Bulimia Nervosa

Bulimia nervosa is an eating disorder with two subtypes—purging (vomiting) and non-purging (other compensatory behaviours to get rid of unwanted calories). It is characterised by uncontrollable binge-eating episodes, often followed by application of a compensatory strategy (vomiting; laxatives; amphetamines; diuretics; exercise) to rid oneself of the unwanted calories or food.

Some bulimics will engage in long periods of starvation (restricting) followed by binge-purge episodes; others may eat non-restrictively for periods of time, before engaging in a binge-purge episode. Unlike anorexia nervosa, where extreme emaciation is the hallmark of the condition, bulimics may be underweight, normal weight or overweight.

This makes it easier to conceal the true extent of the problem, meaning that it may take many years before a bulimic gets help. Bulimia is a relatively common condition: 2% of women will have it at some point in their lives (as compared to around 0.2% of men). It can occur at any age, but tends to have a more common onset in late teens and early twenties. Some bulimics may have formerly been anorexic; but not all. Bulimia involves repeated cycles of excessive and usually secretive eating within a short time frame.

The food consumed in binges will probably be highly calorific (chocolates, cakes, biscuits), and binges will be followed by strong feelings of self-loathing, shame, guilt and despair. There will be a compulsion to rid oneself of the extra calories and this is typically achieved by self-induced vomiting (purging), use of laxatives, diuretics, powerful stimulants such as amphetamines, over-exercise (which may see a sufferer spending hours in the gym every day), or extreme starving and fasting. Some bulimics will migrate between these compensatory behaviours over time. Symptoms of bulimia nervosa include a binge-purge cycle that has occurred at least twice a week for three months or more, secrecy around eating, hoarding of food, obsession with exercise, self-harm, visits to the bathroom straight after meals, isolation and withdrawal from social activities.

Bulimics will have an intense fear of gaining weight and their headspace will be absolutely preoccupied with thoughts of food and cravings. Bulimics will experience a sense of being shame-based people, depressed and with high anxiety levels. Bulimia comes with many consequences. Notable ones are erosion of dental enamel, bad breath and tooth decay, caused by stomach acids coming into the mouth after frequent vomiting; rough patches of skin on the knuckles, caused by repeatedly using one’s fingers to induce vomiting; swollen saliva glands, which make the face appear puffy; the face becoming plethoric, or red, because of damage to capillary veins caused by repeated vomiting; dehydration and low sodium levels, which can lead to electrolyte imbalances and kidney damage; an irregular heartbeat; hair loss; infrequent periods; mottled skin on hands and feet; and severe damage to the stomach caused by extreme laxative use.

Many bulimics will have co-occurring psychiatric conditions (such as depression and anxiety disorders) and co-occurring problems in the areas of alcohol, drugs, self-harm and sexual manageability. Recovery from bulimia, and the restoration of a healthy relationship with food and one’s body, is possible, but takes time and a clinical approach that addresses the whole person.

At Start2Stop, treatment of bulimia will involve a combination of: talking therapy, psychological input, dietetic input (from a registered dietician or nutritionist), the creation of food structures (three snacks and three meals per day), DBT, psychiatric input, participation in mutual help fellowships, diary keeping and the provision of adaptive ways of managing distress and anxiety. If outpatient treatment is not quite enough, then living at The Mews House and receiving on-going and daily therapeutic input may be a preferred option.