Bulimia Nervosa is the second most common eating disorder in the world, the first being Anorexia Nervosa. Those who suffer from it have frequent periods of binge eating, consuming inordinate amounts of food in little time, and then purge through vomiting, excessive work-out or severe fasting.
Basic Facts
Some of the symptoms of Bulimia Nervosa are: worrying about food, secretly binge eating and then vomiting, abuse of laxatives, diuretics and diet pills, denial of hunger, using drugs to induce vomiting, exercising compulsively.
Physically, bulimics have chronic gastric reflux after eating, dehydration, electrolyte imbalance (causing cardiac arrhythmia or arrest, sometimes leading to death), inflammation of the esophagus, oral trauma because of insertion of fingers or objects causing lacerations in the mouth or throat, broken blood vessels in the eyes, teeth decay, suspended menses, infertility, constipation, enlarged glands in the neck under the jaw line, calluses or scars on the back of the hands from inserting fingers in the mouth, constant weight fluctuations, among other consequences. [1]
The difference between common binge eating, which happens because of miscalculation or overindulgence, and the binge eating of a bulimic, is that they consume a huge amount of food in a short period of time (2 hours or less) and they feel they can’t stop eating, also feeling physical and emotional anguish.
Then next comes purging, which is, as described above, done by taking extreme measures to rid the body from the food. The problem is that it seldom works for losing weight. Diuretics and laxatives make a person lose water not weight. Also vomiting is useless, as 50-75% of the calories have already been absorbed. As a result, bulimics can either have normal weight, be overweight or underweight, or can change weight constantly, and in the meantime, they can lead “normal” lives on the outside, working, studying, etc, which can make it very difficult to identify those who suffer from it early on.
The frequency in which such behavior happens is also worrisome, it may occur over 2 times a week and for at least 3 months, which is certainly a terrible aggression against the body.
Those who suffer from Bulimia Nervosa are overly concerned about their looks, having self-deprecating thoughts, and keep the habit of binge eating/purging as a compensation for something that is going bad in their lives, and also as an attempt to achieve a better image of themselves. However the compulsion eventually leads to isolation, constant anguish, and more desperate actions, as the inner pain obviously doesn’t go away. [2]
Below are three accounts of people who have suffered from Bulimia Nervosa and overcame it. For information on how to help bulimics, check the first article in this series about eating disorders, and visit the sites mentioned at the bottom of the post.
“The image that I used to see reflected on the mirror was more of a monster than of a young girl. I was in a state where nothing was more important to me than to “look good” and if that meant to be sick I wouldn’t care.
“Many years later and 100% recuperated, I value more how I feel than how I look and these pictures reflect, in one way or another, my physical and mental state. I have accepted and love myself the way I am; I respect my body and take care of it like a temple.
“Rather than looking perfect, I value the fact that I can run or walk for an hour without getting exhausted or losing my breath. I value more the fact that my endurance has increased incredibly and that I have fulfilled successfully the physical challenges that I have set out. When I thought I couldn’t any more, I could…”
- Rosa Acosta [3]
“It's hard to say where my addiction began. I would have to say sometime in middle school. That's when I began to hate my body. I started off skipping meals and working out off and on. By the time I got into high school, my eating disorder became my life. By my freshman year, no one recognized me. I dropped a few sizes and I didn't even notice it till my friends began to talk. I went from a size 6 to a size 2. When I looked in the mirror, all I saw was fat. I could of sworn that I gained 50 pounds.
“When I got really hungry, I would go into my kitchen and eat tons of food. I remember sitting on the kitchen floor at 2am and eating a loaf of bread, a box of gram crackers, a bag of chips and then drinking some orange juice to help it all go down. I would feel so guilty that I would go and throw it all up.
“This happened for a few months then it got even worse. I began to take laxatives and diuretics as meals and kept up the binging and purging. If I was really bad I would bring a heater into my room and crank it up. Plus I would wrap myself with a garbage bag and put on a few layers of sweat pants and sweaters. I lived like this all throughout my high school days.
“Bulimia, to me, is like a giant mental mind game. Everyday I woke up and I hated to look into the mirror. I didn't like the person I saw and I felt so guilty every time someone looked at me and said how healthy I was. I felt like such a liar. I used to work out for three hours a day. That was my life. I started to do triathlons so I would get to work out even more without people questioning me.”
