Frequently Asked Questions

1. What is bulimia?
2. What is bulimia nervosa?
3. Is bulimia treatable?
4. Is complete recovery possible?
5. What are the symptoms of bulimia?
6. What are the signs of bulimia?
7. What are the dangers of bulimia?
8. What are the causes of bulimia?
9. What are the effects of bulimia?
10. How does bulimia affect teeth?
11. What are the facts about bulimia?
12. What are the statistics about bulimia?

What is bulimia?

Reoccurring episodes of binge eating followed by purging through self-induced vomiting, or the use of laxatives or diuretics.

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What is bulimia nervosa?

An over concern with self image when it comes to body weight, size and shape. Reoccurring episodes of binge eating followed by purging through self-induced vomiting, or the use of laxatives or diuretics. Alternatively use of strict dieting, fasting or vigorous exercise, where purging is rare.

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Is bulimia treatable?

Yes. The most effective treatment options help the sufferer to do three things: reduce physical symptoms, change their bulimic thoughts, and address their bulimic behavior.

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Is complete recovery possible?

Yes. With proper treatment, change, and effort over time, you can completely recover from bulimia. In order to maintain lasting freedom from bulimia it is essential to reinforce daily the positive changes in your lifestyle, self-care activities, thought patterns, and behaviors.

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What are the symptoms of bulimia?

* Binge behaviour is a secret one- often involving subterfuge and deception.

* Food is consumed at an alarmingly fast rate, to avoid being found out, or to avoid the guilt and shame that follows.

* Act of vomiting is a means of getting rid of this newly acquired shame and guilt of bingeing- this is also an attempt to get rid of the emotional negativity that surrounds the bingeing.

Immediately after bingeing, people feel briefly satisfied with what they have eaten and feel relieved by abandoning restraints (a sense of struggle produced by not eating all the time). These emotions are soon replaced by feeling disgusted with their eating, shame & guilt as well as depression.

These psychological symptoms are made worse by the physiological effects of binge eating: tiredness due to blood glucose-insulin relationship, abdominal pain- associated with fast eating and the nature of the complex food eaten; headaches and dizziness from the sugar rush & sugar addiction. Feeling of extreme fullness and bloatedness- due to sheer amount of the food consumed pushing against the abdominal walls.

This all leads to a great fear of weight gain, initiating people to take extreme measures of compensating behaviours. Vomiting, Laxative, diuretic use as well as fasting, dieting and excessive exercise follows to rectify the bingeing that took place.

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What are the signs of bulimia?

It is very difficult to spot outward signs of bulimia. Below is a list of signs to be aware of:

* Food wrappers under the bed
* Dehydration
* Heartburn
* Rounded face
* Internal bleeding
* Skin damage to the back of the hand around the knuckles
* Damage to teeth
* Bad breath

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What are the dangers of bulimia?

What causes medically serious consequences in bulimia is the act of vomiting. Many side effects and complications result needing immediate medical attention.

The disturbance of the chemical in the body fluid

The process of vomiting, drinking and vomiting again until the full content of the stomach is empty of food is a serious one. This process upsets the balance of body fluids and salts, namely potassium, sodium and chloride.

Low levels of potassium can result in cardiac arrhythmia, muscle cramps, muscle weakness and Tetany. Dehydration is obvious as a result of excessive behaviour. Although this can be reversed once you stop vomiting and taking laxatives/diuretics. Any long-term damage to heart, kidney and brain tends to be irreversible. Heart arrhythmia and even sudden cardiac arrest (heart attack) is possible.

Heartburn

Frequent vomiting can lead to problems with reflux which is partly digested acidic food coming back up from stomach. Usually it is caused by over eating, by eating rich or spicy food, or by drinking alcohol.

Swollen Parotid Glands

Binge-eating, vomiting, laxative abuse causes a great deal of irritation within the gastro-intestinal tract. Swelling of the salivary glands (including parotid glands) is common – giving rise to rounded face appearance. Sadly, many sufferers associate this as having a fat face – which then adds to the worry of looking and feeling overweight. Thus the vicious cycle continues.

Internal Bleeding

Occasionally violent vomiting causes a tear in the oesophagus (the long tube linking the mouth to the stomach). If the oesophagus ruptures, it is considered a medical emergency. Repeated vomiting over many years can also lead to a weakening of the oesophagus sphincter (muscles). The result of this can cause gastric reflux.

