Bulimia - Introduction

Bulimia is a psychological eating disorder. The main characteristic of Bulimia is episodes of binge eating followed by purging, as a method of weight control. During an average binge, you may consume from 3,000 to 5,000 calories in one short hour. Purging is usually accompanied by feelings of guilt. Its methods include vomiting, fasting, enemas, excessive use of laxatives and diuretics, or compulsive exercise.

During binge eating, the individual experiences a loss of control, followed by a short-lived calmness. This session of calmness is often followed by self-loathing. The oft-repeated cycle of overeating and purging, sometimes several times per day, usually becomes an obsession. Other characteristics of Bulimia include excessive concern about body shape and weight matters. Many people with Bulimia also have anorexia nervosa.

Bulimia - Causes

There is no single, definitive cause of Bulimia. Bulimias usually have a dissatisfaction with their body size and shape. A high proportion have other psychological disorders including depression and generalized anxiety disorder. In most cases, people suffering with bulimia have trouble managing their emotions or have repressed emotions. Eating can be an emotional release for bulimics, however binge eating is tied up to feelings of guilt and loss of control. Although there is no single cause of bulimia, risk factors include:

1. Poor Body Image: The idealization of size zero and anorexic models that occurs in most fashion magazines can lead to unrealistic and unhealthy expectations, and disgust and guilt about one’s own body. Often those who suffer from Bulimia have a distorted view of their own body and see themselves as heavier then they are.
2. Low Self-Esteem: Persons with low self esteem and who see themselves as worthless are at risk for bulimia. Contributing factors include depression, perfectionism, childhood abuse, and a critical home environment.
3. History of Trauma or Abuse: Women with bulimia have a higher incidence of sexual abuse. People with bulimia are also more likely to have parents with a substance abuse problem or psychological disorder.
4. Stressful Change: For those at risk, major transitions such as the onset of puberty, leaving home, e.g. to go to college, a relationship breakup have been reported to trigger Bulimia. Binging and purging may be a negative way to cope with the stress.
5. Appearance-Oriented Professions or Activities: People who face tremendous image pressure as part of their profession are vulnerable to developing bulimia. Those at risk include ballet dancers, models, gymnasts, wrestlers, runners, and actors.
6. Family History: People with relatives who have had an eating disorder are more susceptible to Bulimia.
7. Dieting: Dieting triggers bulimia’s destructive cycle of binging and purging. The more strict and rigid the diet, the more likely it is that you’ll become preoccupied, even obsessed, with food. When you starve yourself, your body responds with powerful cravings—its way of asking for needed nutrition that can result in binge eating.
8. Being Female:  Bulimia disproportionately affects women. Bulimia is estimated to affect between 3% of all women in the U.S. at some point in their lifetime. About 6% of teen girls and 5% of college-aged females are believed to suffer from bulimia. Approximately 10 % of bulimia sufferers are men.
9. Emotional Disorders: People with depression, anxiety disorders, and obsessive-compulsive disorder are more likely to have an eating disorder.
10. Age: Bulimia often begins in late adolescence or early adulthood. Bulimia is more common in college students than in younger teens.

Bulimia - Symptoms

• Uncontrolled or binge eating
• Purging
• Strict dieting
• Fasting
• Vigorous exercise
• Vomiting, or abusing laxatives or diuretics in an attempt to lose weight
• Vomiting blood
• Using the bathroom frequently after meals
• Preoccupation with body weight
• Depression or mood swings; feeling out of control
• Swollen glands in neck and face
• Heartburn
• Bloating
• Indigestion
• Constipation
• Irregular periods
• Dental problems
• Sore throat
• Weakness
• Exhaustion
• Bloodshot eyes

Bulimia - Treatment

Treatment of Bulimia involves steps to stop the cycle of bingeing and purging. It is important for patients to seek professional help early, follow through with treatment, and address the underlying emotional issues that caused the bulimia in the first place.

• Psychotherapy: Psychotherapy is a general term for a way of treating bulimia by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy.

• Cognitive behavioral therapy is often used to treat bulimia. Cognitive behavioral therapy (CBT) helps you identify unhealthy, negative beliefs and eliminate distorting thoughts. An important negative belief that cognitive behavioral therapy addresses is the idea that restrictive eating can help you stay thin, when in fact, the reality is that fasting can often trigger binge eating.CBT is often paired with Mindfulness Meditation.  This form of meditation is a way of refocusing your thoughts and actions into a more positive way of thinking. It generally involves a heightened awareness of sensory stimuli, thus refocusing your attention away from your negative thoughts about body image.
• Family-based therapy is often used for teens or children with bulimia. The role of the family is to provide love and support, and help ensure that healthy-eating patterns are followed and helping the person restore proper weight. This type of therapy can help resolve family conflicts and encourage support from concerned family members.
• Medications: Antidepressant medications, prescribed by a doctor, will help reduce the symptoms of bulimia. Antidepressants or psychiatric medications can also help treat accompanying mental disorders, such as depression or anxiety.
• Weight Restoration and Nutrition Education: For sufferers who are underweight due to bulimia, the first goal of treatment will be to start getting them back to a normal weight. Dietitians and other health care providers can give you information about a healthy diet and help design an eating plan that can help you achieve a healthy weight and instill normal-eating habits.
• Hospitalization: If you have a severe form of bulimia and serious health complications, you may need treatment in a hospital.

Bulimia - Prevention

• Early Intervention: Pediatricians may be in a good position to identify early indicators of an eating disorder and help prevent its development. During routine well-child checks or medical appointments, they can ask children questions about their eating habits and satisfaction with their appearance. Make sure that you have a regular family doctor, keep up good communication with him or her and
• Avoid Teasing About a Child’s Appearance: Parents can cultivate and reinforce a healthy body image in their children no matter what their size or shape. Be sure not to tease a child's size, shape, or appearance. Even jokes can harm a child’s psyche and contribute to their own self-image.
• Talk About It: If you notice a family member or friend with low self-esteem, severe dieting, disordered eating behaviors, and dissatisfaction with appearance, consider talking to her or him about these issues. Although you may not be able to prevent an eating disorder from developing, your encouragement can steer someone toward healthier behavior or professional treatment before the situation worsens.
• Mindful Meditation: This form of meditation encourages you to accept the here and now, rather than strive for unrealistic and unhealthy goals. It involves a heightened awareness of sensory stimuli, thus encouraging a focused engagement with the present moment, and refocusing your attention away from your negative thoughts about body image. While it is primarily used in the treatment of bulimia, its calming and anti-stress properties can assist prevention too.

Bulimia - Conclusion

The glamorization of unrealistic and unhealthy body images and size zero models is a leading cause for the increased incidence of bulimia among women and teenage girls. Bulimia begins with dissatisfaction of the person's body and extreme concern with body size and shape. Usually individuals suffering from bulimia have low self-esteem, feelings of helplessness, control issues, and a fear of becoming fat. Bulimia tends not to have one single cause and its treatment is usually multi-faceted. Treatment usually involves a combination of psychotherapy with antidepressants. As mental support and community are integral to care, treatment is generally done using a team approach that includes you, your family, your primary care doctor or other medical provider, as well as mental health providers and dietitians experienced in treating eating disorders. Mindfulness is often paired with CBT and can be used in its treatment or prevention.  If you have bulimia or may be at risk, be good to yourself, and surround yourself with those who love you. Love and support can help improve self-esteem, and readjust your own body image and sense of self-worth.

REFERENCES

1) Proulx K. Experiences of Women with Bulimia Nervosa in a Mindfulness-Based Eating Disorder Treatment Group. Eating Disorders, January-February 2008

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