- Anonymous [4]
“It is a very dangerous illness to have, because I carried on at school, I did my exams, I didn't do very well, but I did my exams, I'd go into university, I went abroad for a year, then, so I did carry on, meanwhile, I was secretly vomiting, my teeth were decaying, my period stopped for quite a while... and I unfortunately grew to learn to hate myself... it was on university actually that I realized I had to see somebody... and it was basically… I knew I had to stop, because I was living a dual life.
“There's absolutely nothing glamorous or exciting or positive at all about developing an eating disorder. All it does is… it's decaying your body, it shortens your life, you know, I still spend ridiculous amounts of money on my teeth, which are really in a bad way. It affects people's fertility, and I think really importantly, it affects one's identity and how one feels about oneself in the short life that we have here and it affects your relationships with family, friends, partners. For many many years I didn't have a relationship because I was too afraid to. Because I was living in this terribly self-destructive bubble.
“In terms of getting help, I think the difficulty is you can't force somebody to talk to somebody, especially with an illness like this, because you're living in denial, and for me there was a huge shame about it, terrible shame, it’s sort of the ultimate… it's grotesque, you know, people don't want to know about your disfunctioning, whereas, you just want to be normal, you want to fit in. And it's an addiction. So until you realize that there's something wrong in your behavior, it's not a way of surviving, it's the opposite, only then will you want to get help.”
- Liselle Terret, who was 38 at the time of the interview, was bulimic from age 14 to 23. [5]
Come back tomorrow for the last article in this series: Media & The Way We See Ourselves.
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Eating disorders are epidemical nowadays, but Anorexia Nervosa together with Bulimia Nervosa are the most common ones. Anorexia Nervosa is a disorder in which someone fasts for long periods of time in order to look thinner or as a means to feel in control of their lives. Those suffering from it select the kinds and amounts of food they eat, and they get so obsessed with becoming thinner, they don’t know when they went too far.
Basic Facts
Though it is thought that people suffering from anorexia often see a distorted image of themselves as being fat, that is not always true, as blogger Emily Troscianko, a former-anorexic, tells in her account, which completes this article. According to her, she used to focus her thinning goals on parts of her body, like her belly and thighs, ignoring the rest, and when once forced to focus on her whole body, she was shocked.
It is considered as warning signs that someone is suffering from Anorexia Nervosa: practicing self-starvation with weight loss, unusual sensitivity to cold, excessive fear of gaining weight, excessive facial/body hair for lack of protein, compulsive exercise, no menses or intermittent ones, and hair loss.
Also, unlike common knowledge, anorexics take excessive interest in food, are secretive or detached from the rest of the world, have little energy to do any extended physical or mental activity, though they feel hunger, they control it neurotically, and may justify their behavior as being a search for perfection. [1]
The numbers for Anorexia Nervosa are staggering:
There are two kinds of Anorexia Nervosa: the restricting type, in which people take a few calories a day or only drink water, and the binge-eating/purging one, in which they eat something they feel they shouldn’t have or they binge and then to compensate, they workout excessively or vomit.
Living with Anorexia
The greatest difficulty in dealing with those suffering from Anorexia Nervosa, and of course, of several other mental sicknesses, is that they don’t realize how sick they are. Until something happens to draw their attention to the seriousness of their situation, they feel empowered, enjoying the fake sense of control and superiority over those who don’t act like them.
For Emily Troscianko, her breaking point was when she looked at herself in the mirror and, after 10 years of anorexia, noticed how the ball gown she wanted so much to wear, highlighted the “Dachau contours” of her “spindle arms and scrawny neck and bony bust”, which made her cry; and also when her mother, who was moving away with her boyfriend, told her plain and simple “your anorexia is not welcome at our new house.” [3]
Her mother, writer Sue Blackmore, commented about her desperate last act of trying to recover her daughter: “It was probably more like selfishness and straightforward honesty. I'd had enough of all this misery. The books always tell you to try to separate the anorexia from the person who is suffering from it. The anorexic will tell you that she is her anorexia; that she wouldn't be herself if she ate like other people do, as "fat" and "greedy" people do. I had never tried to follow the books' advice, but I guess that was somewhere in the back of my mind. I wanted my Emily back!” [4]
With the help of a college friend, Emily went to see a doctor, started a treatment, and persisted on the long bumpy way back to health. Sue’s desperate curt words worked to raise Emily’s awareness, but that may not be the best method for everyone. For ways of helping those who suffer from anorexia and other eating disorders, check the previous article.
