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Bulimia Nervosa

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 proven.

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 tests.

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.



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