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| Eating Disorders & Dieting - Bulimia |
BULIMIA : WHAT IS IT ALL ABOUT?
ABulimia describes an illness which contains a range of very specific behaviours. Typically are regular episodes of “binge” eating, usually in private, of foods believed to be fattening and therefore in some way “forbidden” to someone conscious of needing to control her weight. Foods typically eaten during a binge will include biscuits, chocolate, crisps, bowls of cereal, large amounts of toast with butter, chips cakes tubs of ice cream etc. Eating continues until the urge to eat is gone, tension is reduced, physical satiation is reached, (often to the point of pain), or the person is interrupted.
Sometimes the food is enjoyed, but it is more likely to be eaten quickly and without tasting, and our definition requires that this kind of eating will be accompanied by feelings of anxiety, guilt and remorse. Following a binge, but not always immediately afterwards, there will be an attempt to get rid of the calories absorbed by making oneself sick, and/or by taking laxatives. Some bulimics try to contain their weight by indulging in excessive exercise and additionally by starving for periods of time.
In its most severe form, the sufferer eats vast amounts of food sometimes resulting in physical damage - rupture of the stomach for example - followed by self-induced vomiting to the point of causing life threatening chemical imbalance. Cases are known where someone has eaten raw meat, dog food, or food from other people’s rubbish bins. The cycles of bingeing and purging can occur up to twelve times each day.
There is no standard definition of the word “binge”. It is well known that normal eaters periodically overeat. 86 % of college women responded “yes” to the question “ do you ever binge eat However this figure dropped to under 10% when stricter definitions of a binge were applied. The key is that normal eaters are less disturbed by their eating habits than bulimics. For a true bulimic one mouthful too many of a meal may be regarded as a broken rule. Vomiting may be provoked simply by the feeling that he or she cannot accept the retention of additional calories.
There is also disagreement about the FREQUENCY of binge eating which satisfies the definition of bulimia. Some people binge and purge several times a day and some only once or twice each month. Research shows that the frequency of binge eating episodes among bulimics varies from once a week to 46 times.The average is once daily, with the number of calories consumed in the binge ranging from 1,200 to 11,500.
Overall, bulimia can be said to exist when several but not necessarily all of these symptoms exist TOGETHER - i.e. episodes of overeating, accompanied by guilt and self hatred, secrecy, excessive fear of gaining weight, over concern with body size , failure to eat in a systematic way and removal of calories by purging.
THE DEVELOPMENT OF BULIMIA
Most bulimics see their condition as a breakdown of self control indicating that they are at best morally weak (lacking willpower), and at worst mentally ill. This is likely to be felt most powerfully by people who either dieted very successfully in the past or who were anorexic, and who therefore felt totally in control around food. Whilst research suggests that there is, in some people, a connection between mood disorder and bulimia, it is not really helpful to view oneself as a bad person or as emotionally flawed.
BULIMIA AS AN OUTCOME OF DIETING
In most people, the emergence of a binge eating problem is directly related to the effects of dieting, because food restriction has far reaching consequences both for the body and the mind. Many different research studies have shown that after dieting, and irrespective of whether you are fat or thin, most people find that they are unable to stop eating when full, and develop marked preferences for foods rich in sugar and fats - the very foods which someone concerned with body size will be anxious to avoid.
Another side effect of dieting is a tendency to gain weight easily, as a result of complex physiological defences against food restraint, including altered metabolic rate. These processes are more intense in cases where:
- the diet has been unwise, or lacking in essential factors such as fats;
- where weight loss has been too great, or
- Aided by unsafe such as diet pills, and liquid meal replacements.
Some people respond to the breakdown of control with great dismay and may attempt to vomit after a particular binge, or they try it because they have “heard about it”. Vomiting, if successfully attempted, becomes therefore a way of dealing with the guilt, of having ones cake and eating it, of dealing with the secret greedy person inside without showing her on the outside.
THE BULIMIC PROGRESSION
Initially, purging is used when a binge occurs accidentally, but in later stages it becomes an option when the sufferer senses that she may have crossed some line of acceptability with her eating, giving her permission to carry on and eat to saturation point. Eventually, binges will be planned well in advance, or may become a necessary part of the daily routine, with time being specifically set aside for the ritual of eating and vomiting. A long term bulimic will say “I cant seem to function until I have had my binge - then I can get on with things.”
