What is Bulimia Nervosa?

By Dr. Loretta Lanphier, ND, CN, HHP, CH

Eating disorders such as bulimia nervosa can be life-controlling and potentially deadly as well. The odd thing about this illness is that some who have it appear to have it all together on the outside, but inside they are full of fear, remorse, and guilt. Let’s see what we can learn about bulimia so that we can give some hope to those who are caught in its trap.

What is Bulimia Nervosa?

Bulimia nervosa, or simply bulimia as it is commonly referred to, is an eating disorder characterized by eating abnormally large amounts of food (bingeing) followed by extreme attempts to rid the body of the food and calories consumed during the binge (purging). Individuals who suffer from bulimia are known as bulimics, and they typically engage in bulimic behaviors under a shroud of secrecy and shame. Many also hide the disease, even from themselves, through a strong denial system that shields them from the reality of the disease and the toxic consequences it is having on their health. The combination of secrecy and denial can make it very difficult for bulimics to get well.

Bulimia can strike any one of any age, but the vast majority of bulimics are adolescent girls and young women of college age. It is estimated that bulimia affects more than 2 million females in this age group here in the United States. Overall, the illness strikes an average of 1-2% of all women in the Western world. Bulimia is much more common in the US and other developed nations, for reasons we will discuss in further detail. Serious medical consequences can result from bulimia, and in some cases it can even be fatal.

What Type of Behaviors Do Bulimics Engage In?

Most people with bulimia are obsessed with their looks, primarily their weight and body size. When they look in the mirror, they are unable to have an objective view of themselves, but are constantly comparing themselves to others, usually extremely thin people. They are generally very critical of their appearance, never seeming to be satisfied with their body. This kind of thinking helps them to justify behaviors that deep down they know are wrong and harmful. This is why there is such a large amount of guilt felt by most bulimics.

Officially, bulimia is classified into two major categories: purging bulimia, and nonpurging bulimia. However, the line between the two can be quite blurry.

  1. Purging bulimics are known for taking measures after a binge that may include self-induced vomiting (usually by putting their fingers or an object such as a tooth brush down their throats), or abusing substances such as laxatives, diuretics (drugs that encourage urination), or enemas. These behaviors are often done in secret, and many bulimics develop a rigid routine that they follow in order to purge themselves.
  2. Nonpurging bulimics use other methods to rid their bodies of food consumed during a binge including extreme dieting, fasting (going with out food for a period of time), and excessive amounts of exercise.

Regardless of the distinction, the result is the same for both types, with similar symptoms, signs, and health risks for both. The signs that accompany bulimia can be broken down into both physical and emotional/behavioral. Common physical signs include:

  1. Poor dental health
  2. Physical damage to teeth (enamel)
  3. Puffy cheeks (due to swollen salivary glands)
  4. Sores or ulcers in the throat and mouth
  5. Bloating
  6. Excessive gas
  7. Poor bowel function
  8. Dehydration
  9. Inflammation of the esophagus
  10. Fatigue
  11. Abnormally dry skin
  12. Sores or scarring on the fingers or hands (due to exposure to stomach acid while inducing vomiting)
  13. Irregular heart beat
  14. Irregular menstrual cycles (including cessation of menstruation, a condition known as amenorrhea).
  15. Lowered libido

Typical emotional signs may include:

  1. Overeating at a single sitting to the point of discomfort or even pain.
  2. Recurring cycles of bingeing/purging.
  3. Obsession with dieting.
  4. Periods of intense exercise, often to the point of exhaustion.
  5. A skewed perception of one’s own body.
  6. Excessive trips to the bathroom during or after eating.
  7. Hoarding food.
  8. A sense of loss-of-control regarding food and eating.

What Are the Causes of Bulimia?

There are many potential causes for bulimia. Bulimia is a complex disease that involves a lot of factors, including biological, cultural, psychological, and others. Some of the most common include:

