Bulimia is a condition where the sufferer purges (gets rid of) calories they have eaten by vomiting or other means. Binge-eating is common in bulimics, but often the purging follows a normal sized meal or snack too.

Like anorexia, bulimia has nothing to do with weight or food, but is an outer symptom of and way of coping with inner turmoil.
Since a person's bulimia may not be discovered for some time, it is in some ways the most secret and isolating of all the eating disorders. Binges may be triggered through extreme unhappiness and a desperation to escape the way they feel. Purging then ‘cleanses' the body of the food consumed.

Bulimia is more common than anorexia. Because anorexia can easily lead to bulimia, and vice versa, about 50% of anorectics will go on to develop symptoms of bulimia at some stage.

A stressful event or depression often triggers an eating binge. This binge eating may temporarily relieve the bulimic's feelings of depression or stress, but this is often followed by greater feelings of depression and anxiety. This will then trigger a purge.

There are a variety of ways in which bulimics purge: vomiting; taking an excessive amount of laxatives (drugs that induce bowel movements), diuretics (drugs that remove water from the body by increased urination), enemas (a process that expels waste from the body by injecting liquid into the anus), fasting, or excessive exercise.

The psychological signs of bulimia are not usually the same as anorexia, unless the two conditions are overlapping (bulimarexia).

Although bulimics have a distorted body image, it is not always to the same extreme as an anorectic. Many bulimics are not concerned about putting on weight and use purging as a method of control or punishment, rather than a method of weight loss.

Bulimic Personality: People with bulimia use bingeing and vomiting as a way of daling with sad or angry feelings. Bulimia may lead to feelings of guilt and self-disgust. On the outside, people with bulimia may appear to be popular and able to cope, but inside they may feel insecure and vulnerable. They may become secretive, have severe mood swings, and use lying as a way of covering up their shame. Many are aware of their problem and want to change, but are frightened that, on discovery, people may feel disgust at their behaviour.

The diagnostic criteria for bulimia:

  • Binge eating accompanied by an awareness that the eating pattern is abnormal.
  • Repeated attempts to lose weight through severely restrictive diets, self-induced vomiting, use of laxatives, cathartics, enemas, colonics or diuretics, medications or excessive exercise.
  • Binge eating and purging occur on average at least twice weekly for three months.
  • Fear of not being able to stop eating voluntarily.
  • Depressed mood
  • Self-deprecating thoughts following eating binges
  • Self-evaluation is overly influenced by body shape and weight
  • There are two main types of bulimia:

    PURGING TYPE: after eating, the sufferer engages in purging activity such as self-inducted vomiting, taking laxatives, or diuretic abuse.

    NON-PURGING TYPE: After eating, the sufferer engages in non-purging activities, such as fasting or over-exercising, to try to compensate for the food consumed.

    Symptoms and signs:

    Although bulimia is often difficult to spot, since weight may be normal, there are still signs that you can look out for if you suspect a friend or loved one of having bulimia:

  • Fluctuations in weight, often going from one extreme to the other
  • Tooth decay, caused by vomiting stomach acids
  • Swollen salivary glands causing the development of hamster cheeks
  • Dehydration and poor skin condition
  • Fatigue, dizziness, and fainting
  • Constipation and abdominal pains
  • Cuts and sores on the knuckles from repeatedly sticking one's fingers down the throat to induce vomiting (known as 'Russell's sign')
  • The development of rituals around eating
  • Avoidance of social eating situations
  • Consuming enormous numbers of calories at one sitting
  • Disappearing to lavatory after food consumed: to vomit up same
  • Recurrent sore throats
  • Becoming withdrawn, moody, irritable
  • Obsession with body shape, size, diets and weight loss
  • Shopping for food frequently
  • Laxative and diuretic abuse:

    Abuse of laxatives and diuretics is sometimes found in sufferers of both anorexia and bulimia. It is a common misconception that taking laxatives can help you to lose weight. In reality, laxatives work near the lower end of the bowel and do not significantly change the way that food (and calories) is absorbed by the body. Laxative abuse is painful, dangerous and can also be addictive. The only weight you are likely to lose by taking laxatives is water weight, which can easily lead to dehydration.

    Diuretics are drugs used to lower the amount of salt and water present in the body. They are most commonly prescribed to patients with high blood pressure, oedema (water retention) or congestive heart failure. They are not intended to be used as a means of losing weight and can have side effects including headaches, dizziness, muscle cramps, impotence, and, in rare cases may cause an irregular heartbeat.

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