Some experts believe that the act of binge eating is accompanied by a release of tension in the early stages of bulimia. Eating therefore acquires the power to relieve stress through dissociation and becomes a habit which is difficult to break. Since vomiting also relieves anxiety after a binge, in later stages bulimia people may experience the urge to vomit when they are angry, tired or upset. We can say then that the sufferer becomes “hooked” on the binge eating and purging and makes adjustments in their life to accommodate it. Healthier coping skills are given up or replaced by bulimic behaviour.
The development of bulimia varies among individuals. Some people report dieting behaviour on and off for many years with one period of weight loss immediately preceding the illness.Younger people often start to purge immediately after first serious diet. The ability to vomit with relative ease may be a factor influencing the severity of the illness.
It is reported that many “compulsive overeaters” attempt vomiting during the course of their condition but if early attempts are not successful this strategy will be abandoned and the bulimic syndrome will not progress.
WHO SUFFERS
It is not known how widespread the disorder is but it typically occurs in young women aged on average 18 years. The age of people seeking treatment varies from the early teens to late sixties, and men represent 5 percent of officially reported cases. The illness favours, but is not confined to, higher social grades and greater educational attainment and thus bulimia is more commonly found in girls’ boarding schools, and among women at college or university. One American study recently reported a 40 percent incidence of bulimia among college women but a figure of around 10 per cent for this target group, compared with 3 percent of women in the population at large, seems more realistic.
WHY WOMEN?
These figures reflect the greater pressures on women in our society to control their weight, together with a tendency for thinness to be increasingly valued as social status rises. Finally, it is believed that educated women tend to hold more perfectionist attitudes, making them more critical of how they look.
There are however additional dynamics which may contribute toward the development of bulimia in women. Psychoanalytic literature describes certain factors in the rearing of females and in the relationship between mothers and daughters which contribute to suppression of needs, denial of feelings (particularly anger) and body insecurity - all of which can find expression in bulimia.
Bulimia in men is more likely to be associated with conflicts over sexual identity. Younger men, unsure of their own masculinity often try to emulate sporting “masculine” role models such as famous cyclists or track athletes.
RECOGNISING BULIMIA
Bulimia is usually well concealed from family or friends and can remain undetected for many years. Many husbands, parents or friends will have no idea that anything is amiss. There are however, certain behaviour patterns which give clues to a possible problem. These include:
- Disappearing to the bathroom after a meal, running bath water or playing the radio at high volume.
- Strange night bird behaviour, staying up and going to the kitchen after everyone else has gone to bed. Or going for unexpected walks or drives at night. A bulimic tries to get rid of people, or have them go to bed, so that they can binge.
- Disappearance of large quantities of food, or overeating, without apparent sign of weight gain.
- Finding food wrappers hidden behind chair cushions or under beds.
- Unexplained irritability and mood swings.
TREATING BULIMIA
People with bulimia can return to healthy eating regardless of how long they have been involved with binge eating and purging, and furthermore many of the physical side effects of the illness will disappear. The main difficulty for many individuals is finding a therapist with an adequate training in and understanding of the eating disorders. Factors such as distance, availability and cost affect the ability of people to find adequate help once they have accepted their need of it. For many bulimics the shame and embarrassment of their condition will have allowed it to go untreated for many years by which time urgent assistance is needed.
Due to existing conditions of training, many Medical Practitioners are not skilled in the treatment of bulimia although they may be aware of the condition and able to refer their patient to a suitable specialist centre. Hospital in-patient treatment will be necessary for only the smallest minority of cases. Unfortunately, for many people especially from the South of Britain, hospital treatment for bulimia will involve a stay in, or outpatient help from, a psychiatric unit with no specialised help for bulimia.
CONCLUSION
We have come a long way since bulimia was first identified several years ago. It is important to get the message across to the many desperate silent sufferers, that they need not be ashamed to ask for help, and that if they are motivated to be well, their prospects for recovery are good.
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