17 April 12 Bulimia: the other eating disorder

Guest post by Donna P. Feldman MS, RD, Nutrition journalist and consultant, Radio Nutrition

Usually when we think ‘eating disorder', we imagine an emaciated-looking young woman, possibly a celebrity. Anorexia is typically what comes to mind. But there are other eating disorders that are just as serious, even if they don't fit that extreme physical image. People suffering from bulimia — out-of-control bingeing followed by purging — can be normal weight or overweight. But they definitely have an eating disorder, one that can have serious consequences.

Why would anyone engage in this behavior: eating thousands of calories at one time, then vomiting? Bulimics themselves ask this question, yet they feel completely out of control and helpless to stop themselves. Binge eating is a learned reaction to stress, anxiety, depression and other emotional conflict. It's actually a coping behavior, like self-medicating with food, especially sugary, high-carb foods. If you ask a bulimic person what their preferred binge foods are, the answer is typically ice cream, cookies, cake, candy, pastries, pretzels, crackers, chips and bread. No one binges on stuff like apples, broccoli, cheese, salad or steak.

Bulimia can have serious health consequences. Binge-purge cycles can lead to chemical imbalances in the body. Dehydration and electrolyte imbalances caused by vomiting can lead to irregular heart rate and even heart failure. Vomiting can cause inflammation or injury to the esophagus, as well as tooth decay. Purging and laxative abuse can lead to chronic digestive disturbance, including constipation. In addition to those physical problems, the secretive binge-purge behaviors make bulimia a very isolating experience. Bulimics are usually suffering from symptoms of depression, but whether that is a cause or effect is not well understood.

While some people may secretly envy an anorexic's ability to resist eating, few people would find bulimia attractive. It's embarrassing and distressing to the afflicted person. This makes it hard for a bulimic to seek help, which is unfortunate, because treating bulimia isn't just a matter of using self-discipline to quit the behavior. Bulimia is not just dieting behavior that spiraled out of control. It's driven by a very complex set of emotional triggers. Psychotherapy can be a very effective treatment, if the psychotherapist is experienced in treating bulimia and the bulimic person is committed to working on change.

Here are some common signs of bulimic behavior:

  • Feeling out of control about your eating behavior
  • Bingeing to the point of physical discomfort and pain
  • Binges done in secret
  • Eating far more food in a binge that you would ever eat at a normal meal
  • Preoccupation with weight and body shape
  • Forced vomiting or exercise, or laxative abuse to purge the food.
  • Fear of gaining weight
  • Rigid compensatory exercise routines in response to eating, in an effort to burn off calories

In fact, the term "exercise bulimic" is now recognized as a disorder. Instead of, or in addition to, purging, exercise is used to deliberately burn off excess calories. The person may jump on a treadmill or stationary bicycle after eating, until a certain number of calories are burned, or run very long distances for the same purpose. Exercise schedules can take over the bulimic's life.

If you're bulimic and want to change, the first step is finding a therapist to work with. Unless your situation is so severe that you need inpatient treatment, weekly sessions with a local therapist should be sufficient. The therapist should have experience dealing with eating disordered clients. While one particular therapist may be highly recommended and very experienced, this may not be the right person for you. You should feel comfortable working with your therapist, even if the therapist expects you to work on issues that feel uncomfortable. The next step is showing up for your therapy sessions and following through.

It's also a very good idea to work with a registered dietitian on food and nutrition-related issues. An RD experienced with eating disorders can help you understand what balanced meals look like and help you work through changes. If you've been engaged in severe bouts of bingeing and purging, you should probably be checked by a physician to be sure your health hasn't been compromised.

What if you suspect a friend or family member is bulimic? This can get tricky, since you don't want to be confrontational and lose that person's trust. But if you see signs of bulimic behaviors, you need to have a frank and supportive discussion. Signs may include:

  • Frequent smell of vomiting (on the person, in the bathroom)
  • Empty food packages or wrappers stuffed into the trash
  • Food missing from the pantry or refrigerator — a new half-gallon of ice cream or a new package of cookies simply disappears
  • The person frequently disappears into the bathroom after dinner for prolonged periods.
  • A rigid routine of excessive exercise, especially after eating

You can find more information about signs and symptoms, as well as advice on helping friends or loved ones navigate through treatment options, at the Eating Disorder Referral and Information Center website. This national organization also has searchable information on treatment options in your area. In addition, you may find referral and information centers in your own locality.

Katherine Isacks, MPS, RD, CDE
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Disclaimer: The information provided here does not constitute medical advice. If you are seeking medical advice, please visit your healthcare provider or medical professional.

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Eating Disorders/Bulimia

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