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What is bulimia?
Bulimia is the most common eating disorder. Someone with bulimia has an overwhelming urge to eat large amounts of food at once (called binging). They often have an intense feeling of being unable to stop eating.
These binges can happen daily, several times a day, or a few times a week. The average is about once a day. The amount of calories consumed during a binge ranges from 1,200 to 11,500.
There are two types of bulimia: purging and non-purging.
Purging means that after overeating, people with bulimia make themselves throw up or use laxatives to flush food out of their system quickly. They are trying to stop their body from absorbing the calories to prevent weight gain.
Non-purging bulimics usually don’t force vomiting. Instead, they control their calorie balance by fasting, or by exercising a lot.
These behaviors stem from emotional problems such as poor body image, low self-esteem, stress, history of abuse, or control issues. Bulimia is a very serious condition if not treated.
Treatment should be approached from a few different angles—individual therapy, nutritional counseling, maybe family therapy or a support group, and possibly with medication.
Therapists and other mental health professionals can help bulimics explore the relationship between thoughts, emotions, and behaviors.
Most common symptoms
Many people will ask why people with bulimia are often normal weight or overweight. Although they purge, not all of the food intake comes out. People don’t end up losing weight and the body dissatisfaction is only perpetuated and the cycle continues. —Dr. Bobbi Wegner
Bulimia is binging and purging (getting rid of the calories).
Binging is quickly eating a lot of food in a short period of time, while feeling a loss of control and unable to stop.
A person might binge on high-calorie, comfort foods, such as sweets, candy, or chips. But they can binge on any type of food. Binging may be spontaneous or it may be planned.
Symptoms fall into one of four categories: behavioral, emotional, physical, and cognitive (related to your thought process).
- Eating an abnormally large amount of food, alone or with others
- Purging through either forced vomiting, using laxatives and diuretics, fasting, or exercising a lot
- Secretive behavior (such as hiding food)
- Spending a lot of time in the bathroom after meals.
- Hoarding food
- Fear of weight gain
- Feeling overwhelmed
- Feeling out of control
- Yellow teeth
- Vitamin and mineral deficiency
- Broken blood vessels in eyes
- Irregular menstruation
- Scars and irritation on knuckles from inducing vomiting
- Irrational thinking
- Negative thought patterns
- Being overly focused on food
Bulimia is a complex disorder. Anyone with bulimia needs to see a mental health professional. Ask your doctor for a referral. Or check your insurance company for a list of covered providers. Also, psychologytoday.com has a list of therapists that you can search.
If not treated, bulimia can lead to other types of problems like anxiety, depression, and substance abuse.
If you have thoughts about harming yourself, go to the ER or call 911. The National Suicide Prevention Lifeline is 800-273-8255 and offers free, confidential support any time of day.
Treatment of bulimia
You are not a bad person. The secrecy is part of the disorder. The unhealthy behaviors (bingeing and purging) serve some psychological need. It is crucial to learn what that need is and find other healthy ways to get those needs met. —Dr. Wegner
Treating bulimia often requires more than one kind of therapy. You may work with a psychiatrist, a psychologist, a social worker, and a dietician. The National Eating Disorders has more resources on information and support.
Types of therapy include:
- Talk therapy: In sessions with a therapist, you explore your relationship between thoughts, emotions, and your behaviors. The goal of treatment is to learn to notice unhealthy thought patterns and behaviors while developing positive coping skills.
- Family therapy can teach family members more about bulimia and how they can best support their loved one.
- Support groups are a way of sharing information and getting emotional support from others going through the same thing.
- Nutritional counseling can be helpful in developing a healthier relationship with food.
- Medication: The antidepressant medication, fluoxetine (Prozac), is used to treat bulimia. Other antidepressants are sometimes given to treat underlying mental illness, such as anxiety or depression.
Who is likely to have it?
- Bulimia affects females at a much higher rate than males.
- Teenage girls and young women are particularly at risk.
- It affects people of all races and ethnicities.
- Bulimia is often under-reported because the behaviors happen in secret.
Many people feel completely out of control—like they are spinning out of their own lives with no hope. It is possible to get the negative pattern of bingeing and purging under control. It takes commitment, but have faith this can get better. —Dr. Wegner
No one knows for sure exactly what causes bulimia. Experts agree that certain factors increase the risk of getting it. Possible causes include:
- Family history of bulimia
- Poor body image
- Low self-esteem
- Being involved in a sport or other activity that focuses on appearance and performance, such as ballet
- Impulsive behavior (tending to act without thinking)
- History of abuse or trauma
- General stress
There is not one clear way to prevent bulimia. Many factors, including genetics, play a role. Anticipating all the potential risk factors is impossible, but following healthy lifestyle habits can make a big difference.
- Develop a healthy attitude around food and eating. Try lots of food, eat when hungry, and stop when full. Follow your natural cue. Mindfulness focused on food helps develop these skills too.
- Develop a healthy body image, praising the function of the body, not the form.
- Try to manage stress and anxiety.
- Notice and name people who have unhealthy relationships with food among those closest to you (family and friends).
- Understand your potential risk factors.
- Get help with a mental health specialist at the earliest sign of changes in unhealthy eating or thoughts around food.
Dr. Bobbi Wegner is a Supervising Clinical Psychologist at Boston Behavioral Medicine, a Lecturer in Human Development and Psychology at Harvard Graduate School of Education, and CoFounder of nouVenu: a virtual platform that provides real support for real parents from real experts. She is on The Board of Advisors of Ignite Mental Health, developed out of Harvard Innovation Lab (like Buoy). Dr. Wegner writes and speaks nationally on modern families, stress, and coping, and also has a specialization in Clinical Health Psychology. She has a column on Psychology Today (Perfectly Imperfect Parenting), is a Parenting Expert on NBC News Learn, and is on the Today Show Parenting Team. Her book on raising boys is due out Spring 2021 with New Harbinger.