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Bulimia

Characteristics Common to Bulimics

Bulimia generally includes any of the following:

  • A cycle of bingeing and purging
  • Prone to substance abuse
  • Diuretic abuse
  • Vitamin abuse
  • Shoplifting
  • Suicidal thinking
  • Extreme mood swings
  • Hypoglycemia
  • Likely previous rape or sexual abuse
  • Vomiting
  • Laxative abuse
  • Fasting
  • Rigid dieting
  • Secret/deceptive eating

  1. Tend to hide and bottle up feelings – especially anger
  2. Hypersensitive to criticism, though have a critical spirit themselves
  3. Shame to control self and others
  4. Impulsive in thought and action
  5. Has great difficulty with intimacy, both sexual and emotional
  6. Obsession with weight, though tend not to be extremely overweight
  7. Addicted to the scale
  8. Tend to have very strong need for other’s approval, but feels as though they never get it
  9. Very secretive, deal with very high amounts of guilt
  10. Obsessive in thought about physical body
  11. Believes that God disapproves of them
  12. Tremendous physical exhaustion
  13. PMS tendency, irregular periods
  14. Dizziness, headaches, constant thirst
  15. Digestive disturbances, extreme, bloated
  16. Electrolyte imbalance resulting in muscular weakness
  17. Dental problems
  18. A life of extremes in relationships, spirituality, and emotions
  19. Chronic low self-esteem
  20. Disturbed metabolism.

What works in treatment?

  1. Whole person approach
  2. Non-diet approach
  3. Self-esteem retraining
  4. Nutritional reeducation
  5. Spiritual renewal
  6. Relationship enhancement
  7. Identity development

Bulimia Symptoms

  • 95% to 98% female
  • 84% have some college education
  • Usually white-this is changing
  • 64% are closer to proper weight
  • On the average, binges occur 11 times per week
  • Average number of calories consumed: 4,800
  • Average age at onset: 18
  • Estimated number of bulimic college women – 20-30%
  • Very unhappy and have low self-esteem
  • Often depressed
  • Tend to be passive individuals
  • Tend to rely on others, especially me” for self- validation
  • Afraid of rejection
  • Perfectionists
  • Isolated
  • Very secretive
  • Unsure how to cope with stresses of life

Behavioral Characteristics.

Bulimia Nervosa

Bingeing and Food ControlEating, in a discrete period of time (e.g. within any 2 hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. Fear of inability to stop eating voluntarily (bingeing), a feeling that one cannot stop eating or control what or how much one is eating.
PurgingCompulsive exercising. Vomiting, laxative, diuretic, or diet pill abuse; or use of other emetics ( syrup of ipecac).
Eating BehaviorSecretive food foraging and hoarding, especially at night. Shoplifting and or petty stealing of money to buy binge food.
Sleeping BehaviorVarious sleep disturbances
Clothing and Dressing RitualsOther obsessive-compulsive patterns, such as trying on clothes five times a day.
Social BehaviorSocial irregularities, alternating withdrawal with erratic need for social contact and approval. Chaotic relationships and interaction.
Abusive BehaviorDrug and/or alcohol abuse. Suicidal gestures or attempts. Self-hatred and self-mutilation. Feelings of self-disgust.

Emotional and Cognitive Characteristics

Individuals suffering from eating disorders have restricted emotions and often cannot identify their feelings. What they are aware of is extremely negative thoughts related to their body – an effective diversion from their emotional turmoil and pain. Their thoughts are obsessively locked onto the Irrelevant and their feelings are avoided and hidden, even from themselves.

Bulimia Nervosa

Body Image ProblemsPreoccupation with appearance and “image”.
Perfectionist BehaviorPerfectionist: high performance and achievement expectations. Perfectionist inside, but sometimes chaotic outside. Facade of normalcy, seemingly “got it together”.
Self-EsteemLow self-esteem: self-loathing, self disgust, and depression.
SexualityMay be promiscuous or confused about sexuality, a mask for a desire to he accepted and respected.
Social BehaviorConstant feeling of being out of control; vacillates between isolation and extreme need for external validation.
Cognitive SymptomsInability to accurately identify and express feelings. Out of touch with one’s feelings, (e.g. anger, affection, humor). Thoughts obsessive and focused on the eating disorder cycle.

Adapted from Mary Pabst, MSW, Maryland Association for Anorexia Nervosa and Bulimia (MANA) from Panhellenic Task Force

Bulimia not always about looking thin

Freshman Jane Felton said she would purge to make herself feel better in comparison to other women, who made her feel insufficient.

“I always thought I was chubby – chubbier than the rest of the girls in my class,” Felton said. “Most of the time I wouldn’t eat, unless I was stressed out or I was really hungry. In those situations, I would just eat a lot of junk food, because that made me feel sick quicker. Then I would run to the bathroom, stick my finger in my throat and throw it all up. I wanted to be pretty,” she said.

According to Dr. Donald McAlpine, a psychiatrist and the director of the eating disorders services at the Mayo Clinic in Rochester, Minn., bulimia, also referred to as bulimia nervosa, is a psychological eating disorder that involves repeated episodes of overeating. This is followed by inappropriate ways of trying to rid the body of the food before weight gain occurs, he said.

