Bulimia: A Vicious Binge and Purge Cycle

By: Sam Schab (@Sam_ghost1408)

When people hear "bulimia" they tend to think that someone just throws up everything they eat. But that's only a small part of this disorder. Bulimia is a binge and purge cycle that results from an obsession with losing weight. 

Bulimia often starts with restricting food intake. Whether restricting is a lower calorie intake or not eating a particular type of food varies from person to person. The body is then starving even if the individual with the illness doesn't feel particularly hungry and will subconsciously tell you to binge. Binge episodes are most often caused by emotional distress because, after starvation, the brain releases endorphins (or "feel good" chemicals) with the overabundance of food. Following a binge, they will feel overwhelming distress to purge, or get rid of, the calories they ingested. Ways to purge include self-induced vomiting, laxatives, diet pills, or excessive exercise. 

These binge-purge cycles are initially caused by an obsession with losing weight. There is not just one cause for this disorder, but genetic predisposition seems to play a significant role. Abnormal amounts of hormones such as serotonin have been shown to cause some disordered eating habits. Other causes may be stresses from family, friends, or media to be a certain weight. 

Diagnostic criteria for bulimia includes:

  • Recurrent episodes of binge eating. Both of the following characterize an episode of binge eating:
    • eating, in a discrete period (for example, within any 2-hour period), an amount of food that is larger than most people would eat in a similar period under similar circumstances
    • a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
  • The binge-eating episodes are associated with three (or more) of the following:
    • eating much more rapidly than normal
    • eating until feeling uncomfortably full
    • eating significant amounts of food when not feeling physically hungry
    • eating alone because of feeling embarrassed by how much one is eating
    • feeling disgusted with oneself, depressed, or very guilty afterward
  • Marked distress regarding binge eating is present. 
  • The binge eating occurs, on average, at least once a week for three months. 
  • The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

Bulimia is very often comorbid with disorders such as generalized anxiety disorder, depression, and substance abuse. There is also a higher risk of self-harm or suicide. However, bulimia cannot be comorbid with anorexia nervosa because the nature of the two illness are practically opposites. 

Some effects of bulimia include:

  • Electrolyte imbalance which can lead to abnormal heart rhythms, cardiac arrest, and even death
  • Chronic gastric reflux after eating
  • Inflammation of the esophagus
  • Rupture in the esophageal wall due to vomiting
  • Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat
  • Breakdown of the teeth
  • Erosion of tooth enamel
  • Swollen salivary glands
  • Constant vomiting can lead to gastroesophageal reflux
  • Peptic ulcers
  • Infertility
  • Enlarged glands in the neck, under the jaw line
  • Calluses or scars on back of hands due to repeated trauma from incisors
  • Constant weight fluctuations are typical
  • Fixation on the number of calories consumed
  • Fixation on and extreme consciousness of weight
  • Low self-esteem
  • Low blood pressure
  • Irregular menstrual cycle
  • Constant trips to the bathroom
  • Depression
  • Frequent occurrences involving consumption of abnormally large portions of food

Psychotherapy and medication have shown a very high percentage of treating bulimia. Different forms of therapy can include cognitive behavior therapy, family therapy, and dialectal behavior therapy. Recovery rates are very high among those who receive treatment. If you are suffering from bulimia, I encourage you to tell someone you trust and seek help. As someone currently recovering from bulimia, I can say everything gets so much better when you aren't always thinking about food and weight.

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