On Bulimia

Bulimia Nervosa is a type of eating disorder and the primary features thereof are described in the Diagnostic and Statistical Manual of Mental Disorders 4^th ed. Text Revision, (DSM-IV-TR), as “binge eating and inappropriate compensatory methods to prevent weight gain. In addition, the self-evaluation of individuals with Bulimia Nervosa is excessively influenced by body shape and weight.”, p. 589. A binge episode is commonly described as one in which an individual consumes far more than most persons would under similar situations. The DSM-IV-TR regards a binge as, “eating in a discrete period of time an amount of food that is definitely larger than most individuals would eat under similar circumstances”, p. 589. Furthermore, individuals engaging in binge eating are often embarrassed of the episodes and usually perform them in secret. Bulimia Nervosa has two subtypes as noted on page 591 of the DSM-IV-TR:

“Purging Type. This subtype describes presentations in which the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode.

Non purging Type. This subtype describes presentations in which the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode.”

What causes bulimia?

There are multiple agents that contribute to the development of bulimia and bulimic symptoms. Therefore, as much as we would like to, we simply cannot reasonably attribute the majority of cases to any one construct, scenario, or event. When asked where they think it all started, some patients will suggest that they were teased about weight at a very early age, (whether or not they were actually over or under weight), others will report witnessing their mothers denigrate themselves in front of the mirror, when getting dressed, or even during mealtimes. Still, others will report that the onset of symptoms likely followed a traumatic event such as sexual assault. Despite the myriad of potential starting points, bulimia nervosa, and eating disorders in general, are not something an individual simply decides to start doing one day for fun; in other words, eating disorders do not come out of nowhere.

Why can't they just stop?

First, if it were this easy, don't you think the people afflicted with this disorder would just stop? As a result of an otherwise competent and successful outward image, many people fail to recognize that bulimia nervosa is a psychological disorder. Oftentimes the patient will have a job, a high grade point average, and may even volunteer or belong to clubs as well. Therefore, people often look at the individual and think, “Wow, he/she is doing so great, how could anything be going wrong”? Sadly, the patient is suffering from a great deal of pain inside. These could be a conglomeration of guilt, anger, sadness, worry, and other painful emotions that the individual is afraid to share with others. The person suffering from this dangerous disorder is trying to address this pain through his or her bulimic symptoms. While each person will have a somewhat different experience in the throws of the disorder, it is often reported that painful feelings become overwhelming and the person tries to stuff them down inside or cover them up by bingeing. The binge can sometimes be described as a violent episode of eating, not something that is slow and calculated, but rather wild and filled with rage, sadness, fear, and general emotional pain. Following the binge, the patient feels physically and emotionally exhausted, not to mention extremely uncomfortably full from the large intake of food rather quickly. A terrible sense of guilt sets in over not being able to control oneself and the self-loathing is thus reinforced during each cycle. The patient who engages in purge-type then engages in some compensatory behavior, such as vomiting, to rid him or her self of the food in order to alleviate the physical discomfort, as well as, in an attempt to atone for the binge, perceiving it as something morally wrong and disgusting. The patient who engages in a non-purge type will also utilize some compensatory mechanism in an attempt to obtain self-forgiveness or a perceived cleansing, but the mechanisms are different, as aforementioned. The patient, as previously stated, is usually very embarrassed about engaging in this pattern of behaviors and therefore tries to keep it hidden, allowing people on the outside to only see the accomplishments and accolades the individual strives to maintain.

How can I help my loved one?

Oftentimes, family members or friends may want to help, but don't know how. It can be difficult knowing what to say or do, as well as, what not to say or do. I would suggest first, remember that your loved one's struggles are real. This is not something he or she simply made up to get attention, be a brat, or any other asinine proposition. Eating disorders are real and the emotional pain and torment the afflicted individual suffers is real. Secondly, you cannot make this all better simply by being a better friend, parent, sibling, etcetera. Eating disorder treatment requires professional help. A team approach consisting of a therapist, nutritionist, and possibly a psychiatrist, is often a good start. Group therapy has been shown to be of immense value in overcoming an eating disorder. This is not something that is cured by once a week visits to a therapist with no experience in the treatment of eating disorders. Third, get some education about what eating disorders are. Read, attend support groups, and talk to therapists. Finally, I want to leave you with a basic list of concepts;

• DO NOT make the discussion about food; strange as it may seem at first, throughout the therapeutic process with your loved one you'll come to understand that eating disorders have pretty much nothing to do with food

• DO NOT be the food police; policing the food makes meal time very anxiety provoking, instead it should be a pleasant time. Furthermore, you are not the nutritionist, the therapist, the psychiatrist, etcetera, you are the loving family member or friend who is part of the support system; stick to your appropriate role.

• DO be consistent in your support; even if you're upset with your loved one, you can love and support him or her in recovery. Along this line, it is perfectly okay to talk about feelings; the therapist will likely guide you as to how best to communicate what you're feeling to your loved one as he or she goes through this struggle in recovery. There are no good or bad feelings, though there are helpful and unhelpful ways of showing those feelings.

• DO take care of yourself. Supporting a loved one in his or her recovery, whether from an eating disorder, chemical addiction, or any other psychological disorder, can be overwhelming. The best way you can be there for someone else is if you are in a healthy frame of mind; it is not uncommon and may actually be recommended that the friends and family of the patient also seek their own therapists.

I hope this has shed some light on the subject of bulimia nervosa and given you some things to think about. If you think you or someone you know might be experimenting with or engaged in an eating disorder, please speak with a psychologist or therapist who is experienced in the treatment of eating disorders. There is an extensive list of eating disorder treatment centers listed by state in the Gurze Books website: www.bulimia.com. Here's to wishing you Good Mental Health.