Symptoms, Causes, Recovery
By Abigail Natenshon, MA, LCSW GCFP
What is Bulimia Nervosa?
Bulimia Nervosa is an eating disorder marked by
out of control eating followed by some form of
purging, such as vomiting, rumination and/or
excessive activity. It typically accompanies a
pathological fear of weight gain leading to food
restriction, followed by the need to gorge in
response to extreme hunger. The excessive
caloric intake leads to the perceived need to
purge, though many people purge without having
eaten excessively. With bulimia, one’s eating
lifestyle becomes disregulated and feels out of
control, as do many other aspects of
life for the afflicted person.
What is a bulimic binge?
Bulimic eating episodes are called binges;
binges are defined as the consumption of large
amounts of food during a short period of time.
In some instances, victims of bulimia cannot
stop eating until they have consumed so much
food that their body and skin aches. In other
instances, victims of bulimia report having
"binged" on as few as 5 grapes, or on three
teaspoons of cottage cheese. It is my opinion
that a bulimic binge has less to do with the
amount of food consumed, and more to do with the
sense of being out of control and virtually
compelled to consume the food. The manner in
which the food is consumed (generally frenzied
and mindless, where the food is hardly tasted)
is also important in determining a binge. Many
bulimics describe a "trance-like" state that
comes over them when they are binge eating.
As an example of a binge episode, one young
woman with bulimia found herself, at a time of
great stress, compelled to drive into a 7-11
convenience store where she purchasing three
cupcakes; she then proceeded to stuff them down
her throat whole in an emotional frenzy in the
dark and deserted alley behind the store. As far
as she was concerned, her binge had begun at the
moment when she drove her car up to the front
door and did not finish until she had purged the
cupcakes. She felt that she was in an altered
state throughout the five-minute interval, and
experienced a profound sense of relief from her
anxiety following the binge/purge cycle. The
bulimic cycle releases endorphins, brain
chemicals that infuse a person with a sense of
numbness or euphoria. Ironically, the relief
passes in short order, only to be replaced by
anxiety and guilt about the bulimic behaviors.
What causes bulimia?
Bulimia results from the coming together of
diverse factors, both chemical and
environmental. People are born with an inherited
predisposition towards developing bulimia,
particularly in cases where addiction and
substance abuse, mood disorders, and/or eating
disorders are present within one’s genetic
history. Bulimic individuals who experience the
most difficult struggle in making a full
recovery are those who suffer simultaneously
from addiction to substances. A significant
correlation between the development of clinical
bulimia nervosa and sexual abuse has also been
In addition to genetic predisposition,
environmental factors may be responsible for
triggering the onset of bulimia. These might
include peer pressures, family attitudes, the
influence of the media creating a need for
thinness, poor self-esteem and a lack of
acceptance of self and body shape. In addition,
poor eating habits can be the start of a problem
that can eventually escalate to bulimia; dieting
and resulting hunger lead to gorging, and
gorging leads to the propensity to purge.
Bulimia and anorexia can also be understood as
the misuse of food to resolve emotional problems
in people with a genetic propensity. When a
person is incapable of facing feelings, defining
problems, and resolving them effectively, that
person is more apt to become susceptible to the
onset of bulimia. Bulimia and anorexia are the
most lethal of all the mental health disorders,
killing or maiming for six to thirteen percent
of its victims, 87 percent of whom are
individuals under twenty years of age.
What are the symptoms of bulimia?
Other symptoms of bulimia may include the abuse
of laxatives, diuretics, and/or diet pills, all
of which represent a form of purging. People
with bulimia often suffer from depression and
anxiety and may develop ADHD. Another very
common form of bulimic purging is seen in
compulsive and excessive exercise, which is also
commonly known as an activity disorder. Many
people suffer from bulimic symptoms that do not
quite match the current description in the
Diagnostic and Statistical Manual; these people
are victims of what is known as EDNOS, or Eating
Disorders Not Otherwise Specified.
How easy is it to recognize bulimia?
How easy is it to visibly recognize bulimia in a
loved one? Not easy at all. Typically, bulimic
individuals appear to be of normal weight, and
their purging behaviors take place secretively.
Emotionally, the bulimic individual may become
withdrawn, irritable or unable to focus in
attempts to learn and work. Observers need to
learn how to read the hidden signs of a hidden
disease. Most often, bulimia is a disease that
the victim covets and holds close, fearful of
loosening a grip on a crutch that they perceive
has sustained and supported them through life
and hard times. By purging one's dinner, (i.e.
taking control of one's food and one’s own body)
the victim feels in control of every aspect of
life. With bulimia, purging becomes a metaphor
for undoing or deleting problems or concerns,
for refusing to recognize, face and deal with
life's challenges and difficulties. Be aware
that bulimia, though the most life threatening
of all the mental health disorders, is also a
physiological disorder, though it rarely shows
up in the doctor's office or in medial lab
Who suffers from bulimia?
Children are reported to suffer from bulimia at
ever younger ages. The average age of onset has
recently dropped from the range of 13 to 17 to
that of 9
to 12. As girls reach puberty at ever younger
ages, they find themselves growing larger at
precisely the time when they are most aware of
society's prescription for them to become
thinner. Dieting, rather than healthy eating
becomes a way of life for children in search of
thinness. Dieting damages healthful metabolic
processes and establishes unhealthy eating
habits that bring young people into their adult
years with a propensity for disordered eating
and ultimately, for over-weight and obesity.
The unresolved issues and dysfunctional eating
and lifestyle habits connected with bulimia are
frequently brought into a person's adult years.
Many bulimic individuals in their 20's, 30's and
40's harbor these secret diseases alone and
isolated, as partners, parents, and
professionals. A member of my therapy group for
adults with bulimia and anorexia stated that
during the 20 years of her bulimia, she had
never told a single person of her struggles. She
believes that her husband and four children
still do not know. Another gal spoke of seeing a
psychiatrist for seven years, twice a week,
without confessing to him that she was bulimic.
When asked why, she stated that she felt he
would be “grossed out” and would not want to
work with her anymore.
Do people recover from bulimia?
It has been said that “Once bulimic, always bulimic.” Not so.
Research has shown that where detected early and treated effectively, 80% of
victims of bulimia recover. Recovery dramatically improves quality of life
for the sufferers of bulimia, and saves lives that can be lost in sudden
death that ensues from electrolyte imbalances and c. My book,
When Your Child Has an Eating Disorder
is a reader-friendly and effective guide for patients, parents and
professionals in bringing about healing.