Bulimia nervosa 101
You may have heard of bulimia.
It’s a common eating disorder, but there’s still much stigma and misinformation attached to it.
This blog will give you an overview of what exactly bulimia is, the signs, and how to begin recovery.
What is bulimia nervosa?
Bulimia nervosa is an eating disorder characterised by a cycle of binge eating and compensatory behaviour, known as purging. These binge-purge cycles are often accompanied by feelings of a lack of control over episodes of eating.
The exact cause of bulimia is unknown, it is instead contributed to a range of factors all interacting. Bulimia may also develop over time so the original cause is forgotten or unknown. Some contributing factors in bulimia development are:
1. Genetics: people with first-degree relatives who have a bulimia history may be more likely to develop an eating disorder. There has been no precise gene identified currently but familial links have been found.
2. Neurological: the neurotransmitters dopamine and serotonin – aka the happy hormones – have both been linked to bulimia. They are also linked with depression, bipolar disorder, and anxiety which often co-occurs with bulimia.
3. Personality traits: There are personality traits often found in those with bulimia. Commonly found traits in those experiencing bulimia include impulsivity, unstable moods, emotional intensity and a lack of mental flexibility. This is often coupled with perfectionism – a strive for flawlessness. This perfectionism may mean mistakes are seen as personal failures to be avoided at all costs.
4. Dieting: people who diet are at a higher risk of developing an eating disorder. Dieting and strict restrictions can lead people to enter the binge-restrict cycle which can cause bulimia.
5. Childhood trauma: there is a strong link between childhood trauma and eating disorders. This can include divorce, loss of parents, abuse (including sexual, emotional, physical etc.) as well as bullying and neglect.
6. Sociocultural: we live in a time of societal pressure and the ‘thin ideal’ being promoted. It’s easy to internalise these beliefs and feel not enough when we do not meet them. Societal and peer pressure can crossover.
7. Stressful life events: this can include a breakup, new job, moving house, leaving for university, experiencing puberty etc. For some young people moving up from primary to secondary school can be enough to trigger bulimia.
What are the signs of Bulimia Nervosa?
The DSM-5, which is used by doctors to diagnose eating disorders, has the following criteria for a diagnosis of Bulimia Nervosa (BN):
- Recurrent episodes of binge eating (binge eating refers to eating a large quantity of food in a certain time period that is larger than most people would eat during a similar time period / under similar circumstances). Binge eating is also defined as a lack of control over eating during bingeing episodes.
- Recurrent compensatory behaviours such as self-induced vomiting, laxative misuse, use of diuretics, medication use, fasting or excessive exercise. These are often seen as means to prevent weight gain, feel less full, or relieve discomfort.
- This cycle of binge eating and compensatory behaviours happens, on average, at least once a week for three months.
Signs and symptoms of bulimia
It can be hard to read a doctor’s symptom list and wonder what that actually means. Below are some common signs and symptoms. However, know that each person is an individual, and if you feel you are experiencing bulimia then seek help. Don’t feel as if you have to tick off a certain number of symptoms before you’re ‘sick enough’.
Behaviours of bulimia:
- Food rituals
- Skipping meals and/or consuming small portions
- Disappearing quickly after eating, often to the bathroom
- Hoarding food
- Excessive use of mouthwash, mints, gum etc.
- Wearing baggy clothes to hide your body
- Maintaining a very rigorous exercise routine regardless of weather, illness etc.
- Frequently checking in the mirror for perceived flaws
Emotional signs of bulimia:
- Frequent mood swings
- Low self-esteem
- A lack of self-control
- Denial of binging, purging etc.
- Feelings of shame after binging and/or purging
Diet behaviours seen in bulimia:
- May practice different diets such as Intermittent Fasting, low carb, low sugar, etc.
- Drinking excessive amounts of water, low-calorie drinks, or caffeinated drinks
- All or nothing with eating
Physical signs of bulimia:
- Unusually swollen cheeks and jaws
- May have calluses on the back of hands if vomiting (known as Russels’ sign)
- Teeth may be discoloured, stained, or decaying
- Maybe bloated from fluid retention
- May have noticeable fluctuations in weight – this can be up or down
- Stomach cramps and/or other gastrointestinal issues such as acid reflux, constipation etc.
- Can experience anaemia, low thyroid hormone levels, low potassium
- Dry skin, sometimes yellowing of the skin
- Thinning of hair on the head
- Poor wound healing and impaired immune functioning
Cognitive signs of bulimia:
- Difficulty concentrating
- Obsession and pre-occupations with food, weight, and body shape
- Poor impulse control
- A desire to control situations
Hormonal signs of bulimia:
- Menstrual irregularities – missing periods or only having a period while on hormonal contraceptives
- High cortisol levels: sleep problems, feeling stressed, anxious and maybe depressed
- Avoiding social gatherings involving food
- Uncomfortable eating around others
- Eat meals in secrecy
- Creation of a lifestyle to fit food rituals and exercise
- May have suicidal tendencies
- Low self-esteem
- Can also experience depression, anxiety and sleep disorders
What are the risks of bulimia?
Bulimia affects everyone differently but can have serious consequences for the body. Physically, those experiencing bulimia can experience electrolyte imbalances in the body, affecting the heart and other major organs. Other physical effects include:
- Medical complications due to self-induced vomiting. Including erosion of tooth enamel and rupturing of the oesophagus.
- Effects on fertility, especially if the menstrual cycle is lost in women. Bulimia during pregnancy may put the baby at risk. Bulimia may also decrease the sex drive.
- Digestive tract issues especially if using vomiting or laxatives as a form of purging.
- Extreme fatigue, dizziness and even fainting.
The effect of prolonged stress may also affect your mental health, which can have lasting effects. This is due to a focus on body image as an indicator of self-worth. At Ease Nutrition Therapy, we don’t believe in part recovery. We want to help you fully heal your relationship with food, so you can live a full meaningful life. Read about how we can help you here.