Getting to grips with bulimia nervosa
By Dr Pookie Knightsmith
What is bulimia nervosa?
Bulimia nervosa is the most prevalent of all named eating disorders. In a report published by eating disorders charity BEAT earlier this year, it’s estimated that of those with eating disorders, 40% are bulimic, 10% anorexic, with the rest falling into the EDNOS category (Eating Disorder Not Otherwise Specified).
People with the condition restrict the food they eat, then binge, and then purge themselves of the food they have just consumed, often by making themselves sick or using laxatives.
Who is affected?
Anyone can be bulimic, male and female, but it’s most common in women between 16 and 40. It is often more difficult to notice, or diagnose, as people affected by it are often a normal weight, and are very secretive about their behaviour.
Here are characteristics of the illness, along with warning signs to look out for as a parent.
The binge-purge cycle
A key characteristic of bulimia nervosa is the binge-purge cycle (see graphic at the top of this feature).
Bulimic people often have a drive to become thinner, and may begin very strict and unrealistic diet plans. Many people with bulimia are emotional eaters, so when they experience a slip from their diet, or are under stress, they will often turn to food – usually bingeing on unhealthy convenience food such as crisps, chocolate or cake in order to comfort themselves.
After a binge, they will attempt to avoid weight gain by purging. Most frequently, sufferers will make themselves vomit, abuse laxatives, diuretics (either chemical or herbal), or compulsively exercise. People usually feel guilty or ashamed after a binge-purge episode, which strengthens their resolve to diet, as they believe that if they could only stick to a diet plan and lose weight they’d be happier and more respected by others.
As they slip up again, the cycle repeats itself.
Self-evaluation based on weight
People with bulimia often have very low self-esteem and attach disproportionate importance to their weight and shape. They usually consider themselves too fat, regardless of their actual size. They also believe that others constantly judge them based on their weight, which is why they are so motivated to control it.
Bulimia can be very difficult to spot. Because it involves a cycle of restricting, overeating and purging, sufferers are often a normal weight.
Any weight fluctuations caused by the binge-purge cycle are usually not very noticeable. Additionally, people with bulimia are often very secretive about their eating habits, going to great lengths to hide their illness. Despite this, parents are often best placed to notice these things and knowing some of the warning signs can help you identify a potential problem.
None of these things on their own mean that someone is definitely developing bulimia. But if they’re exhibiting several of these signs, you’re right to be concerned.
- Chews gum or drinks water regularly to cover the smell of vomit or to prevent them from eating.
- Believes they’re fat when they’re not.
- Can’t focus on school work.
- Secretive behaviour. If you notice your child behaving secretively around food, or your child’s friend expresses concern about this, it shouldn’t be dismissed.
- Visits the toilet immediately after meals.
- Loss of friends and increasing isolation. Young people suffering from an eating disorder will often distance themselves from others as they become more and more wrapped up in their disorder.
Other warning signs, present in some cases
Weight fluctuation might be noticeable due to the binge purge cycle. Only 50% of calories are expelled by purging – so sufferers can gain weight when bingeing and purging heavily during difficult periods, and then lose weight when bingeing and purging less.
- Callused knuckles due to repeated vomiting. This sign is not always present (for example if the sufferer uses other purging methods alone, such as abuse of laxatives) but is the most clear and easy to spot indicator of the illness.
- Wearing scarves. Scarves will sometimes be worn to hide swollen glands or puffy face caused by vomiting.
- Tooth decay/sensitivity and sore throat. Acid in vomit wears away teeth. Dentists often notice erosion of enamel on the inside of teeth of someone who vomits regularly.
What can you do?
If you are worried that your child might have bulimia, it’s important to seek medical help straight away by booking an appointment with your GP. First, though, it's a good idea to speak to your child about it. To help you take these first steps, take a look at our articles on talking to your child about an eating disorder and seeking professional treatment.
Beat is the UK’s leading charity supporting anyone affected by eating disorders or difficulties with food, weight and shape. It provides a range of services and resources that can help and support you and your child:
· Have a look at the Beat Message Boards.
· Use HelpFinder, Beat’s online directory to search for services near you.
Anorexia Bulimia Care - national eating disorders organisation.
Dr Pooky Knightsmith’s free resources for schools and professionals