In most cases, the disorder is not solely about being thin. It can also become a way to “gain total control of some aspect of their life,” Judy Blackstone, a UW-Eau Claire counselor said.

According to the National Eating Disorder Association, overwhelming lifestyles full of never-ending homework, significant other pressures, difficult family relationships and additional stressing aspects are common causes for self-induced purging.

“None of the eating disorders are about food,” Blackstone said. “They’re about the way we feel about ourselves.”

Cases of bulimia may start in post-adolescence due to unattainable standards of American society and continues all throughout college, she said.
The Spectator News

Metabolic Abnormalities in Bulimia Nervosa

Persons with anorexia nervosa eventually become visibly recognizable because of their severely underweight status. In contrast, those affected by bulimia are typically of normal weight and are not as easily detected. This disorder is characterized by binge eating and purging.

Bulimia is most common in late adolescent females. Comorbidity with other psychiatric disorders is typical, and patients with a concomitant personality disorder (e.g., borderline, narcissistic, and antisocial disorders) have a worse prognosis. Although most bulimics purge by vomiting, abuse of laxatives or diuretics also occurs. The number of times a bulimic patient purges can vary widely, from as seldom as once or twice weekly to as often as 10 times per day.

The medical complications of bulimia relate to the method and frequency of purging. Repeatedly induced vomiting can lead to the loss of dental enamel, increased dental caries, swollen salivary glands, Mallory-Weiss esophageal tears, and gastroesophageal reflux. Laxative abusers can develop severe constipation on withdrawal of laxatives, related to damage to the myenteric plexus. The typical electrolyte abnormalities associated with bulimia are hypokalemia and metabolic acidosis. Different purging methods result in different constellations of serum and urine electrolyte disturbances (see accompanying table). The author notes that although severe hypokalemia in an otherwise healthy young female specifically suggests bulimia, most patients who purge do not develop electrolyte abnormalities. Therefore, screening for hypokalemia or other electrolyte derangements is not a sensitive means for detecting purging.

Treatment of the medical complications associated with bulimia is usually possible, but the underlying disorder can be challenging to manage. Fluoridated mouthwash and toothpaste can help ameliorate dental caries, and the use of sour candies may decrease salivary gland swelling. Antacid medications help reduce reflux symptoms, and nonstimulant laxatives may be used to decrease constipation in those with previous stimulant laxative abuse. Oral repletion of low potassium is typically accomplished with 40 to 80 mEq per day of supplementary potassium, until a normal serum potassium level is achieved. Patients with severe hypokalemia and metabolic alkalosis need volume repletion with intravenous normal saline to turn off the renin-angiotensin-aldosterone system and allow normalization of potassium levels.
Mehler PS. Bulimia nervosa. N Engl J Med August 28, 2003;349:875-81.

Teen-agers suffering from bulimia may also be struggling with a chronic form of depression

Often masked by the bulimia itself, dysthymia – a lower-level, chronic form of depression – is often present in bulimics and may even predispose them to the eating disorder, shows the research by Perez and her colleagues Thomas E. Joiner Jr. of Florida State University and Peter M. Lewinsohn of the Oregon Research Institute.

“As pernicious as major depression can be, it tends to remit, even if untreated,” she notes. “By contrast, dysthymia is unrelenting, often lasting decades, with the average episode length lasting more than 10 years.”

It’s this long-lasting nature, Perez says, that makes dysthymia, rather than major depression, more likely to be associated with bulimia, which is characterized by unrelenting negative feelings about one’s self.

Bulimics, she says, tend to have chronic low self-esteem. Previous models, she notes, have proposed that high perfectionism when dashed by low self-worth is predictive of bulimia. Because of this, the chronic and pervasive self-esteem problems associated with dysthymia may make dysthymic people vulnerable to bulimia, she says.

The relationship between bulimia and dysthymia might be the struggle to regulate unrelenting negative moods stemming from the depression and the feelings of low self-esteem associated with the eating disorder, Perez speculates.

Individuals who suffer from simultaneously existing disorders, such as bulimia and dysthymia, usually have a worse course and prognosis in treatment than those who only suffer from one disorder, Perez says. She believes that her findings can provide additional information to create more focused and effective treatments for teens with bulimia. Knowledge of the co-existence of bulimia and dysthymia in teens can help therapists assess specifically for dysthymia in bulimic patients and choose a treatment that will combat both disorders, she says.

Perez reasons that as the course of bulimia progresses, the social support network and resources of a bulimic person may start to diminish, making negative life events harder to overcome. The binges and purges that serve as a type of coping mechanism in the beginning of the disorder may, over time, lose their comforting aspects while their harmful ones continue to be amplified. This, in turn, may cause the intensity of the depression to increase, making the occurrence of major depression and bulimia more common in adults, she says.
http://www.tamu.edu/
http://www.news-medical.net/?id=6763

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SYMPTOMS

DISORDERED EATING
any excessive control of caloric intake.

AMENORREAH
loss of menstrual cycle

OSTEOPOROSIS
low bone density and fragile skeleton