
• Sees self larger than actual size
• Reluctant to eat at restaurants
• Frequently dieting
• Mood swings
• Frequent trips to bathroom after meals
• Large amounts of food in home
• Irregular mealtimes
• Large amounts of food missing (home, work etc.)
• Frequent use of laxatives and/or diuretics
• Mood swings
• Excessive exercise
• Isolates from family and friends

What are the symptoms of bulimia?

Bulimia is typically a progressive disorder and there are some common symptoms that indicates someone has moved beyond just showing warning signs. Again, everyone is different, so the presence of symptoms depends on how long they have been bulimic and the frequency of their binge-purge cycle.

Symptoms of bulimia nervosa may include:

• Weight constantly fluctuates (up and down)
• GI symptoms that are not related to any illness
• Swollen cheeks or jaw area
• Broken blood vessels in eyes
• Brittle hair and nails
• Poor sleep habits
• Discolored teeth (from gastric acid)
• Calluses on back of fingers and/or hands from self-purging
• Irregular menstrual cycles

Screening Tool

The National Association of Eating Disorders offers a free on-line screening tool for eating disorders.  It's geared toward individuals ages 13 and above. You can access the screening tool here.

Stay Tuned

Part Two of All About Bulimia Nervosa will explore how bulimia is diagnosed, levels of severity, effects on health and available treatments.  I will also share what I did (and still do) to prevent my own issues with bulimia from becoming "active" once again.

Let's Hear from You

What "red flags" and symptoms have you experienced or observed that's missing from this article?

References

Bulimia Symptoms & Common Side Effects