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Eating Disorders - Bulimia

Definition

Many people experience ups and downs when it comes to how they eat and how they feel about their bodies. However, when someone has a pattern of eating a lot of food in a way that is “out of control” (binging) followed by extreme efforts to rid themselves of the effects (purging), they might be diagnosed with bulimia.

Binging is eating a large amount of food in a relatively short amount of time. Binging can describe eating in a way that feels “out of control”, and can cause secretive behaviours (hiding food, eating large amounts of food when no one is around etc.). Binge eating can make someone feel a lot of shame, worry and guilt.

Purging can describe a lot of different behaviours. Throwing up on purpose, misusing laxatives, fasting and excessive exercise are all different “purging” behaviours. They are done with the purpose of getting rid of the food/calories eaten during a binge.

Bulimia can also cause a person to base their self-worth on their weight or shape, believing their weight and shape is the thing that matters most. They can develop an extreme fear of becoming “too fat”. Unlike anorexia, people with bulimia are typically a healthy weight or in some cases overweight while still having the illness. This does not, however, make the disorder any less concerning or threatening to a person’s health. 

There are other eating disorders that involve binge eating. For example, binge eating disorder occurs when someone binges without purging afterwards. Sometimes if a person has only some of the signs, symptoms and behaviours that come with having bulimia, they’ll be diagnosed with "other specified feeding and eating disorder (EDNOS)," formerly known as “eating disorder not otherwise specified” (EDNOS).

Eating disorders are complicated, and not everyone fits neatly into a “category”. 

Causes

Like all mental health issues, eating disorders like bulimia are complicated and do not have one identified cause. Even though the symptoms of eating disorders can seem to be all about food and body image, they are often more complicated than just wanting to look or eat a certain way, and there are underlying issues that can be addressed through treatment.

Many influences are involved in the development of eating disorders, such as biological, psychological, genetic and environmental factors. Here are some of these contributing risk factors or “triggers”:

  • Low self-esteem or self-worth
  • Trauma (e.g. abuse, grief, etc.) or feeling a lack of control in life
  • Stress or deep emotional difficulties that are avoided or unresolved
  • Other mental illnesses
  • Social pressure and idealization of thinness
  • Bullying
  • Dieting
  • Perfectionism
  • Early puberty
  • Family history of eating disorder or mental illness
  • Chemical imbalances
  • Participating in activities or situations where there’s a focus on appearance, weight or body type (e.g. athletics, dance, etc.)
Signs and Symptoms

Below is a list of signs and symptoms for eating disorders. You might notice that many of these signs or symptoms could be explained by a number of issues, not just eating disorders. If you are concerned that you or someone you know has an eating disorder, it is important to talk to a doctor.

  • Low and irritable mood
  • Anxiety
  • Social withdrawal
  • Fatigue and weakness
  • Intense preoccupation with food, weight, and related subjects
  • Refusal to eat certain foods
  • Frequent comments about feeling “fat”
  • Wearing baggy or layered clothing
  • Food rituals (obsessive and abnormal eating patterns such as picking food apart)
  • Weight loss or frequent fluctuations
  • Rigid exercise
  • Frequent trips to the bathroom after meals
  • Secretive food behaviours including eating alone or lots of hidden wrappers/food
  • Discolouration or staining of the teeth
  • Sore throat and swelling of the cheeks or jaw area
  • Digestion issues (e.g. constipation, heart burn, etc.)
  • Dehydration
  • Dizziness
  • Poor concentration and memory
Help

Bulimia is treatable. For eating disorders or any other mental health concern, if signs or symptoms are interfering with your life in any way, it’s time to seek help. Eating disorders are potentially life-threatening and have the highest mortality rate of any other group of mental illnesses.

If a person’s pattern of eating behaviours and feelings around food, exercise and/or body image are interfering with physical health or the ability to live a comfortable life, it’s time to talk to someone. That someone could be a friend you trust, a teacher, your family doctor, a crisis line, or counsellor.

If it is a friend you are concerned about, they may resist help or not even recognize that they need it. Someone who has bulimia may have a very distorted view of how they look, and an inability to realize how serious their illness is. They might need you to make the first step.

As always, if you feel like your friend might hurt him/herself or someone else, it’s time to call emergency services. 

Visit the Help Section to find out how to get help for yourself or a friend.

Treatment

Like other mental health issues, eating disorders and how they are experienced will differ from person to person. Because each case is unique, the treatment will likely be unique for each individual. Research has indicated that the earlier someone gets help, the better.

Currently, the most effective and long-term treatment for an eating disorder is some form of therapy and counselling coupled with attention to medical and nutritional needs. This can involve outpatient therapy such as individual therapy (e.g. Cognitive Behavioural Therapy), group or family therapy, medical and nutritional management by a family doctor and dietician. Some medications have also shown to be helpful.

