Bulimia is an eating disorder characterised by eating large volumes of food (bingeing) and then compensating for this by purging (using laxatives, vomiting, diuretics, fasting or overexercising to “purge” the calories). Bingeing is hugely different to simply indulging or consciously and positively enjoying eating more. Instead, it is a negative out of control rapid and self-harming act where a person eats whatever they can find, very fast, often secretly in a bid to use food to cope with negative thoughts, emotions, or situations. A binge is followed by incredible guilt and subsequent purging.
As with Anorexia Nervosa, a person with Bulimia will often entwine self-worth with weight and body image. This eating disorder also has genetic causes and is linked to those high at risk of anxiety and depression. This disorder is more linked to depression than Anorexia Nervosa, with a larger body again seen as failure and low self-worth. It is also often more undetectable, as it often does not necessarily come with low BMI, and so diagnosis and treatment are much harder to achieve, and recovery is on average much longer.
Signs of Bulimia Nervosa
Long term effects
As with Anorexia Nervosa, the long-term effects depend on the severity of the disorder. If persistent for many years, Bulimia can cause osteoporosis (brittle bone disease) as the body fails to absorb sufficient calcium, rotten teeth (if purging with vomiting) and gastrointestinal disorders and liver, kidney, and heart problems.
There are many treatments for Bulimia Nervosa, all patient specific. Often the best treatment is to find the root cause of the behaviour, the thoughts and feelings surrounding the link between weight and self-esteem and the cause of the anxiety or depression. Then the stages of nutritional support treatment can begin. Treatments focus on identifying and reducing the triggers of binges, preventing an individual from getting energy deficient and too hungry, angry, lonely, tired, or ill (illness can reduce blood sugar as your body requires additional energy to fight disease) and providing them with sufficient negative emotional distress tolerance coping mechanisms to adapt to challenges, without the need to binge and purge. This can involve the use of nutritional support to ensure they always have sufficiently balanced blood sugar levels, CBT, and therapy to help them examine the flawed thinking patterns that trigger binges and behaviour (balanced exercise, yoga and increased social support) and environmental changes (removal from a stressful job or home environment), to help them feel more at ease.
Distraction techniques for triggering situations or distressing emotions, providing alternative ways of reducing stress and getting the Dopamine surge other than food, are essential in preventing a binge. This can involve exercise to increase (they are Cortisol stress reducing brain chemicals) Endorphins (not overexercising or using exercise to purge calories, but in a balanced way such as a walk-in nature or a sociable dance class), seeing friends or family, creativity (reading, art, theatre, tv, hot baths, massages, sex, gardening), or anything else that brings you pleasure in order to increase Dopamine without food.
As with Anorexia binges and sometimes in Binge eating disorder, an individual with bulimia will get a sense of self-pride with others from eating little, “good food” meals and denying themselves treats in public. This creates cycles of secret binges, at home often at night when a person is tired, energy deficient and so has low blood sugar and may feel hungry (even if had sufficient food- it is common to confuse hunger and tiredness in eating disorders). Recovery is about ceasing the bingeing, purging behaviour, and restoring a healthy relationship with food and their bodies.
Researched by: Laurentia (Laura) Campbell. Neuroscience and Nutrition scientist (with focus on the gut microbiota and omega 3) and writer. Former anorexic and binge eater turned gourmet food connoisseur, researcher, writer, marketer, and evidence-based nutritionist. See https://www.linkedin.com/in/lauracampbell007/ and https://medium.com/@laurentiacampbell.
Technical reviewer: Alice Benskin, MSc Personalised Nutrition