Bulimia nervosa is a severe mental health disorder that if left untreated can become life-threatening. It involves the intake of excessive amounts of food and then engaging in compensatory behaviors to counteract this intake. There can be purging bulimia where the person uses self-induced vomiting or laxatives, enemas or diuretics to rid the body of the food. In contrast, there can be non-purging bulimia where they use other compensatory methods such as strict dieting or engaging in excessive exercise. These two types of bulimia are not necessarily exclusive and often overlap. Despite this focus on food, truly bulimia is not about food, but anxiety. People experiencing bulimia are often worried about their weight or body shape. They are likely to have high expectations for themselves and a tendency to focus on their self-perceived flaws. As bulimia goes deeper than simply a concern about food or weight and is rather due to deeper seeded low self-esteem, it can be very difficult to recover from. However, with good support and the right treatment, it can certainly be overcome.
The eating disorders in general are linked to dissociation and alternate states of consciousness achieved through food types and binging/fasting/purging activities. — Leslie E. Korn Ph.D., MPH, LMHC, ACS, NTP
What are the risk factors for bulimia?
- Beliefs – a belief that a thin body is ideal.
- Gender and age – bulimia is more common in females and more often likely to emerge in the teen and early adult years.
- Culture – living in a culture where there is lots of pressure to keep your body skinny.
- Stress – big life events and periods of high levels of stress, including traumatic events can sometimes trigger eating disorders.
- Personality – having high expectations for yourself, low self-esteem and having difficulty expressing yourself or being impulsive.
- Family – bulimia can sometimes run in families both due to genetics and also due to parents modeling the above beliefs and behaviors to their children.
- There have also been links identified between feeling inadequate, alcohol use, other mental health concerns, a history of overeating in childhood and early puberty.
How does bulimia work?
Lose weight at any cost. This is the demand urgently and consistently made to patients classified as “overweight” or “obese.” — Alexis Conason Psy.D.
Generally once started, bulimia will become a self-perpetuating problem and continue to cycle until treated. This cycle is called the binge-purge cycle and each cycle event has a trigger. These triggers are rarely the cause of the bulimia overall, but more so the triggers for each individual cycle and can be different each time.
Generally, a cycle will be triggered by an event where someone has either been physiologically or emotionally deprived of something. This means that those who generally diet or restrict foods are at a higher risk. Emotionally, there can be specific feelings that act as triggers such as feeling sad, lonely, guilty or helpless. These emotions could be cause be a significant event or maybe even just an accumulation of everyday stress. For people with negative core beliefs such as “I am worthless,” it can be very difficult to tackle the eating disorder without first addressing these beliefs. Otherwise, the beliefs continue to cause sadness and hopelessness which then trigger a binge-purge cycle. This is why it is so important to work out that person’s unique triggers when treating an eating disorder.
This step in the cycle involves consuming much more in one sitting then the person normally would in a meal. During this time the person can feel “out of control” or not even notice how much he might be eating. This can start with eating just a little bit of something bad (i.e. a square of chocolate from a big block) but escalate to eating the rest due to already feeling guilty. Otherwise, a binge can happen when someone tries to use food to comfort themselves when they are upset and then this develops into a complete binge. Finally, it can also occur when the person has been severely restricting their food intake and can be how the body is trying to get the nutrients that it needs.
Afterwards, the person is likely to feel full to the point of feeling sick. It can also cause physical pain and indigestion for them. This is often coupled with emotional pain, shame, embarrassment, disgust, and self-criticism.
Often the negative feelings (both physical and emotional) experienced due to the binge are extremely difficult for the person to manage. Due to this, they tend to engage in a purging activity relatively quickly after the binge.
Sadly, there is a lot of guilt and shame attached to these behaviors so they tend to be done in private. — Lisa Ferentz LCSW-C, DAPA
Calm before the Storm:
After purging (either once or multiple times) the person can sometimes experience a period of calmness. Based on their experiences they may aim to stop the behavior at this point. Sadly though, one way they tend to do this is to begin dieting and as discussed above, this can sometimes lead to further binge-purge cycles.
There is Hope:
It is important to know that even though people tend to feel hopeless and powerless within this situation, the cycle can be broken. With good support around them and professional treatment from a therapist, it is possible for someone experiencing bulimia to make a complete recovery.
For further information about the psychology behind bulimia, please see the links below.