What is Bulimia?
Bulimia is characterised by:
- Binge Eating - eating a large amount of food in a short period of time (eg. 2 hours) with the feeling that they are out of control around that eating - ie, cannot stop once they have started.
- Inappropriate compensatory behaviour - to prevent weight gain (eg. vomiting; misuse of laxatives, diuretics or enemas; fasting; or excessive exercise)
- Dissatisfaction with body shape and weight
What is a large amount of food?
This will differ for different people. However, a large amount of food is usually much more than what an individual would usually eat in a similar situation. Most binges tend to include sweet high-calorie food or food that the person considers to be 'bad'. It is also common for the person to eat the food very quickly during the binge. The binge will continue past the stage at which the person feels full and will often end up in pain from being so full.
What triggers a binge?
A binge may result from feeling low or depressed; an external stressor (eg, an argument with a friend); intense hunger after restricting eating; or feeling bad about their body weight or shape. The binge may be planned in advance or may be a spur of the moment thing. Most people with bulimia are very ashamed of their eating behaviours and will become very secretive, trying to hide food, hide the evidence of a binge or hide the fact they are vomiting or using some other compensatory behaviour eg. the person may vomit into bags in their bedroom instead of going to the bathroom.
Inappropriate compensatory behaviors
In order to prevent weight gain after a binge (as well as to relieve some of the feeling of being so full) most people will try to rid their bodies of the food they have just eaten. The most common behaviour is vomiting. Other methods include the misuse of laxatives, diuretics and occasionally enemas; fasting or restricting food intake for a day or several days or exercising excessively.
Dissatisfaction with body shape and weight
A final important feature of bulimia is the individuals dissatisfaction with their bodies. They will often feel fat and want to lose weight and be very fearful of weight gain. Often, their self-esteem, or the way they feel about themselves is based on how they feel about their bodies. While most people with bulimia are of 'normal' weight or do not become severally underweight the physical effects of bingeing and purging (especially vomiting and abusing laxatives) can be very serious and the person's physical safety will need to be monitored closely. Most people who suffer from bulimia feel ashamed and guilty about what they are doing and want it the stop. Treatment often includes learning new coping skills and working through the underlying issues (in individual or group therapy) as well as learning how to listen to their bodies in regards to feeling hunger and full. Practical tools may be looking at the person's daily routine and establishing when are the high risks times for bingeing or purging - these may be when the person is lonely or bored or after a particular stressful event. Looking at how to reduce these triggers is an important first step to overcoming this disorder.
References: American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th Ed.) United States of America: American Psychiatric Association.