What is bulimia?
Bulimia nervosa, commonly referred to as bulimia, is usually characterized
by a pattern of binge eating (i.e., eating abnormally large amounts of food
in a short period of time, and feeling out of control during the experience) followed by an attempt to get rid of
the food and calories in what is called a "purge." Purging may include self-induced vomiting, using laxatives or diuretics, or using exercise.
What constitutes a binge?
Binging involves an abnormally large amount of food eaten in such a way that the binger feels out of control. A binge can end 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.
gastrointestinal problems: irritation of esophagus which may result in pre-cancerous changes (Barrett's Esophogus), as well as irritation of the stomach,
salivary glands and throat from persistent vomiting
damaged or discolored teeth: gastric acids erode tooth enamel
lung irritation: choking while vomiting causes food particles
to lodge in lungs, causing inflammation
chronic loss of bodily fluids: depletes blood potassium, sodium
and chloride levels, resulting in muscle spasms, weakness, irregular
heartbeat and kidney disease
Bulimia can cause very serious medical problems and even death.
Your blood levels and electrolytes can become severely imbalanced,
thereby threatening your vital organs. Permanent damage can be done
to your throat or to your normal intestinal functioning; and when
you have been vomiting, it irreversibly erodes the enamel on your
teeth. Normally, a medical work-up, ongoing medical monitoring,
and sometimes dental treatment is required.
Who does it happen to?
If you are bulimic you may be slightly underweight or overweight,
but you are usually within a normal weight range. However, you are
often unhappy with your body, and fear becoming fat. You (similar
to individuals who become anorexic) tend to feel insecure about
your own self-worth. You may feel dependent on others for approval
and appreciation, and ultimately count on others' opinions of you
for your self-esteem. Because you are so vulnerable to what others
think of you, you are especially susceptible to the messages overvaluing
thinness that saturate our culture. Although bulimia occurs more
frequently with women, it does develop with men as well.
How does it happen?
You may have “discovered” purging as a way to feel better after an episode of overeating. Maybe you were coached by a peer to use it as a way of eating whatever you wanted while still controlling weight. However it started, you probably found that the bingeing and purging behaviors quickly gained momentum. In part, this can be because of genetic and biological predispositions discussed below. But it can also be because of how bingeing and purging function to control people’s emotional states. If you often
feel that your negative emotions are unacceptable, you may require yourself to hide anger, unhappiness, discomfort or any other undesirable feelings you have. You often
feel that your negative emotional state will be unacceptable or
intolerable to others.
Thus you may require yourself 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. You may get
so good at this that you don't even know when you are having feelings,
much less what the exact feelings are. You may only know that something
internal feels extremely uncomfortable, that you can't stand it
and you must do something to rid yourself of it. This is where bingeing and purging come in.
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
yourself 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 out of your 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.
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 you feeling
you have done something bad to yourself. 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 you when you have just binged. In addition,
you 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 undo it
These awful feelings lead you 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 varies from person to person. The purging behaviors usually
begin benignly, almost by accident, but gradually become a ritualistic
part of the bulimic cycle. You never believe that you 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. If you have been bulimic for some time, you tell
yourself you are fully in control and can stop whenever you want,
while deep down doubting you 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, you never get to feel known and valued
by others in any real way.
What is the role of genetics and biology?
It is now becoming clear that genetics and biological predisposition play a critical, though not exclusive role in the development of an eating disorder. Studies of people with anorexia and bulimia have found links to specific chromosomes, and a 2006 study led by the University of North Carolina, Chapel Hill, estimated that 56% of the responsibility for developing anorexia nervosa is determined genetically. Other studies have examined variations in serotonin and dopamine receptors in patients with anorexia and bulimia which could serve to reinforce eating disorder symptoms like food restriction.
What is the significance of biological predisposition for people with eating disorders?
Firstly, it can lessen some of the shame and blaming that goes on when someone develops an eating disorder. Too often, people with eating disorders blame themselves for becoming preoccupied with food and their bodies, not realizing the extent to which these obsessions can be driven by biological susceptibilities. People can be much more compassionate with themselves when they understand that—even though there may have been times when they’ve consciously chosen to use a disordered behavior in order to cope—they didn’t choose the disorder itself. Understanding the biological contribution may also allow some people to feel less shame about utilizing psychiatric medications like antidepressants or anti-anxiety drugs as part of their recovery.
Does this mean that socio-cultural factors aren’t important in the development of an eating disorder?
Not at all. Plenty of people have variable neurotransmitter levels and do not struggle with eating or body image, and many other people with eating disorders have no corresponding predisposition. Even for people with a predisposition, it is the environment in which they live that can mitigate or promote the expression of their genetic tendencies. This is one of the reasons that it remains critical to address the “thinness culture.” Another is that dieting—with its potential for malnourishment and disruption of brain chemistry—can contribute to an existing problem in susceptible individuals, or create a completely new one to deal with. In fact, dieting has been called “ a necessary, but not sufficient condition for the development of an eating disorder.” When it comes to understanding and treating eating disorders, it’s important to think in terms of both nature AND nurture.
Hope
Recovery from bulimia is very possible, and will be easier the earlier
you decide to do something to interfere with the self-destructive
patterns. 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, you 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,
psychiatric medication can be extremely helpful, in conjunction
with counseling, to stop bulimia. Also, a nutritionist can be invaluable,
first in establishing safe and healthy nutritional guidelines, and
second in helping you learn how to eat normally again.
Located on the third floor of Health Services.
Confidential information or care is available through individual
appointments or phone consultation with a Nutritionist to discuss
the many types of eating concerns you may have regarding yourself,
a friend, roommate or teammate. Health Education also offers workshops,
pamphlets, and reading materials covering these and related issues.
There are no fees for Health Education services.
Located at the corner of Brown and Charlesfield streets.
Confidential information and care is available on a walk-in, or
by scheduled appointment basis. Care is available for initial, current
or past disordered eating patients. There are no fees for medical
care at Health Services. However, there may be fees incurred if
laboratory tests, medications, specialist or emergency hospital
care is needed.
Located on the fifth floor of J. Walter Wilson.
Confidential appointments are available at Psychological Services
for students concerned about their eating issues. Guidance is also
available for those who are concerned about a friend, roommate,
or teammates' eating. Services include crisis intervention, short-term
psychotherapy and referrals. There are no fees for appointments
at Psychological Services.
This site looks at ways we can feel good in the bodies we have.
One of their slogans: "Remember, your body hears everything
you think." Other topics on the web site: Size Acceptance;
What do you say when everyone around you is dieting? 200 Ways to
Love the Body You Have; Dieting Detox; Evaluating Weight Loss Programs:
What are the Red Flags? Free subscription to email newsletter "Body
Positive Pages."
Highly recommended web site, offering support and programs for people
seeking a lifestyle without diets. You can take a self-profile quiz
that cues you to the many benefits of a non-diet life. Slogan: "You
Count, Calories Don't." Run by a registered dietitian. This
site includes a chat line, resources and links to other sites.
This site provides signs of eating disorders, motivational support
talks, information on cultural issues and how to help loved ones.
This site includes definitions, statistics, warning signs, causes
and frequently asked questions.
This site provides general information about eating disorders and
body image concerns, tips for helping a friend and referral sources.
Provides information and treatment resources for all forms of eating
disorders.
Articles from the ADA on eating disorders, including The Female
Athlete, Compulsive Eating and Anorexia.
Information on eating disorders, books for sale and resources in
Spanish.
Adapted
from the Boston College Eating Awareness Team
Written by Boston College Counseling Services
Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.