The throat is often damaged to due to an induced gag reflex by sticking a finger or device. The back of the throat is frequently injured and often bleeds then becomes infectious prone. Obvious tell-tale sign is that your voice becomes hoarse.

Skin Damage

People who stick their fingers in their throat to induce vomiting are prone to develop surface lesions. The repeated contact of the front teeth to the skin of the hand can result in abrasion of the skin, small lacerations and callosities on the surface of the hand (near the knuckle). This might be the only outward physical sign of bulimia.

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How Does Bulimia Affect Teeth

Tooth ache is common and frequent sore throats along with sore gums are also apparent. This is due to vomit containing hydrochloric acid (from the Digestive juice in the stomach) reaches the mouth frequently – causing erosion of the dental enamel (mainly on the inner surface of the teeth).

Many rush to brush their teeth vigorously after vomiting in an attempt to get rid of the smell. This actually damages the teeth further rapidly by the scarring effect. Once eroded, tooth enamel cannot be replaced. Constant exposure to acidity contributes to erosion of enamel, tooth decay and tooth loss.

This is often very painful and may lead to infections, bad breath and abscesses. Other dental problems include Jaw joint disorders, increased temperature sensitivity, periodontal disease, gingivitis and decreased salivary flow.

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What are the causes of bulimia?

• Genetic factors are known predictive factors that allow you to inherit such tendencies from your parents, or some case even from your grandparents (as the genetic emphasis can skip a generation and exert it self with the gap).
• Many people with bulimia, have a tendency to have a higher than average natural weight. Parental obesity has been found to be more prevalent among people who have developed bulimia and having greater exposure to a series of diets.
• Some studies also show that depression once inherited from parents, can cause depression in people who then develop some form of eating disorder themselves. It is often prevalent just before the bulimia actually develops.
• Weight loss following an episode of physical illness can also bring about bulimia.

Psychological Factors

• Low self-esteem.
• Extreme concern about body weight, size and shape
• Being a perfectionist and having high standards.
• Being histrionic, whereby over dramatising any given situation.
• Vulnerability towards alcohol.

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What are the effects of bulimia?

Bulimia has a profound and debilitating effect on your psychological well-being and your social life.

Depression

• Feelings of guilt
• Poor concentration
• Feelings of worthlessness
• Irritability
• Lack of energy
• Loss of self confidence
• Depressed mood
• Social withdrawal
• Feelings of hopelessness

Anxiety

• Worrying
• Tension pains (e.g. head aches)
• Nervous tension (e.g. being on edge)
• Avoidance of anxiety provoking situations
• Anxiety in meeting people
• Anxiety in specific situations
• Panic attacks

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What are the facts about bulimia?

Bulimic sufferers tend to have a higher than average natural weight or they tend to fall within the normal range of the body weight scale – making it the most different case to detect, due to very little outward signs and symptoms.

Incidents of bulimia are lowest in the rural area, intermediate in urbanised areas and the highest in large cities.

Bulimia nervosa is more common than anorexic nervosa. Prognosis is better for bulimia; however medical complications do exist due to the purging nature of this condition.

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What are the statistics about bulimia?

Adolescent females from the age of 15 to 30 are more likely to suffer from bulimia than any other age group.

1 in 20 (a typical school class size) suffers from some form of eating disorder amongst female high school and college students.

Between 1988 and 1993 alone, there was a threefold increase in the actual recording of bulimia.

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“I Suspect a Friend, Partner or Family Member Has Bulimia, but I’m not sure. What are the signs, symptoms or behaviors that I should look out for?”

Identifying bulimic people is not an easy task. Those who suffer from an eating disorder keep it a secret and are very good at hiding the effects of bulimia, even from the people they live with.

Look out for telltale bulimia signs. For example, do they avoid social occasions that involve the presence of food; have you found hidden food wrappers or come across a number of unaccounted food bills?

Locked bathroom doors and turning on the shower to mask the noise of vomiting (binge & purge), are an obvious give away. So is coming across unknown tablets, which may be laxatives.

Finding loved-one’s missing from their bed, only to find them coming back from the kitchen, with a weak explanation that they needed a drink of water. This may sound plausible at first – but if it happens on regularly basis then it is not surprising if you get suspicious.

