Bulimia Nervosa

Bulimia often begins with rigid dieting which leads to inadequate nutrition, hunger and fatigue followed by powerful urges to binge. Terrified of gaining weight from the binge and driven by intense feelings of guilt and shame, people with bulimia then purge themselves through self induced vomiting, laxative abuse, excessive exercise and/ or periods of fasting.

Although body weight may appear normal, the distress of the binge/purge cycle can cause extreme feelings of worthlessness, guilt, inadequacy and depression. Bulimia, not as visible as anorexia, is often a hidden illness. Sufferers speak of feeling guilty, ashamed and disgusted by their behaviour and take great pains to keep it a secret from those closest to them. This contributes to their feelings of despair, loneliness and depression. Combined with the physical effects of bingeing and purging, people with bulimia can become both physically and emotionally overwhelmed.

Some Signs of Bulimia Nervosa include:

  • secretive eating (missing food)
  • going to the bathroom after each meal weight fluctuations
  • swollen glands (creating a ‘chipmunk’-look)
  • broken blood vessels (eg. tiny red dots around the eyes)
  • mood swings
  • depression
  • severe self-criticism
  • self-worth determined by weight
  • fatigue
  • muscle weakness
  • tooth decay
  • hoarse voice
  • complaints of sore throat
  • avoidance of restaurants, planned meals or social events
  • fear of not being able to stop eating voluntarily
  • self-deprecating thoughts following eating
  • fasting
  • self-worth determined by weight
  • puffy face

Possible Physical Complications of Bulimia Nervosa include:

  • dehydration and rebound oedema (retention of body fluid giving a ‘puffy’ appearance)
  • easy bruising
  • anaemia (iron deficiency)
  • fainting
  • heartburn
  • abdominal pain
  • stunting of height/growth
  • hypoglycaemia (low blood glucose levels) which can cause confusion, illogical thinking, coma, shakiness, irritability, and fatigue
  • reduced concentration, memory, and thinking ability
  • loss of bowel function (cramping, constipation, diarrhoea)
  • cardiac irregularities
  • electrolyte imbalance (e.g. sodium, potassium, chloride - possibly leading to heart attack)
  • hyperfunctional voice disorder
  • bowel or stomach rupture
  • irreversible loss of dental enamel
  • changes in hair, skin and nails (dry, brittle)
  • reduced metabolic rate leading to slow heart rate, low blood pressure, reduced body temperature and bluish coloured extremities)
  • kidney dysfunction
  • fertility problems / infertility
  • reduced bone density and osteoporosis
  • severe sensitivity to the cold

Vomiting can cause:

  • erosion of tooth enamel and cavities
  • sore throat, stomach aches, constipation, indigestion and heartburn
  • abdominal pain and bloating
  • enlarged salivary glands
  • electrolyte imbalance resulting in cardiac arrhythmia, muscle fatigue and cramps
  • pop blood vessels in your face and swell up your neck glands

Diuretics (or water pills) can cause:

  • water loss
  • loss of vital fluids, electrolytes but also important nutrients
  • heart, kidney and liver problems
  • water retention
  • dehydration which can cause kidney damage
  • possibly leading to heart failure and sudden death

Laxative misuse can cause:

  • bowel problems
  • constipation
  • bloody diarrhoea
  • stomach aches
  • cramps
  • problems to your digestion
  • dehydration which impairs body functioning
  • weakening of bowel which may lead to difficulty with bowel movements
  • bleeding which can lead to anaemia
  • bowel disease
  • electrolyte imbalance

Diet Pills can cause:

  • habit-forming and dependency
  • hunger
  • possible death
  • increased heart rate, palpitations, and chest pains
  • dizziness
  • high blood pressure
  • nausea
  • anxiety
  • irritability
  • insomnia
  • dry mouth
  • diarrhoea

Bulimia nervosa is sometimes considered to be less serious or fatal compared to Anorexia nervosa, however because bulimia nervosa is associated with high-risk, impulsive behaviours such as reckless driving, promiscuity, substance abuse, kleptomania, and self-harm, it is imperative to treat each case seriously. This is not to say that every person with bulimia will engage in these activities, however they may have an increased likelihood of doing so.

Many psychological factors are associated with bulimia nervosa, including anxiety, depression, and personality disorders. Due to feelings of shame and a psychological need to maintain the bulimia, the disorder will often go undetected for years. Simply trying to stop the person from engaging in bulimic behaviours will not cure the disorder, because the underlying dysfunctional thought patterns are what drive and maintain these behaviours in the first place. These dysfunctional thought patterns are not limited to food, in fact they permeate many aspects of the person’s life, making their bulimia not just about food or body image alone. People with eating disorders will often describing hearing a ‘voice’ in their head. What they are referring to is not an auditory hallucination (it is not psychosis) but more of an internal self-dialogue that has become very negatively skewed. However the sufferer often does not realize that they have dysfunctional thought patterns, or that the voice inside their head is negatively biased towards them. To them these things seem real, and the voice is typically moralistic and authoritative in tone, requiring the sufferer to ‘obey’ whatever it says. Things the voice may say to them are

“you are repulsive”
“you are worthless”
“you’re a bad person and you deserve to be punished”
“you’re an obese piece of lard, go home, nobody wants to see you - you’re offensive to look at!”

It is tremendously difficult for the sufferer to fight against this voice, to be able to eat properly, to socialize and go about daily activities when they are hearing this several times a day. Some common beliefs they have about themselves include:

I am worthless
I am bad and deserve to be in pain
Nobody could ever love me
I am a waste of space

Note the similarity of the common beliefs to their internal dialogue. Eventually most sufferers, if not treated, will increasingly isolate themselves from friends and family members. It is important that the sufferer seek help to address these underlying psychological problems including any concurrent psychological illnesses such as depression and anxiety (which often occurs together with eating disorders). Because morality is interwoven with the eating disorder mindset, the sufferer will often believe, on some level, that punishing themselves (through food or other self-harm techniques) for being ‘bad’ is actually the morally right thing to do. Interestingly, while the eating disorder is damaging the sufferer both psychologically and physiologically, feelings of ambivalence towards recovery are initially virtually guaranteed. The sufferer will typically see the eating disorder as their best friend, and will do anything to defend it (including lying to loved ones) because the sufferer feels the eating disorder is helping them to cope, — and survive. However after a while, many sufferers begin to see this ‘friend’ as more of a ‘foe’ and truly want to overcome their disorder. Health professionals specialising in eating disorders are not unfamiliar with this ambivalence towards recovery - it is more par for the course and will need to be addressed in treatment if the person is not completely ready to make a recovery. It is this set of complex, interwoven psychological difficulties that make recovery from an eating disorder terrifying and incredibly difficult - however, bulimia nervosa is a very treatable condition and recovery is definitely possible.