The word Bulimia means ‘appetite of an ox’, the word Nervosa is ‘of the mind’ or ‘of the nervous system’.

Bulimia Nervosa is a Mental Health Illness.

Bulimia has no barriers when it comes to age, gender or race.

Eating disorders have the highest mortality rate of any other mental health illnesses with a staggering 20% of people dying every year as a direct consequence of their illness or through suicide. These are staggering statistics.

It is also a psychological illness that has a major impact on a person’s physical and mental health, and a profound effect on anyone who is part of their life!

What is Bulimia?

Bulimia is when someone eats huge amounts of food at any one time (binging) and then ridding themselves of that food through by vomiting and laxative abuse (also known as purging) or over exercise.

With Anorexia the person will evaluate themselves through body weight and shape. With Bulimia, only when a binge has taken place they will panic and want to rid themselves of the food they have eaten in case it affects their weight.

Eating disorders in general are often linked with a low self esteem and low self worth. Someone suffering may feel that they have no control over something in their life and the only thing they feel they have control over is their food and behaviours.

They have a false belief that by managing body weight and shape they will be happier.

In truth they are chasing the impossible because once they reach a weight the problems are still there. The individual strives for a bigger weight loss and nothing has changed until the weight loss becomes a medical risk and their self control is ‘out of control’.

If the binging is out of control and the compensatory behaviours are excessive then the control is lost and the eating disorder has total control over you!

If someone is at a critical level or life threatening level then that person’s medical condition becomes the priority and emotional support or counselling will not be offered until that person is stabilised and their weight is increased to an acceptable level. This will vary depending on the area in which you live but it is considered that a BMI of over 16 is acceptable to start therapy.

A good outcome for recovery is when a established eating pattern is in place, weight is improving at a steady pace, everyone involved is socially aware of their suffering and the steps are put in place to make changes in their life.

If someone has had a lifetime of living with an eating disorder then often it is more realistic to gain management of their illness, feel very proud of changes they have made and the responsibility they have taken to ensure their medical safety.

Any improvement should be seen as a positive with focus being on the ‘cup is half full not half empty’!

What is a binge?

Someone in ‘binge mode’ will do so on high carb, high sugar type foods. They often eat things in a very controlled and systematic way, and will have planned the ‘binge’ and often foods are eaten in a specific order. The food is often eaten with ferocity too.
Once the food has been eaten there is an overwhelming need to rid themselves of that food as they panic that they may gain weight. Ridding themselves of the food is known as ‘purging’. This may be through vomiting, laxative abuse, diuretics (water tablets) or exercise. The purging behaviours are often referred to as ‘compensatory behaviours’.
Try keeping a food diary, this may help in making a connection with food and mood – what was happening for you at the time of your binge, what were you feeling, what were your thoughts.
In the case of Bulimia Nervosa, if the compensatory behaviours are out of control and the binge purge cycles are frequent and excessive, the person may become medically at risk through low potassium levels.
Potassium is a chemical that regulates the heart; if potassium levels are low the sufferer may be at risk of heart irregularities and, at worst, heart failure.
Sufferers will use food and food issues as a coping strategy for something they feel they have no control over. They often feel they cannot control what is happening within their life so the one thing they can control is their food.

We have talked about an eating disorder being about feelings not about food – when someone is in binge mode they feel that their problems disappear as the high carb / high sugar has a direct affect on the base of the brain. Have you heard of the sugar rush?

Sadly when the binge is over and the compensatory behaviours (i.e. vomiting and laxative abuse) are finished, the guilt and shame takes over and the person reverts to a low mood once again.

That person binges to experience an overwhelming feeling of wellness, it takes that ‘crutch’ away and they will not cope on a day to day basis.

What is actually happening is that the sufferer becomes embroiled in a vicious cycle of binging and purging. This cycle leaves very little time for relationships, socialising and family!

Physical effects of BulimiaPhysical effects of Bulimia

  • A person may be underweight but not always unless they are restricting their food together with binging and purging. The reason for this is the chemical changes in the body. The body repairs itself by absorbing fluids and food and the body is sent into chaos as it is trying to repair the damage from previous binge/purge cycles.
  • Calluses on knuckles if they have induced vomiting (sometimes becoming infected).
  • Cross contamination between hand and mouth.
  • Sore Throats
  • Poor hair and skin condition – skin very dry and hair falling out or breaking off.
  • Swollen Glands in the face and neck – giving a false sense of wellness (often known as hamster chops or moon face). This is because the glands get blocked as a result of vomiting.
  • Blood shot eyes due to the pressure of vomiting.
  • Ruptured Esophagus due to the pressure on the muscles from vomitting
  • Teeth erosion – as the tooth enamel is stripped away and this is caused by the stomach acid when vomitting
  • Teeth may become arched at the front due to enamel erosion. The rest of teeth are affected by enamel erosion, too, causing poor condition of gums as well as the teeth. The poor dental condition can result in recurring infections and abscesses.
  • Muscle weakness: the muscles that hold the bladder in the womb and the bowel, if weakened through poor nutrition and compensatory behaviours, they may prolapse (drop) and surgery will be necessary to repair the muscle
  • Feeling bloated – tiredness
  • Sleeplessness – if bingeing and purging through the night.
  • If cycles are frequent and excessive, the person may become medically at risk of low potassium levels (see ‘Keeping Safe’ on the left). This is caused by excessive vomiting or laxative abuse.
  • If an individual with bulimia is to experience chest pains; involuntary twitching; pins and needles; muscle cramps or loss of movement in the lower limbs it could be that potassium levels are low and medical support should sought as soon as possible. Remember that potassium is a chemical that regulates the heart. The normal potassium level is 3.5 to 5.2 and anything below 3 would normally be hospitalised. In the case of hospitalisation, a drip would be given containing a potassium supplement. Bloods are re-taken to ascertain improvement in potassium levels and this will continue until you are at a safe level. They would normally give Sando k – an effervescent potassium drink followed by Slow K (a slow release tablet.) potassium supplement. A GP would check your bloods weekly or in some cases twice weekly in extreme cases.
  • In severe cases death can happen as a result of heart failure

