Bulimia nervosa – it´s not a choice

Bulimia nervosa – often also described as a binge-purge-disorder – is in many ways similar to anorexia. People often think that bulimia nervosa is about vomiting the food in order to stay thin and not gain any weight. But that´s not all about it. Suffering from bulimia nervosa is not a choice. Why someone actually might purge (PS: vomiting is not the only way to do it), has a deeper laying background and it is not just about the purging part!

The clinical picture and the difference to anorexia

The people affected are most likely to show a visible preoccupation with their body shape and/or weight. This often goes hand in hand with a fear of gaining weight and connecting their self-worth with their outer appearance. This is what makes bulimia nervosa and anorexia so similar. Often it can be even observed, that bulimia follows a period of anorexia/starvation.

Most bulimia nervosa patients are in a (what the BMI considered as) healthy weight range. It can not be seen from the outside that the patients struggle with perservative binge episodes, which go along with a loss of control around food. Within these binges larger amounts of foods are consumed within a period of time. (*larger = more than a comparable person would eat within the same time). To compensate the amounts of food consumed a purging period follows. Actions taken might be self-induced vomiting, but also doing excessive amounts of sports, starving themselves afterwards and/or the abuse of laxatives and diuretics. These episodes occur at least once a month over three months.

Check out this post to read more about the binging and purging part.

consequences of bulimia nervosa

symptoms	consequences
– unstable body weight – binge episodes – purging behaviour – feelings of isolation, boredom and emptiness – shame and lower self esteem – frustration, fear, anger, tension – depressed, low mood	– tiredness – lack of minerals/malnutrition – muscle cramps and arrhythmia – circulatory disturbance – constipation, inflamed pancreas – corrosion of the throat and oesophagus – damaged teeth and kidneys – enlarged parotid gland

Why purging makes addictive

“Purging can make you feel a weird sense of pride.” I am not glorifying Bulimia here, but a successful purge shortly leaves exactly this feeling behind. Because you reached what you wanted: You escaped from the reality, displaced your real feelings and prevented weight gain. The food and the success release short-term endorphins in your body. The guilt and shame usually kick in later. And this is what makes this eating disorder so dangerous. Once you discovered, that you can just “burn it all off again” or just purge it all afterwards, it becomes a habit and a justification to binge in the first place. This feeling of pride covers the knowledge about the consequences of bulimia nervosa.

It´s important to understand, that bingeing and purging are dysfunctional coping mechanisms to cope with life; Emotions, to fill a lack of emotions, a response to trauma, avoiding problems. Check out my blog post about the binge-purge cycle to understand it and get some helpful tools on hand.

No one knows, …

Since most sufferers do have a “healthy” weight and seem to eat – it can stay undetected for years. It´s not as obvious as anorexia nervosa, where the patients are losing weight rapidly. Some bulimia patients lose weight, some gain weight and others might maintain their weight. The people affected become pretty good in hiding their disorder above all the fact, that they move back from friends and family.

And for someone that might have never suffered from an eating disorder itself, it can be really hard to understand, why you are choosing to make yourself sick or workout for hours without any enjoyment. So, reaching out for help and getting help becomes very difficult.

Signs someone might suffer from bulimia nervosa

get help

It is important to understand that bulimia nervosa is not just a bad habit. It is a mental illness, that needs to be treated. And recovering in your familiar surroundings can be really hard, as there are a lot of triggers. Such as your family, the supermarket, your work place, your daily routine, … Identifying your triggers can be helpful to find the best way of treatment for yourself.

If you have access to proper therapy, behavioral therapy will teach you how to handle your triggers, emotions, etc. without using food. Bulimia gets also often treated in inpatient treatment centres or in day clinics. However, since not everyone has access to therapy, or the waiting lists are too long (no, you should not wait until you get a therapy place, to get better. Choose to get better NOW), there is also online-therapy. On the internet you can also find some bulimia-coaches. But be careful with coaches, a lot of them have the approach, what helped for them will fix everyone´s problems. Also: “Coach” is not a professional. Literally anyone can become such one without any education.

Opening up to someone that is close to you, is the first step. They don´t have to be able to relate to what you are going through. But what you are carrying on your shoulders right now, is too heavy to handle with all on your own. Telling someone might give you the necessary motivation boost to actually make an effort to get better. BEST: open up to your doctors, so he can help you to get into proper care.

The book “brain over binge” helped me a lot to understand where the urges come from and the amount of times I actually engaged in purging behaviours decreased drastically within a short time. But this is just my experience. It is not a wonder-book. Getting educated only will not cure your eating disorder.

Don´t be ashamed

In Middle school I used to make fun about bulimics in class. “How could someone be so dump, stuff a whole cake in their mouth, just to make themselves sick and throw up later?” This is only the result of a lack of education. No one ever talked about the fact, that this is not a choice. So, I had to find myself feeling sick and miserable, screaming and jumping around the bathroom, because the food would not come up, to understand, that bulimia is about A LOT more than just bingeing and purging.