"It Won't Happen To Me!": Bulimia

Definition
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 well.

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.

Hope
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 again.

Medical problems
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 required.
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Adapted from: Siegel, M., Brisman, J., and Weinshel, M. (1997). "Surviving an Eating Disorder." Harper Perennial Publishers, NY, NY.