Bulimia nervosa is a serious and potentially life-threatening eating disorder characterised by a cycle of bingeing and compensatory behaviours such as self-induced vomiting designed to undo or compensate for the effects of binge eating.
Criteria for Diagnosis
According to the DSM-5 criteria, to be diagnosed as having Bulimia Nervosa a person must display:
- Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:
- 1.Eating, 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.
- 2. A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
- Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
- The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Things to look out for (Warning signs)
- Evidence of binge eating. This might include the disappearance of large amounts of food over short periods of time. Finding food wrappers and containers which may suggest consumption of food eaten secretly.
- Evidence of purging behaviours, including regular trips to the bathroom after meals, signs and/or smells of vomiting, discovery of packages of laxatives or diuretics.
- Excessive and inflexible exercise routines. This will be in spite of bad weather, fatigue, illness, or injury. Resulting from the compulsive need to “burn off” calories consumed after a binge.
- Blood-shot eyes. Regular vomiting can cause small haemorrhages in the eyes.
- Swelling of the cheeks or jaw area.
- Calluses on the back of the hands and knuckles from self-induced vomiting.
- Discolouration or staining of the teeth.
- Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.
- Withdrawal from usual friends and activities.
- In general, behaviours and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
- Frequent changes in weight
EEDOS aim to help those suffering from Bulimia Nervosa to gain a healthier relationship with food.
How you may experience Bulimia (Symptoms)
- A compulsion to eat regardless of levels of hunger or fullness until the binge event is ‘done’ – this can sometimes feel like waking up from a trancelike state.
- A feeling of being out of control during the binge-eating episodes. You may feel like you have no choice but to continue, until it stops.
- Self-esteem and self-worth are closely linked to your body and body image conflicts. All feelings become that of ‘being or feeling’ fat.
- A complete denial of feeling prior to a bulimic episode, following by a powerful cascade of self directed negative emotions, such as shame, disgust, anger and depression, after an episode.
- An overwhelming need to expel the feelings (vomit/purge) as much as the food, associated with a binge episode. Everything needs to come out until you are empty in every way.
- Bulimia can become your ‘secret’ friend, always there when you need it. This attachment can feel comforting and needed. However it can also leave you feeling quite alone and isolated with your condition.
Consequences and Complications
- Bulimia nervosa can be extremely hard on the body. Recurrent bingeing and purging can disrupt the entire digestive system and purging behaviours can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Some of the complications that arise from bulimic behaviour include:
- Retinal displacement. As a result of the intense pressures of vomiting, blood shot eyes can be a usual side effect. Less often reported is the serious damage that can be done, requiring surgery to correct it.
- Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviours.
Inflammation and possible rupture of the oesophagus from frequent vomiting.
- Tooth and enamel decay and staining from stomach acids released during frequent vomiting.
- Chronic irregular bowel movements and constipation, made worse with laxative use.
- Gastric rupture is uncommon, but does occur in extreme cases.