Bulimia nervosa in a nutshell
A person with bulimia nervosa shows a preoccupation with food and often secretly chokes. A binge is an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances (for example, most people will overeat on vacation). Binge eating also exhibits a lack of control over eating during the episode, calorie intake ranging from 3,000 to 40,000 per episode. The incidence of this disorder is unknown, as it is secret and is kept hidden out of fear or shame. Bulimia nervosa often begins in adolescence, but the recorded incidences range from 5 to 70 years.
Binge-eating episodes are followed by various forms of purging. Vomiting can be induced by inserting a finger or other object down the throat. After a while, inducing vomiting may no longer be necessary. The person will check that all the food has been vomited before completing the purge. The immediate aftermath feelings are relief, power, of being able to overeat but avoid consequences, of “winning” and of fooling everyone. One young woman reported, “It’s the one thing my father can’t control.” These feelings are positively reinforcing and help explain why the disorder continues. However, negative feelings such as self-deprecation, self-hatred, fear of discovery, guilt, and being out of control follow the positive ones. Bulemies often promise never to do this again.
Other forms of purging include laxatives (usually 2 to 30 laxatives per use), diuretics, diet pills, or enemas. These methods do not achieve weight loss, but still the feeling of getting rid of the intake is satisfying and reinforcing. Non-purge methods include excessive exercise (up to five hours per day), which can be rationalized as fitness. Fasting, an attempt to compensate for excessive eating, is counterproductive as it causes bingeing again when the person feels hungry.
The physical ramifications of bingeing followed by purging can include swollen salivary glands, broken blood vessels in the eyes, ruptured stomach, esophageal tears, dehydration, electrolyte imbalance (which compromises heart function), and malnutrition. Because vomiting erodes the enamel on the inside of the teeth, an eight-year-old bulimic reports that dental repairs cost $ 10,000.
Bulimia nervosa has several causative factors. A biological factor points to serotonin in the brain and its regulation of satiety and food preferences, as well as in the regulation of impulses. About 85% of bulimic patients suffer from hypoglycemia (low blood sugar), which can contribute to the urge to binge; Over time, the behavior develops addictive qualities. A multilevel model for the etiology of bulimia nervosa includes social, cultural, family and personal factors: society overvalues thinness and obesity is highly stigmatized; bulimic families express increased anger, aggression and conflict (without conflict resolution skills), indirect communication, lack of support and lack of finances; excessive attention to food and weight in the family (the degree of symptoms is associated with the occurrence between mothers and sisters); excessive preoccupation with pleasing others; strong peer group influences to be attractive (slim), to gain approval from other women, and to attract boyfriends; feeling of ineffectiveness and low interoceptive awareness, generating high anxiety; a disconnection from unpleasant feelings by diverting attention to food. Bulimics can display other impulsive behaviors such as drinking, sexual promiscuity, kleptomania, waste and drug use.