Emily Troscianko keeps a blog on Psychology Today (Hunger Artist), where she shares the main events of her life while she was sick, her recovery process, and addresses the myths about Anorexia Nervosa. Here are two excerpts from the articles on the site:
“This meant that changing - living a ‘normal' life - was something that I not only believed I could never do: I believed I could never want to do it, ever. Why on earth would I want to give up the magnificent, all-eclipsing pleasure of my nightly meal of bread and boiled vegetables and chocolate on my own in bed for the ‘pleasures' other people claimed to find in other things? It was completely implausible that anything could replace that ecstasy of sucking a great mouth-filling lump of milk chocolate and then falling asleep a little before sunrise (in winter, at least).
“This is why I want to write this blog: because for so long, and with increasing conviction, I was so sure that I didn't want to be ‘better', as everyone always seemed to assume I must. I could see all the things that were wrong with how I was living, of course; I wasn't stupid. But they couldn't see all the things that were right about it, and unrelinquishable. I read all the anorexia self-help books, with case-studies of girls who got better and looked back on their old lives with the marvelling incomprehension of someone who's come back from the dead. But I always thought I was different.
“I knew, from the other parts of those books, that I had all the unglamorous symptoms the other girls had, and indulged in the same warped behaviours (who'd have thought all we anorexics would want masses of salt on absolutely everything?), but I kept on thinking that with me it was something more special, or at least something redeemed by the things it let me be: thin (so my difference from everyone else was unmissable), hard-working (nothing and no one else in my life to keep me from reading and writing), safe, untouchable.
“For me, it was a little war of attrition: gradually, over the years, enough things amassed that made staying the way I was seem less possible, until the constellation of chance and will power and deathly tiredness was at last enough to make me change.” [5]
“Whether you sometimes check the calorie count on the back of packets, or worry when you've missed a gym session, or wish you could still get into the jeans you used to love, or buy low-fat yoghurt - whether you read up on nutritional theory or just panic vaguely when you've had too much ice cream for pudding - there is anxiety there, there is a sense of being slightly out of control.
“The anorexic sees these people and sees weakness, sees hypocrisy and the failure to act consistently: she or he, by contrast, takes this feeling of fear and decides to deal with it, and controls food, drink, and exercise more or less perfectly, and can then feel more or less contented, and safe. When anything at all goes ‘wrong', though, and ‘control' is forsaken for an instant, everything threatens instantly to crumble.” [6]
Come back tomorrow for the article on Bulimia, and on Wednesday, for the closing one on Media’s influence on our image of ourselves.
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The world is sick; not only nature but also people. Be that stress, ordinary sicknesses or those which aren’t officially recognized as such, like eating disorders, maybe all of us carry one form or another of sickness, either mental, physical or both.
This is the first in a series of articles about eating disorders, and how media, society and our present hectic way of life can destroy us from inside out.
First, here is some information on what are eating disorders:
The numbers are stunning. About 7 to 10 million women and 1 million men suffer from eating disorders in America, whatever their age, social class or ethnicity. The numbers throughout the world are equally distressing, and have been increasing.
The organization ANAD, whose site most of the contents of these articles about eating disorders are based on, reports that the most critical groups for developing the disorders are the one by the age of 20 and the one between the age of 16 and 20, which sum up to 86% and 43% of the cases respectively. Also the majority of the cases last from 1 to15 years, and there’s 50% of cure and 6% of death among them.
People who suffer from eating disorders have basically very low self-esteem and want to look thinner, either overall or certain parts of the body, even if in order to achieve that, they have to make the hardest sacrifices, such as spending the whole day without eating, eating only a few types of food, throwing up after eating, eating and not swallowing, etc. There are also cases in which people want to feel in control of their lives or dull inner pain.
Eating disorders cause many grave health problems, such as severe malnutrition, ruptured stomach, tooth/gum erosion, heart, kidney, and liver damages.
Despite all the harm it causes, there are few adequate programs and services to fight these disorders around the world, and few schools have programs to educate about the dangers, which is absurd when you take into account that most of those who develop them are still in school years.