  1. Cultural influences: The media is a constant source of messages, especially to young women, that push the idea of thinness and physical beauty as the holy grail to bring popularity, health, wealth, and happiness. Fashion models and entertainers that are extremely thin can affect the minds of young fans, making them believe the lie that “thinner is always better,” and creating discontent with their own body. Peer pressure can be so intense that it encourages people to get obsessive and extreme about reaching that “ideal” weight, body size, or shape. A dysfunctionally high value is placed on physical appearance in our culture, so much so that it encourages behaviors that can lead to severe consequences.
  2. Psychological: Many victims of bulimia also struggle with other emotional problems such as low self-esteem, poor self-image, and other mental conditions like depression or obsessive-compulsive behaviors. In an effort to deal with the stresses and pressures of life, bulimics will often turn to food for relief, only to develop bulimic behavior patterns that feed right into their other emotional problems. It’s a catch 22: they want to use food to help them cope with stress, but they also are obsessed with their appearance.
  3. Family influences: People may become bulimic because they were exposed to it in their family of origin. Bulimia tends to run in families, and in some cases this may be biological. Studies indicate that women who grow up in a family where bulimia is present are more likely to develop it themselves. Often the reasons for this may be more sociocultural than genetic. Bulimic behaviors may be more of a learned response than an inherited disorder. Certain families have values that elevate physical appearance, and this may increase risk for bulimia. In fact, some studies have been done that indicate young women who grow up in homes where the males (father and brothers) ridicule them about their appearance have a higher incidence of bulimia.
  4. Serotonin: Recent research hints that eating disorders such as bulimia may be influenced by serotonin levels in the body. It is known that this chemical found naturally in the brain is involved in the regulation of appetite and food intake.

There appear to be other factors that can increase risk for bulimia. These include:

  1. Certain occupations: If you are a television personality, film actor, entertainer, model, athlete, or anyone in the public eye, your risk is increased for bulimia. It is found in especially high numbers in runners, gymnasts, and ballet dancers. In some of these fields, the competition is so fierce and the pressure to be thin is so great, that it encourages eating disorders of all types, including bulimia.
  2. Age: The vast majority of bulimia cases occur in adolescent girls or young women in their twenties. In reality, anyone who is going through a stressful time of transition in their lives, such as puberty, going away to college, entering the work force, or changing careers is more susceptible to bulimia.
  3. Dieting: Individuals who are constantly dieting can be victims of bulimia, even if they are currently successfully losing weight. Bulimic behaviors can be used to maintain weight loss and the praise that accompanies it, or they can be a response to unsuccessful diets as a desperate measure to control.

What Are the Consequences of Bulimic behaviors?

Bulimia, as with any eating disorder, can be a very serious illness, and can be life threatening in some cases. These kinds of behaviors are very hard on the body, and can have a slew of negative effects. Some of the most common include:

  1. Dental problems: Excessive vomiting is very hard on the teeth and gums. Gum disease, cavities, and chipped or decaying teeth may occur because of the negative effects of stomach acid. Bad breath may also become a chronic problem.
  2. Sores in the mouth and throat: This is another potential affect of stomach acid. Bulimics can experience bleeding when inducing vomiting, a sign that the tissues of this area are deteriorating. This can open the door to cancer in the mouth, throat, or esophagus.
  3. Low potassium levels: Vomiting can lead to dehydration and a dangerous drop in potassium levels in the body. Potassium is critical for regulating heart beat, and insufficient amounts can lead to irregularities of heart rhythms. In addition, if a bulimic uses syrup of ipecac to induce vomiting, heart beat can be even further disturbed.
  4. Poor intestinal tract health: Purging can wreak havoc in the gut, leading to constipation, malnutrition, and internal bleeding that can be life threatening.
  5. Hypotension: Low blood pressure as a result of bulimia can produce fainting and other symptoms.

How Can Bulimia Be Treated?

There are several options available for treating bulimics. As you might expect, conventional medicine often tries to throw medication at the problem as first line treatment. I would be very careful about taking antidepressants or other medications that are commonly prescribed. This is especially true if you have never used any of these drugs. They are supposed to correct brain chemistry, but in many cases I believe they disrupt it and only make matters worse. However, many doctors will give them out like candy, thus violating the trust of their patients and exposing them to many hazards that they are likely not aware of.

The best way to treat a condition like bulimia is to encourage victims to come out of the closet and admit that they need help. One of the biggest problems for many bulimics is that they isolate themselves in a private world of secrecy and shame. There are self-help and support groups available in most geographical areas that can be of great assistance to recovering bulimics.

I would also suggest instituting a plan to change your dietary and lifestyle choices so that you can learn how to better deal with the stressors that likely triggered the bulimia originally. Eating a whole foods based diet, getting consistent physical exercise, and finding support to overcome this illness will build you up physically and emotionally, and is a much better and more successful option than the use of mind-numbing drugs that do nothing to deal with the real issues behind the bulimia.

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