Bulimia

Understanding Bulimia

Bulimia is a serious eating disorder. It’s characterized by cycles of binging, or eating excessive amounts of food in a single sitting, followed by purging, which is an attempt to get rid of the extra calories consumed. If it isn’t treated, bulimia has the potential to be life-threatening, due to the strain it causes on the body.People with bulimia struggle with body image and self-esteem. There is a sense of a loss of control with the binging episodes, followed by an attempt to regain control by purging. Purging takes many forms, including vomiting, fasting, using laxatives, and over-exercising.Bulimia is treatable, but professional assistance is often needed in order to recover. With help, people with bulimia can examine the underlying issues leading them to binge and purge, and learn to live a healthy lifestyle.

History of Bulimia

Bulimia was first included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. The cycle of binging and purging existed long before this, though. The Roman emperors Claudius and Vitellius, for example, both purged after excessive eating. The first recorded incident of behavior similar to bulimia was in about 370 B.C. when Greek soldiers purged themselves.Purging behavior was also recorded in ancient Egypt. Physicians would recommend purging once a month to improve health. This behavior likely stemmed from the belief that human diseases were caused by food.It wasn’t until the 20^th century, though, that the connection was made between patients binging, or overeating, and purging, and that this behavior was a distinct disorder. The Mayo Clinic compiled a list of patients who had been treated for anorexia in 1930. Anorexia is characterized by prolonged fasting to prevent weight gain. Of these patients, over 50% were voluntarily vomiting in order to control their weight.In 1979, British psychiatrist Gerald Russell published a description of bulimia nervosa, including diagnostic criteria and treatment options. This led to bulimia’s inclusion in DSM-III in 1980. Once bulimia appeared in the DSM, there was an increase in patients being diagnosed as bulimic. Today, bulimia is present in about 1.5% of women and .5% of men.Today, bulimia occurs more frequently in developed countries and is more prevalent in cities than in rural areas. Though initially thought to be more prevalent in Caucasians, the lifetime prevalence of bulimia is actually higher in Latinos and African Americans. Bulimia is common across all economic brackets and in countries throughout the world. Research indicates that the onset of bulimia is happening at younger ages for both boys and girls.

Types of Bulimia

There are two types of bulimia: purging and non-purging, though both are often referred to as purging.

Purging bulimia

This is characterized by directly trying to “get rid of” food by self-induced vomiting, laxatives, or enemas.

Non-purging bulimia

This involves other methods of preventing weight gain from excess calories, including over-exercising, fasting, or strict dieting.

Causes of Bulimia

The exact cause of bulimia is unknown, but its thought to stem from a combination of biological factors, societal influences, and environmental factors.

Biological Factors

Bulimia is more common in those that have a relative with bulimia, which suggests a genetic link. Abnormal levels of serotonin, a chemical in the brain, may also play a role in vulnerability to bulimia. Serotonin plays an important role in impulse control, appetite regulation, and social behaviors. Researchers have found that patients with eating disorders were twice as likely to have variations in the gene for serotonin than those without eating disorders.The lack of serotonin in the brain may be a part of what leads to disordered eating, as binging on high carbohydrate foods can increase the levels of serotonin in the brain.Women are more likely than men to have bulimia, and young women are more likely to have it than older women. Gay and bisexual men are more likely to have bulimia than heterosexual men. Other psychological disorders, including anxiety and depression, may also play a role in causing bulimia.

Social Factors

There is immense pressure on women to conform to “ideal” body types, as portrayed by the media. For many, these “ideal” body types are impossible to attain, leading to unrealistic expectations and a sense of dissatisfaction with their own body, which can then lead to bulimia. Men can also be vulnerable to this societal pressure.Low self-esteem is another common factor in those with bulimia. Low self-esteem can stem from a number of sources, including trauma, abuse, and feelings of imperfection. Those that work or perform in positions that highly value physical appearance can also be more vulnerable, including actors, models, and athletes.Athletes, in particular, can be vulnerable to bulimia due to the pressure to conform to a physical standard and the availability of exercise to purge. Because exercise is a part of athletics, this can make bulimia in athletes especially difficult to detect.

Environmental Factors

The events of a person’s life can also influence their vulnerability to bulimia. These include traumatic events and physical, emotional, or sexual abuse. Life transitions can also be vulnerable periods, including leaving home for college, going through a divorce, or experiencing the death of a loved one.Post-traumatic stress disorder, or PTSD, is especially prevalent in those with bulimia. Traumatic events that lead to PTSD can include sexual abuse, being abandoned by a parent, domestic violence, natural disasters, experiencing war or violence, suffering an illness or injury, or the death of a loved one. Bulimia can arise as a way of coping with trauma.

