The second kind of eating disorder we'll look at is called Bulimia, let's see what that's about.

Bulimia

This section describes bulimia in a way that is meaningful both for those who suffer from it and those who do not. If you think that YOU may have bulimia, reading this page will help you to better understand the condition.

What is it?

Bulimia nervosa was first recognised by doctors as an eating disorder in 1979. The name means literally ‘the hunger of an ox’. This 'hunger' is not due to any physical condition, but is an expression of emotional need, or distress.
Typically, a person suffering from bulimia will binge eat a large quantity of food to satisfy this hunger. Then, he or (most usually) she will immediately get rid of the food by vomiting or taking laxatives. After a binge, some bulimia sufferers may starve themselves, reduce their food intake, or take vigorous exercise in an attempt not to gain weight.

Individuals with bulimia feel out of control during these periods of binge-eating, and will almost always binge alone because they feel ashamed of their own behaviour.

Bulimia sufferers become trapped in a cycle, where they binge-eat and then purge the food they have eaten by vomiting or using laxatives. These periods of purging are followed by feelings of shame and self-disgust, with promises made to themselves not to binge or purge again. This is followed by a period of starvation, which sets the stage for the next binge - and so the cycle continues.

Binge eating usually consists of eating foods believed to be fattening - and therefore in some way 'forbidden'. Foods typically eaten during a binge will include biscuits, chocolate, crisps, bowls of cereal, large amounts of toast with butter, chips, cakes, ice cream etc. Eating continues until the urge to eat is gone, tension is reduced, the individual feels full, (often to the point of pain), or he/she is interrupted. Sometimes the food is enjoyed, but it is more likely to be eaten quickly, without tasting, and this will be followed by feelings of anxiety, guilt and remorse.

How does it start?

In the majority of sufferers, the emergence of a binge-eating problem, such as seen in bulimia, is directly related to the effects of dieting. Studies have shown that after dieting, no matter whether you are fat or thin, many people find that they are unable to stop eating when full, and develop a preference for foods rich in sugar and fats - the very foods which someone concerned with body size will be anxious to avoid.

So, most bulimics see their binge-eating as a loss of self control. This is likely to be felt most acutely by people who either dieted successfully in the past or who were anorexic - and who therefore felt in control around food. Many people are dismayed at the loss of control and so may attempt to vomit after a particular binge. Or sometimes, they try vomiting because they have heard about it in the media. Vomiting becomes a way of dealing with the guilt of having over-eaten - of dealing with the secret greedy person inside without showing her on the outside.

Initially, vomiting is only undertaken when a binge occurs accidentally, but in later stages it becomes more frequent, giving the individual the means to eat to bursting point - without putting on weight. Eventually, binges and purges will be planned well in advance, or may become a necessary part of the daily routine, with time being specifically set aside for the ritual of eating and vomiting.

The act of binge-eating may provide a release of tension in the early stages of bulimia. Eating therefore provides a way to relieve stress - and becomes a habit which is difficult to break. Since vomiting also relieves anxiety after a binge, in later stages bulimia sufferers may experience the urge to vomit when they are angry, tired or upset. The individual becomes 'hooked' on the binge-eating and purging. Normal coping skills are given up or replaced by bulimic behaviour.

Like all eating disorders, bulimia is a complex condition with no easily identifiable 'cause'. However, some situations have been identified that may lead to bulimic behaviour. These are:

Therefore, to understand bulimia, we shouldn't see it simply as an extreme fear of being fat. Nor should we view it as a moral weakness or a failure of willpower. It is not. This is why repeated promises to stop bingeing so often fail. The different aspects of bulimia, - the food cravings, binge-eating, vomiting, self-disgust and guilt are demonstrating, as a whole, emotional difficulty in coping with some past or present situation, such as those listed above. Bulimia may be expressing personal distress concerned with unmet emotional needs, feelings of inadequacy, low self-esteem or lack of control over some aspect of the individuals' life.

Who suffers?

Bulimia typically occurs in young women aged around 18 years, particularly those who are well educated, although sufferers may be from the early teens to late sixties. Men represent 5% of officially reported cases.

The large proportion of bulimia sufferers who are women reflect - as in the case of anorexia - the greater pressures on women in our society to control their weight. Also, well-educated women tend to value being 'thin' and may be more perfectionist, thus making them more critical of how they look. In some cases, the relationship between parents and daughter leads to suppression of needs, denial of feelings (particularly anger) and body insecurity - all of which may be expressed in bulimic behaviour.

Bulimia in men is more likely to be associated with conflicts over sexual identity. Younger men, unsure of their own masculinity often try to emulate sporting 'masculine' role models such as famous cyclists or athletes.

People suffering from bulimia often have low self esteem, a fear of inadequacy and a need to gain the approval of others. The individual will usually see herself as being kind, lacking in confidence and unassertive.

Secrecy

Bulimia could be called a 'disease of secrecy', as it is common for people with bulimia to feel so embarrassed and ashamed by their behavior that they will desperately try to hide it from others. As the sufferer will vomit or otherwise purge food eaten during a binge, or exercise excessively to prevent weight gain, their weight may not fluctuate much, which can make it difficult to tell when someone is suffering from bulimia.

Consequences of bulimia

Bulimia can cause serious medical problems. Some of these are life threatening and include:

Some people with an eating disorder have symptoms of both bulimia and anorexia. This can be especially dangerous because of the combined effects of severely restricting food intake and purging.

Recovery

Any individual with bulimia can return to healthy eating, no matter how long they have been binge eating and purging. Also, most of the physical side effects of the illness will disappear once a normal eating pattern is resumed. We'll discuss recovery from bulimia - and other eating disorders - in more detail later in this section.