Bulimia nervosa, commonly referred to as bulimia, is usually characterized
by a pattern of binge eating (i.e., eating large amounts of food in a
short period of time) followed by an attempt to get rid of the food and
consequent calories in what is called a "purge."
Who does it happen to?
People who are bulimic may be slightly underweight or overweight, but
they are usually within a normal weight range. However, they are often
unhappy with their bodies, and fear becoming fat. They (similar to individuals
who become anorexic) tend to feel insecure about their own self-worth.
They feel dependent on others for approval and appreciation, and ultimately
count on others' opinions of them for their self-esteem. Because they
are so vulnerable to what others think of them, they are especially susceptible
to the messages over-valuing thinness that saturate our culture. Although
bulimia occurs more frequently with women, it does develop with men as
How does it happen?
People who develop bulimia tend to be conforming and eager to please.
They often feel that their negative emotional states will be unacceptable
or intolerable to others. Thus they may require themselves to hide anger,
unhappiness, discomfort or any other undesirable feeling they have. It's
as if any emotional state that is threatening should be made to disappear.
Such a person may get so good at this that she or he doesn't even know
when they are having feelings, much less what the exact feelings are.
They may only
know that something internal feels extremely uncomfortable, that they
can't stand it and they must do something to rid themselves of it.
What do emotions have to do with eating?
With bulimia, food turns into an outlet for all those feelings and conflicts
that cannot be exposed. Binge eating can be a way of cramming oneself
so full that the difficult feelings are pushed out of the way, or simply
numbed during the intense activity of eating. Purging, on the other hand,
gets the difficult feelings right and totally out of a person's system.
If you can flush it (by vomiting or using laxatives) or pound it (by heavy
exercise) out of your body, a disturbing feeling really doesn't have to
be dealt with. Or at least it can seem that way, until the feeling recurs.
What constitutes a binge?
A binge can range from an intake of 1000 or more calories. However, sometimes
a bulimic will consider a small amount of food (i.e., a piece of cake)
to be a "binge." A binge normally ends when there is no more
food or when the body is painfully bloated. It usually occurs in secret;
it may be planned in advance; or it may be the case that any unplanned
eating--even one bite--can suddenly cascade into a binge. Some people
binge occasionally, while others will binge many times a day.
How it turns around on a person
Once a binge begins, all emotional feelings are blocked out and the food
acts as an anesthetic. In this way, very briefly it does what was hoped.
Inevitably, however, a binge leaves a person feeling they have done something
bad to themselves. It quickly yields intense feelings of new types, which
become as intolerable as the ones that set off the binge to begin with.
Shame, guilt, self-disgust and self-hatred may flood the person who has
just binged. In addition, she or he may become terrified about weight
gain--regardless of the caloric intake of the binge. Altogether this makes
for an experience of feeling terribly out of control.
Trying to un-do it
These awful feelings lead the bulimic to purge in an attempt to undo or
reverse the "damage" of the binge. Purging can take many forms
and often involves induced vomiting and laxative abuse. Other means of
purging include the use of diuretics, enemas and colonics; fasting or
strict dieting; rigorous exercising; the use of diet pills, and amphetamine
or cocaine abuse. The amount and frequency of purging in bulimia varies
from person to person. The purging behaviors usually begin benignly, almost
by accident, but gradually become a ritualistic part of the bulimic cycle.
No one ever believes that they will end up in an out-of-control cycle
of bingeing and purging.
It seems to take on a life of its own
Binge leads to purge, leads to binge, leads to purge, and on and on. The
cycle of behavior can become powerfully fixed and difficult to break apart.
A person who has been bulimic for some time, may tell themselves they
are fully in control and can stop whenever they want, while deep down
doubting they will ever be able to find a way out of the behavior. It
is a very lonely existence being bulimic. So much hiding and pretending,
one never gets to feel known and valued by others in any real way.
Recovery from bulimia is very possible, and will be easier the earlier
the bulimic person decides to do something to interfere with the self-destructive
patterns she or he has developed. Usually getting better will require
two things: a determination to create some behavioral change; and a commitment
to doing some psychological work to understand and tend to the original
roots of the problem. Often, a person with bulimia will need to try a
variety of strategies and turn to an array of professionals to accomplish
change. Counseling with a psychologist or other mental health professional
can help with making mental, emotional and behavioral changes. In some
cases, a particular kind of psychiatric medication can be extremely helpful,
in conjunction with counseling, in quelling bulimia. Also, a nutritionist
can be invaluable, first in establishing safe and healthy nutritional
guidelines, and second in helping a bulimic person learn how to eat normally
Bulimia can cause very serious medical problems and even death. A person's
blood levels and electrolytes can become severely imbalanced, thereby
threatening vital organs; permanent damage can be done to a person's throat
or to normal intestinal functioning; and a person who has been vomiting
will irreversibly erode the enamel on their teeth. Normally, a medical
work-up, ongoing medical monitoring, and sometimes dental treatment are
Adapted from: Siegel, M., Brisman, J., and Weinshel, M. (1997). "Surviving
an Eating Disorder." Harper Perennial Publishers, NY, NY.