Risk Factors for Bulimia

There is no one specific type of person that is vulnerable to bulimia. There are some traits that do increase the risk of developing bulimia, though. These include:

Having a sibling or parent who is overweight, obese, or has an eating disorder.

Being overly concerned with weight and appearance.

Struggling with depression.

Being overweight and starting a diet.

Having a tendency toward perfectionism.

Struggling with living up to societal ideas of thinness and beauty.

Signs and Symptoms of Bulimia

Bulimia can be difficult to detect by others. Binge eating is often carried out in secret, and those with bulimia may maintain a normal weight.

Diagnostic Criteria

The diagnostic criteria for bulimia include:

Recurring episodes of binge eating. Binge eating is defined as eating more during a set period of time than what would normally be eaten by others in the same circumstances. There is a feeling of a lack of control during the binge eating, as if you can’t stop eating.
Recurring episodes of “compensatory behavior.” This is behavior that tries to compensate for the food eaten by getting rid of it. This may include self-induced vomiting, using laxatives or diuretics, or excessive exercise.
That this behavior occurs at least once per week over a period of three months or more.
A sense of self that is heavily influenced by body image and weight.

Other Signs and Symptoms

Bulimia can be difficult to detect by others. Binge eating is often carried out in secret, and those with bulimia may maintain a normal weight.

Bulimia usually starts during adolescence (between 13 and 20 years old) and is more prevalent in women than with men. Possible signs of bulimia include:

Being overly preoccupied with body shape and weight.
Being afraid of gaining weight.
Feeling that they can’t control their eating.
Eating until they feel discomfort or pain.
Being preoccupied with dieting or exercise to the point that it keeps them from other activities.
Withdrawing from activities with family or friends so they can engage in binge eating or purging behaviors.
Going to the bathroom immediately following meals.
Exercising excessively.
Having calluses or sores on the knuckles or hands.
Damage to the teeth or gums.
Low blood pressure.
Irregular menstrual cycle.
Unhealthy or dry lips, skin, hair, and nails.
Swollen salivary glands.
Self-harming.
Suicidal tendencies.
Lack of energy.

If you’re concerned that you or a loved one may have bulimia, it’s important to seek treatment as soon as possible.

Effects of Bulimia

Bulimia can have drastic, life-threatening effects. The effects vary depending on the methods used to compensate for extra calories, but can include the following:

Tooth decay, swollen gums, erosion of tooth enamel, and gingivitis from vomiting.
Tooth sensitivity to hot and cold due to the loss of enamel.
Dry, unhealthy looking skin.
Changes in metabolism and electrolyte imbalances, which can lead to heart problems, including arrhythmia and death.
Seizures due to electrolyte imbalances or low blood sugar.
Dehydration, which can lead to fatigue, weakness, fainting, and kidney disease.
Tearing or inflammation of the esophagus. Tearing of the esophagus can lead to life-threatening bleeding.
Burst esophagus, which requires immediate surgery.
Swollen salivary glands.
Low blood pressure, which can lead to fainting or loss of consciousness.
Suicide attempts.

Issues with bowel movements due to laxative abuse.
Digestive problems, including constipation, irritable bowel syndrome, diarrhea, and heartburn.
Gastroparesis, which is difficulty moving food through the digestive tract.
Chronic gastric reflux.
Peptic ulcers.
Pancreatic damage.
Medicines that induce vomiting, such as ipecac, can trouble breathing, weakness, chest pain, and low blood pressure.
Hormonal problems, including missed or irregular periods and difficulty conceiving.

If someone is a type I diabetic and bulimic, this can lead to a condition called diabulimia. This means that they’re cutting back on required insulin in order to lose weight, and this can result in a stroke, going into a coma, or even death.

Myths and Misconceptions about Bulimia

Bulimia can seem difficult to understand to those on the outside. There are some common myths and misconceptions that can make seeking help even more challenging for those with bulimia.One common misconception is that bulimia is all about weight. Though weight is a factor, bulimia is more complex than that. It can stem from feelings of inadequacy and a need to please others. It can be a way to manage stress and exercise a sense of control over external factors.Another misconception is that it’s all about food. During a binging episode, food is a coping mechanism, and enjoyment is minimal at best. Once the food is consumed, or even while food is being consumed, there are feelings of disgust and powerlessness. Many people with bulimia associate food with anxiety, shame, and a lack of control.Some may feel that bulimia is easy to spot, which is another common misconception. In fact, it can be quite difficult to tell a person has bulimia. People with bulimia tend to have a normal weight and put a lot of pride into their appearance. They go to great lengths to hide their binge eating and purging.Another common misconception is that bulimia only affects young women. Though it’s most common in women, men can also have bulimia. Older women are also susceptible to bulimia, especially if they’ve experienced a traumatic life event or transition.