Bulimia

Why do you keep throwing up?

Some people may think that bulimia is the opposite of anorexia because people who have it tend to eat a large amount of food and are larger in physical size than those with anorexia. While this can be true, people with bulimia often throw up the food they take in. This means they aren’t receiving the nutrients that their body needs. What causes it? How is it treated? Can it be prevented?

Definition

Bulimia is an eating disorder in which a person eats large amounts of food and is unable to control how much they are consuming. Afterwards, they try to get rid of the extra calories in a harmful way. The most common way is by self-inducing vomiting, but other ways include misuse of laxatives, weight-loss supplements, diuretics, enemas, periods of fasting/strict dieting or excessive exercise. This is known as a binge and purge cycle. While the exact cause of bulimia is unknown, we do know that it’s tied to self-image and often associated with other mental health illnesses, such as depression, anxiety or substance abuse. Symptoms of bulimia include being constantly concerned with your body shape and weight, fear gaining weight, repetitive episodes of eating abnormally large amounts of food in one sitting, feeling like you can’t stop eating/control what you eat, making yourself vomit, exercising too much, using laxatives/diuretics/enemas when you don’t have a need to, having periods of fasting/restricting calories/avoiding certain foods or using large quantities of dietary supplements/herbal products that promote weight loss. In order to be diagnosed with bulimia, you must purge at least once a week for at a minimum of three months. The severity is dictated by frequency of your purges during the course of a week. If you notice that a friend or family member has any of the following behaviors, they might have bulimia. These behaviors can include constant worrying or criticizing themselves about being fat, having a warped/unreasonably negative body image, frequently eating unusually large quantities of food in one sitting, have periods of strict dieting/fasting, not wanting to eat in public/in front of others, go to the bathroom right after eating/during meals, are in the bathroom for long periods of time, exercise excessively, have sores/scars/calluses on their knuckles/hands, have damaged teeth/gums and swelling in the hands/feet/face.

Similar to anorexia, bulimia is more common in girls and women, often starting in late teens or early adulthood. However, due to the importance our cultural places on being thin and associating this with success and self-worth, it’s becoming more commonplace in boys and men. If you have a family history of eating disorders, are dieting or experiencing any sort of emotional stress, you are more likely to develop bulimia. There are numerous complications that can arise, including negative self-esteem, problems with relationships, digestive problems, severe gum disease, absent/irregular periods for women, malnutrition, dehydration (which can cause a wide variety of major medical problems), irregular heart rhythms, heart failure, other mental health illnesses (ex. anxiety, depression, personality disorders, bipolar disorder), misuse of alcohol/drugs and suicidal thoughts/suicide.

Treatment

In severe cases of bulimia, an individual can end up hospitalized because their body isn’t receiving the right nutrients it needs. The goal of treatment is to get the person back to and remain at a healthy weight while dealing with the emotional problems that triggered the bulimia in the first place. This involves multiple different healthcare personnel. Your primary care doctor is able to deliver any medical care, oversee your caloric needs and monitor weight gain. A mental health specialist, like a psychologist, can help you to devise strategies to follow the nutritional guidelines that are set by the team. A dietitian can assist in developing the specific plan that you need to follow in order to meet the caloric needs specified by your primary doctor. Another big element is the support from your family and friends. Currently, there is only one medication approved by the Food and Drug Administration (FDA) to treat bulimia. Fluoxetine is usually used to treat depression, but has been found to be helpful in treating bulimia, even if you’re not depressed. It’s key to stick to the plan, learn as much as possible about bulimia, don’t isolate yourself from your support system, make sure you’re getting the right nutrition, resist looking in the mirror/weighing yourself frequently and talk to your doctor prior to starting any exercise routine. Some other tips are reminding yourself what a healthy weight is for your body, identifying situations that may trigger your behavior and come up with a plan to deal with them, prepare for emotional setbacks, look for positive role models, find activities/hobbies that you enjoy and focus on the positive by giving yourself credit/encouragement. For parents who have a child who is bulimic, it’s essential not to blame yourself, but focus on what you can do to help your child by allowing them to express their feelings, schedule family mealtimes and, without blaming them, letting them know that you’re concerned.

Prevention

There isn’t a specific way to prevent bulimia, but there are several things that you can do that might help. The main thing is to focus on having a healthy lifestyle by eating a well-balanced nutritious diet and getting adequate exercise. It’s also helpful to avoid dieting. Instead, have properly portioned, regular meals that are enjoyable and healthy. Remember, it doesn’t matter your size or shape because your value isn’t measured by your appearance. If you have children, this message is especially important to teach them. Also, it can be help to have meals together as a family at a scheduled time because this allows you to set a good example for healthy eating.

Bulimia is an eating disorder that requires professional help to recover from, but the good news is that help is available and recovery is possible. If you have any questions or concerns about bulimia, please speak with your doctor. If you would like more information, please visit MedlinePlus’s bulimia page at https://medlineplus.gov/ency/article/000341.htm