If it’s your child, are they skipping sports at school, playing truancy or are they are being bullied? These may be bulimia tip-offs.

Here is a list of bulimia signs, typical bulimic symptoms and behaviors to look out for. No one item will mean they are bulimic, so look for clusters of supporting evidence, like:

• Often avoiding meals or eating with others. If they do eat, it is a calorie-controlled diet of some kind.
• Eating late at night or indulging in mid-night feasts.
• Habitually visiting the bathroom shortly after a meal and saying they need to have a bath, use the toilet or wash their hair. If this happens check the sink or toilet for any evidence of vomit, smell of vomit or heavy use of air fresheners in an attempt to mask the smell.
• Having notable and regular fluctuations in weight, often due to being on various diets.
• You noticing significant amounts of food going missing, empty packets and food wrappers may accompany this.
• You finding hidden food items or food stored in unexpected places.
• Being generally unhappy about their appearance and weight. Having an obsessive desire to be thin which is communicated through either their conversations or behavior.
• Having an obsession with food and cooking – for example knowing how many calories are contained in individual food items; or they know every way to cook a specific food; are genuinely curious about eating, they read all about it; they entertain everyone through food, but seen to be eating very little of it themselves.
• Having low levels of self-confidence, are moody and have a preference for being alone. Avoid socializing with family, friends and work colleagues.
• Increased activity levels, especially fitness and visiting the gym on a very regular basis.
• Weighing themselves more than once a day.
• Poor management of personal finances.
• General disinterest in life, frequent mood swings and are often depressed.

If you have identified clusters of some of the above bulimia signs or typical bulimic symptoms, chances are your instincts that a loved one is suffering from secretive bulimic tendencies, is true.

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Clinical/Statistical data

Bulimia affects an extremely large proportion of young women and teenage girls. The specific numbers are difficult to determine because often the affliction is misdiagnosed, mistreated or not reported. Data available from the National Institute of Mental Health appears to suggest that as many as 5% of the female population will be effected by this eating disorder. Males also fall victim to bulimia although in lower proportions than females.

What these statistics mean in real numbers is that as many as 7,000,000 females and up to 1,000,000 males will be struck by bulimia.

Whatever the exact numbers are it is clear that this is not a rare eating disorder. It is rampant and demands treatment before the debilitating effects cause severe medical problems. Bulimia demands that an individual gain control over their eating habits. Recurrent binging and purging can lead to extremely serious difficulties.

Gaining control of bulimia, while ultimately an individual responsibility, is difficult and demanding. It generally requires the dedicated help of loved ones and the motivation of the affected individual to want to make a positive change in their behavior that will lead to the adoption of life sustaining and life changing conduct.

Harm that may be caused

Many medical problems are created because of bulimia which can include kidney malfunction, stomach disorders, problems with teeth and gums, malnutrition or other severe ailments. Without proper treatment for bulimia some people will die as a result. There is additional risk for psychological disorders to arise as a result of a bulimic lifestyle, if those problems are not already at the root of the eating disorder. It is evident that bulimia can cause a downward spiraling of an individual’s quality of life and create angst, anger or even depression for it’s victims.

Treatment

Bulimia is most common among teenage girls and women in their early twenties. Intervention and treatment should begin as soon as the eating disorder is recognized and continue until the eating disorder is cured and a healthy life style is adopted. A difficulty that often prevents effective and timely treatment is often caused by the bulimics failure to recognize the problem or by engaging in behaviors that hide or mask the disease. It is not uncommon for a bulimic to feel ashamed of their activities and to be experiencing suffering in plain view of loved ones.

It is often the task of close friends or loved ones to help with the identification of bulimia and encourage or demand that treatment be sought. Positive outcomes are best achieved with diagnosis of the eating disorder in the relatively early stages of formation. Positive outcomes are also likely with those that have been coping with the eating disorder over long periods of time, although it may take a more sustained period of treatment to successfully deal with the eating disorder.

Treatment for bulimia can entail a wide variety of activities. Education, counseling, coaching, mentoring, nutrition and meal planning as well as medical treatment and hospitalization may be required to assist the individual in conquering bulimia. The results of failing to properly treat the eating disorder can be disastrous. However, effective treatment can often result in dramatic progress and provides the best opportunity for enabling the person suffering from bulimia to rejoin their world as well adjusted and healthy individuals.