Nutrition and Bulimia Nervosa

To help break the cycle and achieve nutritional goals change should be introduced gradually.

Meals should be based around individual food preferences initially and the individual may experience bloating which can be uncomfortable. However this is natural and as the body will adjust and the symptoms will reduce.

This is only temporary!

Start off by eating little and often.

High fibre or low sodium (salt) foods help control fluid retention and constipation. Limit gas producing and high fat foods. Begin the re-feeding process with foods that are easier to digest. A structured eating plan may be useful so you can know what you are eating in advance.

The goals of nutritional therapy for eating disorders are:-

  • Identify food fears
  • Correct food misinformation
  • Re-establish healthy eating patterns (this may take time to achieve)
  • Restore Nutritional Status
  • Maintain a Safe Weight
  • Plan Meals
  • Do Not Skip Meals

Signs to look for in Bulimia

If 3 or more of these signs are present there may be cause for concern and it would be advisable to share your concerns with your GP or call our advice line.

Physical Signs to look for in Bulimia

  • Change in character
  • May be low in weight but not always
  • Poor hair condition
  • Poor skin condition
  • Eating large amounts of food
  • Drinking large amounts of fluid with a meal
  • Visiting the toilet straight after or during a meal
  • Sores on knuckles
  • Sore throat and mouth
  • Arched front teeth (acid erosion)
  • Swelling in cheeks (moon face)

Emotional signs to look for in Bulimia

  • Change in Character
  • Low mood
  • Low self esteem
  • Tearful
  • Mood swings
  • Isolation from others
  • Withdrawing socially
  • Fatigue (perhaps due to poor sleep patterns)
  • Lack of concentration

Breaking the pattern

What triggers a binge?

Keeping a diary can be very helpful when trying to identify the triggers that cause someone to binge, as well as helping you to work out how to bring the bingeing under control or have a degree of management over them.

For instance, binging is more likely:-

  • At certain times during the day.
  • Maybe alone in the home in the evening.
  • At certain times of the month. In a female this could be during the menstrual cycle.
  • During a particular season ? perhaps in the winter months.
  • During stressful periods at work, home or before exams.
  • When snack foods are around, like crisps, pastries, chocolate.
  • Whilst unpacking the weekly food shop.
  • In response to something disturbing, seen or read.

Ways of coping

It may be difficult to cope with uncomfortable feelings without binging. If so, help should be sought and a support group may be helpful. Here are some ways to help control the urge to binge:-

  • If being alone is a trigger, try and leave the house, go for a walk or telephone a friend to at least delay the binge; do something enjoyable that is not associated with binging.
  • Being kind to oneself with a treat such as a massage or a favourite film.
  • Allow yourself to experience your feelings. Writing about experiences or drawing them will be helpful to a counsellor in interpreting expression.
  • Seeking inspiration in other peoples writing, painting and sayings.
  • Taking up a new interest, enrolling in an evening class or becoming a volunteer in a worthwhile charity can be so rewarding.
  • Feel Good About Yourself!
  • It is often so difficult to say something good about ourselves; some people only see their bad points. Try and identify just one small thing that you know you are good at. A good mum, a kind person, a good listener, sensitive or compassionate.

Build on that. If you do someone a good turn, feel proud. If you want to treat yourself, then do it! Why? Because you’re worth it!

The first step to recovery is to acknowledge there is a problem! This is the biggest step forward.

Effort must be made to try and resolve the underlying emotional problems. Food can’t simply be avoided and it is more likely someone will binge if they deprive themselves of emotional support.

It is also medically unsafe to starve, binge and purge. Seek the support of your GP to monitor you physically. Ask for a referral to be made for emotional support and check out the services available via the local self help group.

Finally, take each day as it comes. Recovery can take a long time. Make steps small and achievable. Don’t set yourself up to fail by making your aims unrealistic. Focus on the positives and why it is important to you to get better.

GOOD LUCK! Help is a telephone call away!

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