Sometimes residential or hospital-based care is necessary when an eating disorder has led to life-threatening physical problems, or severe psychological problems. Spending time in a clinic or hospital may be helpful for those struggling with an eating disorder. Being in a controlled environment with access to constant care for a while can help a person re-group and develop new habits and coping strategies.

Sometimes bulimia can cause damage to a person’s throat, teeth and stomach and digestive tract, a result of repeated throwing up or misusing laxatives. Medical and dental treatment to address this might be necessary.

Bulimia can also be complicated by other mental health concerns like anxiety, depression or self harm. Treatment strategies may also include addressing these issues as well as the eating disorder.

Family members of someone who has an eating disorder may participate in therapy or support groups, or benefit from learning about the disorder and ways to support their loved one at home.

Every story is different, and sometimes people need to try different types of supports before they find the right plan for them.

A person living with an eating disorder, like any other person, will benefit from maintaining wellness and having good supports in their life. 

Support

Supporting someone with any type of serious illness can be challenging. Ways to help and support a friend or loved one who is living with an eating disorder:

  • Know the signs and symptoms of eating disorders.
  • Encourage professional help for your friend when needed (see Help Section).
  • If your friend is in the hospital, go and visit them if you are able. The hospital may be scary and overwhelming for them and a friendly face can help. Make sure to ask about visitor rules first.
  • Many social situations centre around food. When you have a friend who has an eating disorder, it can be hard to know what to do when you’re planning a party or outing. Here are some tips that might help:

a)    Talk to them. Ask them how they are, reassure them that you want to include them in outings but are unsure of how that is making them feel at the moment. Listen. Check in regularly.

b)    Don’t make a “big deal” out of food. Include your friend in your dinner plans, but understand that going out to eat with people might be a very stressful situation for them. Don’t single them out if they don’t eat much, eat a lot, make a trip to the bathroom after a meal or if they seem uncomfortable. If you think something is wrong, quietly check in with them to see if they are ok.

c)    Certain conversations about food or dieting might make someone feel uncomfortable when they are struggling with an eating disorder. It’s probably not necessary to talk about how many calories were in the burger you just ate, or how you feel guilty for skipping the gym this week.

  • Avoid making comments on people’s weight, eating behaviours or body shape. Even if you feel like the comment is positive (e.g. “You look so healthy!” or “your clothes fit you so much better now!”, etc. ), a person struggling with an eating disorder may not be ready to hear these comments in a positive light.
  • You’re probably worried about your friend, and the instinct might be to tell them to change their eating behaviors. Comments such as, “Do you think you should eat that?” or “Maybe you should make a healthier choice” or “Do you really need a second portion?” are more hurtful than helpful. Logic also backfires. Don’t say, “If you want to lose weight, just eat a little less.” The reason is that what seems like a weight problem or a food problem is usually not about food at all; there are underlying issues that can be addressed through treatment.
  • If you worry that your friend is relapsing into unhealthy behaviours, let them know you are worried about them and encourage them to check in with their doctor or family. If you’re really worried about their health and safety, tell an adult you trust.
  • Treatment is a process. Medications and therapy can take time to help. Be aware of this and try to be supportive as your friend adjusts.
  • Be a sounding board. Listening without judgement and without trying to “fix” their problems can be incredibly helpful.
  • Ask your friend how else you can help. It may be as easy as just providing a distraction, asking them to do simple, relaxing things with you (e.g. like hanging out, watching a movie, etc.).
  • Stay calm and don’t take things personally. Sometimes eating disorders can really distort how someone perceives conversations or situations. How someone reacts or communicates when they have an eating disorder may be confusing, distressing or even hurtful at times. They may be feeling overwhelmed and acting out, and it’s probably not about you.
  • Set some boundaries for yourself, and take care. You can’t help someone if you’re feeling overwhelmed yourself. Don’t be afraid to seek help if you need it.

See the Help Section for more info about helping a friend and self care. 

More on mindyourmind.ca

One young person’s story about having bulimia and recovery.

An interview with Nina Savelle-Rocklin, Psy.D., a recognized expert in eating disorders.

A list of Wellness Tips related to recovering from an eating disorder.

Resources

The information on this page is a simple overview of a complicated health issue. The content has been taken from NEDICNEDA, CMHA and the DSM Library. For more in-depth information, please visit these sources or speak to a medical professional.

Ontario – call ConnexOntario to find out where there are mental health supports in your community.

Crisis – in any situation where someone is at risk of hurting themselves or others, call 911 or a local crisis line.

Please see the Help Section for more information and resources. 

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