Eating Disorders: Bulimia

Bulimia nervosa is usually thought of as the eating disorder in which girls force themselves to vomit. This perception is only partially true. While vomiting is often a part of bulimic behaviour, there are many types of purging other than forced emesis, and the ramifications of bulimia are more serious than mere "vomiting" would tend to indicate.

What Is Bulimia?

Bulimia is a binge-purge eating disorder in which victims eat irrationally, consuming massive quantities of food, only to take action against their bodies to purge the excess calories that they have consumed. While a victim may binge on nearly anything, the most common binge-foods are high-fat and high-sugar (and thus high-calorie) foods. There are two types of bulimics: those who actively purge, and those who don't.

How Do Bulimics Purge?

The common stereotype is a teenage girl sticking her finger down her throat to make herself vomit, but this is somewhat inaccurate. While inducing vomiting by making oneself gag or by taking an emetic like syrup of ipecac are the most common forms of purging, there are more subtle means of purging used by victims who are ashamed of their disorder and want to hide it. Abuse of laxatives and diuretics is common, as is exessive use of enemas.

Some victims of bulimia do not force the food back out of their bodies in such obvious ways; these are the "non-purging" bulimics. They may exercise excessively -- even compulsively -- to burn off the calories they have consumed. Or, they may choose to fast or to severely restrict their caloric intake to compensate for their "failure."

What Causes Bulimia?

Most bulimics have a distorted body-image that places undue stress on their weight and shape. While bulimics may try to restrict their eating, they inevitably fail as the body rebels against the self-starvation, falling into the humiliating "binge" that triggers their next round of purging and restriction. Binges may be triggered by stress, depression, trauma, or significant life events.

What Is a Binge?

A binge does not merely mean eating too much. A binge is an out-of-control behaviour that is almost a frenzy of eating -- the bulimic is almost oblivious to what is being eaten; some have reported a dissociative state, in which they "watched themselves" binge, but were powerless to make themselves stop. Bingeing is eating far more than a normal person would in a given period of time. A binge might start at a restaurant and continue in the binger's bedroom long after the party is over. Binges are humiliating to the bulimic because they emphasize the bulimic's lack of control over food consumption. Bulimics generally do not comprehend that their former self-starvation is the trigger for their excessive eating.

How Damaging Is Bulimia?

Bulimia is a dangerous disorder that is harder to detect than anorexia because the bulimic usually appears to be a normal weight and because bulimics hide the behaviour that is causing them such intense shame. But chronic bulimics can damage their teeth, and usually suffer from depression or anxiety, and may resort to abusing diet drugs or other drugs in an effort to achieve control.

Not Just Girls

While the majority of bulimics are female, some ten to twenty percent of victims are male. Usually, these men are involved in a sport or hobby that mandates certain weight-levels for optimum performance. Some victims of the disorder were overweight as children and were teased or mistreated because of their weight. Rarely, men who had chronically ill fathers reported suffering from bulimia. It has been increasingly reported that men who suffer from eating disorders suffer from the same unrealistic body image expectations as female victims, spurred by the media's obsession with the lean, muscular male physique that does not reflect normal male appearance.

Treatment for Bulimia

Bulimia treatment, like treatment for all eating disorders, must combine many different approaches. The patient must receive psychotherapy to address the underlying issues, medical treatment for the health disruptions, and nutrition counseling to help them learn to eat in a healthy manner. In-patient treatment has the highest success rate, as patients can be carefully monitored and protected from their own self-damaging urges until they have passed the crisis stage of the disorder. Of upmost importance is re-training the bulimic to accept his or her body as it is, and to look at food in a normal, non-confrontational way. For bulimics, food is often the enemy, and reprogramming this faulty thinking is crucial to successful treatment.