Results

The potential results of effective treatment can be dramatic. A person that beats bulimia is often filled with a strong sense of accomplishment and self-assurance. They are armed with the knowledge that they possess the strength to conquer any challenge that life presents to them.

In summary, bulimia is a widespread affliction that can lead to potentially life threatening conditions. The individual with bulimia must desire to make a change in their lives and recognize that help is available to provide information, encouragement, education and counseling. The recognition of the need for change is the first critical step in the pathway leading to success.

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The answer is; discuss your concern with them. Don’t ignore bulimia signs and hope their binge & purge routines will go away or think that overtime they will grow out of their bulimic habits. They won’t and you will only get more apprehensive about the situation.

The problem for many people, who are close to a suspected bulimic, is that they are unsure about how to approach the person and the subject of bulimia. They feel duty bound to help them overcome bulimia but are afraid that if they do, they might damage their relationship.

To assist you with this situation, we have put together a list of positive steps to help you be proactive, do the right thing and maintain or improve your relationship.

Knowledge is the key in helping you take the right approach when confronting a suspected bulimic. Find out all you can about Bulimia;

• Bulimia signs
• Bulimia symptoms
• Effects of bulimia
• Dangers Of Bulimia
• Bulimia medical help
• Bulimia support
• Bulimia treatment programs

With an excellent appreciation of bulimia nervosa, you will find it easier to talk about and have a good understanding of what that bulimic person is going through.

• When you raise the issue of bulimia, do not criticize, condemn or complain. Your objective is to build a trusting relationship so that the person with bulimia feels relaxed and are able to confide in you.
• Find the right time to raise the topic of their binge & purge routines. Make sure there are no interruptions and explain that what ever they disclose about their bulimia, it will not be shared with anybody else.
• Air your concerns; explain how their suspected binge & purge routines has made you want to become involved in what is a very private and personal matter.
• You could start by saying, “Emma, I feel upset when you refuse to eat with us and you go and shut yourself away in your bedroom,” or “I’m concerned about you using laxatives everyday, I fear for the damage you are doing to your kidneys. Can we talk about it so we both understand what is going on for you?” Then be ready to truly listen, understand and empathize.
• If they open up and admit to binge & purge routines, do not make out that you are going to try and rescue them, save them, force them to have bulimia treatment or to stop being bulimic. Your role is simply to be a friend and be there for them. To help guide them on the road to bulimia recovery.
• At this point in time they are coping with Bulimia in the best way they can. Bulimia is already making their lives a misery; so avoid putting any unreasonable expectations, pressures or demands on them.
• Work with them to seek help or agree on how you can provide support or where to get non-medicated treatment for bulimia e.g. assistance with weekly food shopping, help them find a treatment or accompany them when they visit their GP.
• Jointly start a new hobby that may serve to distract their bulimic habits like dancing or walking. Suggest professional eating disorder treatments (Counseling, GP, Group Therapy, Self-Help, Alternative treatments for bulimia, internet based bulimia treatment etc)
• Be careful not to incite Bulimic behaviors e.g. do not give praise when weight loss is noted or criticize when weight is gained.
• Be prepared for denial or a refusal to be helped with their bulimia. Seek support for yourself; this will better enable you to deal with the effects of bulimia that arise from their binge & purge routines. You could simply take some “Time Out” or have regular conversations with a qualified counselor. Learning to deal with bulimia is vital.
• If you are a friend, letting someone else know that you are trying to help a bulimic (like a teacher if you are a student) may help to take some of the pressure off you.
• If you are a Parent, remove the temptation of binging and purging from the home environment. Don’t keep cupboards filled with typical binge foods such as sweets, candy, cakes, biscuits, chocolates, and so on… instead stock up with fruits, healthy cereal bars, nuts and fresh juices.
• Relax some of your own rules around food and body issues. Don’t force people to eat everything on their plate especially if they are bulimic. Give space for others to grow and be independent. Always provide love and affection.
• If you are a partner, remember to focus on the aspects of your relationship that give you both pleasure. Stay focused on the relationship not the binge & purge routines.
• Do not blame yourself for their bulimia. You did not cause the eating disorder; so you have no reason to harbor any guilty feelings.
• Be mindful of how you communicate your own perception of bulimia as well as weight, shape, diets and body image.
• Accept that bulimia recovery will not happen over night, be patient and continue to provide your support and care for as long as it takes.

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