Types of Eating Disorders
Anorexia Nervosa – people who suffer from this disorder spend long periods without eating, and when they do, seriously restrict the amount and kinds of food they eat. They may set aside a specific time of the day to eat and develop rituals for preparing food and eating. Contrary to common knowledge, not all of them have a distorted image of themselves as being fat, instead they tend to focus on parts of their bodies they want to be thinner. Some of them may practice severe fasting as a means to feel in control of their lives.
Bulimia – those who suffer from this disorder have constant periods of binge eating in which they eat excessive amounts of food in a short period of time, feeling unable to stop. Afterwards, they feel guilt or fear, and purge through vomiting, over-exercising or fasting.
Binge Eating Disorder (BED) or Obesity – about 30% of those who take part in weight loss programs are diagnosed for BED. It is present in 2% of the American population and is 1.5 times more common in women. Goals of the treatment include ceasing binge eating, improvement of concerns about weight and shape, weight loss, prevention of further weight gain, etc. Remission rates are high, about 50%, and the general projection is better than for those with bulimia nervosa.
Eating Disorder Not Otherwise Specified (EDNOS) – less occurring disordered eating patterns, such as switching between anorexic and bulimic behaviors, not so often episodes of binging and purging, orthorexia (people who eat normal amounts of food, but select foods obsessively), anorexia nervosa but with regular menses, starvation without substantial loss of weight, repeatedly chewing and spitting out -without swallowing - large amounts of food.
How to Help Those with Eating Disorders
Don’t expect those suffering from eating disorders to talk about their difficulties, as they are often secretive about their ways, and think they are well. However eating disorders are an indirect way of crying for help; those who develop them are in terrible confusion and vulnerability. No matter how hard daily life is around them, it is important to remember that, and offer them love and patience, otherwise recovery becomes almost impossible.
Also brace yourself for confrontation, as your friend or family member may feel angry at your interference. Still, try to talk to them in private, have some evidence prepared to use for persuasion, always try to keep yourself calm and in a non-confrontational attitude, and remind them of your love, and how you can’t simply watch and do nothing. Don’t let any worries and fears keep you from addressing the matter.
Be careful not to use the talk for causing conflict. Express your worries, exemplifying with specific episodes, without placing shame and guilt on them. Don’t make use of simple solutions either, like “if you stop, it’ll be alright”, as that will only annoy them. Disorders aren’t something that one can wake up the next morning without. It took them a long time to get to it; it will take them a long way to recovery.
Then explain the kinds of diagnosis and treatment available, and either make clear that you will seek help or help them do so, if they are ready. Stress the importance of treatment, which is essential to assess the symptoms, provide correct diagnosis and find other medical problems involved, and also determine any other condition, like depression, requiring treatment. In case your friend or family member is reluctant to see a doctor, ask them to get a physical, and offer to make the appointment or go along on the first visit.
There are several types of treatment, and often a combination of several ones, like nutritional counseling, therapy and group support is used. This page has more information on all the types.
The process of recovery is long and strenuous. Besides keeping to treatment plans, family therapy sessions, healthy menus and meal plans, avoiding binges or purges, family and friends have to be prepared to deal with emotional outbursts, to support the person with love and praise, and to always value the achievements despite any slips.
It is important that those who are caring for the ones suffering from eating disorders, take some time for themselves to relax and recharge their batteries. Do whatever makes you feel better, even if for a few minutes a day, and don’t isolate yourself. In addition to keeping contact with friends, support groups are great places to interact with those who are living through the same challenge. It is at least a useful way to be aware that your suffering isn’t unique, and to learn new ways of supporting those who suffer from the disorder.
Also be yourself a good role model. Avoid dieting and negative comments about your own body, educate yourself about eating disorders, learn to listen quietly to your loved one’s concerns and feelings, and try not to criticize.
And finally, these are some actions that must be avoided at all costs:
The next part in this series of articles is about Anorexia Nervosa. It includes not only basic information and sites where to look for help and support, but also a very informative and an emotional account by blogger Emily Troscianko, who was anorexic for 10 years. This part will be published tomorrow.
Besides these two articles, there will be others about Bulimia Nervosa and the part of media in all this mess, which will be published in sequence.
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