Bulimia nervosa, the eating disorder characterised by binge-eating followed by self-starvation, self-induced vomiting, laxative abuse and over-exercising, is more hidden than anorexia or compulsive overeating, according to Harriet Parsons, spokesperson for Bodywhys, the Eating Disorders Association of Ireland.
“It’s harder to spot, because often a person who has bulimia will be within the proper weight range for their age, sex and height. Therefore it’s not obvious like with anorexia, where a person’s weight gets very low, or binge eating, where the person gains a lot of weight. It therefore takes much longer before family and friends notice.”
By the time it is noticed the person may be entrenched in the eating disorder, she says.
Repeated purging affects cardiac muscle
“That can be quite problematic as it may have reached a serious stage. Also, even though the person may look physically healthier than the person with anorexia, they are more physically at risk in terms of their health than somebody who is restricting their food.
“That’s because when you purge regularly (vomit up your food), you become very dehydrated, and this upsets your electrolyte and potassium balance. Potassium is one of the things needed for your cardiac muscle to work and there is a very narrow margin of error for that, so if it drops then somebody can have a cardiac arrest.
“The person with bulimia may look fine but they are more at risk than someone who has anorexia and looks emaciated,” explains Harriet.
While figures for eating disorders are limited, the Department of Health estimates that up to 200,000 people in Ireland may be affected by eating disorders.
Eating disorders are most prevalent in females in the 15-40 group. Two percent of those develop bulimia. Recent studies suggest that 25% of these cases are male.
Causes are multi-factorial
There is no single cause that can explain why a person develops an eating disorder, Harriet says. “It is usually a combination of factors: biological, psychological, familial and socio-cultural.
“The disorder usually develops gradually, as a response to an upset in a person’s life: trauma, loss, bullying, stress overload and/or critical comments about weight or shape. Sometimes the trigger is not obvious.”
A person with low self-worth or without a strong sense of identity may be more vulnerable, however. “People who develop eating disorders tend to be overly concerned with meeting the standards and expectations of others and are super-sensitive to other peoples’ feelings.
“Understanding the emotional background of the eating disorder is crucial to developing an appropriate response and treatment approach.”
Recovery is possible
Bodywhys research shows that a full recovery from bulimia is possible. “Recovery can only begin when a person is ready to change, though, but change can be made easier for a person if those around them inform themselves about bulimia and about how they can offer support and show understanding.
“We’re saying that a person will reach a stage where they no longer engage in the disordered eating behaviours, where their thinking is no longer distorted and where they are able to feel free in their life, able to live spontaneously, tolerate anxiety and emotions, happiness, sadness, and not translate them through controlling their food in their body.”
Many people with bulimia manage to recover on their own with the right level of support.
“Nowadays, there are many self-help programmes available. These can be used on their own or under the guidance of professionals, if needed.
“The Bodywhys booklet Binge eating – breaking the cycle – a self-help guide towards recovery offers information and suggestions for breaking out of compulsive behaviours and taking back control. A combination of nutritional advice and psychotherapy can also provide powerful support to facilitate the changes needed for full recovery.”
CBT or cognitive behavioural therapy is known to be effective, she says.
“This form of therapy helps a person to look at the false beliefs that underlie their sense of self and their behaviour. Family therapy can help identify and resolve problems within the family that may be contributing to the eating disorder too.
“Sometimes anti-depressants are prescribed to help with the depression and reduce the frequency of bingeing and purging.
Difficult for family
Harriet agrees that an eating disorder like bulimia can affect a family greatly. “It’s very difficult, and how difficult it is depends on age of the person. If it’s a child or teenager the parent has more power and the ability to step in and act a bit more.
“If the person is an adult, however, they have to reach the stage where they acknowledge to themselves that they have bulimia before they can start the process of recovery.
“You can’t make somebody do it, but you can think about how you communicate with, to allow space for that acknowledgement to happen.”
An eating disorder can be like a comfort blanket or safety net for the person, she says. “If you approach them and say: ‘That’s destroying your life, you need to give it up,’ they cling to it more, or they hide it. But if you try to create a space where they don’t feel threatened or that they have to defend their eating disorder, they will then open up.
“They can then talk about it and how it’s affecting their life, because a part of them would definitely know that the eating disorder is destroying their life. It is scary for them to articulate that,” Harriet explains.
Starting the conversation
To create a space where conversation can start about the bulimia, as a family member, you don’t focus too much on the food, she says.
“You don’t focus on what they’re eating and not eating and what they’re doing, but on how they are feeling and how they are coping with life. Find little openings for conversations around that and try to have the patience to keep plugging away at it.”
Families of those with eating disorders need a lot of support, she says. “Bodywhys runs four-week family support courses to help families understand what an eating disorder is.
“We explain the mindset the person has and how they can live with that and try and change it and cope with it. We also try and support their person into a place where they will accept they have an eating disorder and do something about it. CL
How would you know someone has bulimia?
Main features:
• repeated binge eating;• compensating for binges: vomiting up, laxative abuse, fasting, diuretics, over-exercising;• preoccupation with body weight, shape and size;• self-evaluation affected by weight, shape and size;• irregular menstruation.Physical signs
• frequent changes in weight;• lethargy, tiredness and insomnia• dehydration;• digestion problems (cramps, wind, constipation, diarrhoea);• poor skin condition;• headaches, tension;• sore throat and mouth ulcers, husky voice;• calluses on fingers;• enlarged salivary glands;• erosion of tooth enamel (acid from stomach affecting teeth when purging).Psychological signs:
• feeling emotional, irritability, mood swings;• dissatisfaction with body image;• feeling out of control;• feelings of inadequacy and worthlessness;• feelings of guilt and shame;• depression;• anxiety.Behavioural signs:
• preoccupation with dieting;• regular binges (uncontrolled
eating);• being sick after meals;• disappearing to the lavatory after meals to get rid of food;• secret hoarding of food;• secret disposal of vomit (eg bags of vomit hidden in bedroom);• lying;• abuse of laxatives;• excessive exercising;• risk-taking behaviours such as alcohol or drug misuse, shoplifting, promiscuity, self-harm;• problems dealing with social situations and interaction with others.Story of recovery
Alf doesn’t remember how or when he began bingeing and purging. “The word ‘purge’ is the perfect description of it,” he says. “When I threw up, I was purging myself of the anxiety, of the unease.
“Over time, my family noticed, and the comments started about bulimia, but I ‘knew’ I wasn’t bulimic. For a long time I ‘knew’ I wasn’t.
“My dad broke down in tears one day, because he was worried about me. He had found remnants of food in the drain outside the bathroom. I ‘admitted’ it to him, but I hadn’t actually admitted it to myself.
“Blood tests showed that I had dangerously low potassium, which regulates the heart, so I was hospitalised for that. Doctors couldn’t figure out the reason for it, as I hadn’t been truthful answering their questions.
“The next morning, I did tell a doctor about the throwing up, and a weight started to lift. I was referred to a consultant who specialised in eating disorders. I told my wife everything after that. I wanted to be 100% open. The more transparent I could be, the better for both of us.
“I started cognitive behavioural therapy (CBT). It’s a year since my last session of CBT, and my relationship with food is moving towards normal.
“It will take some time, and I know there will be times that will test me, but I’m confident I can deal with those.
“Having admitted where I was and having gone through the treatment, I feel so much more comfortable in myself. I’m happier because of it and the people around me are happier.”
Helen who has recovered
from bulimia:
“Eating disorders are horrible diseases. They twist up your self-perception, cause you to push away the people closest to you and overshadow everything good in your life.”
get help
• www.bodywhys.ie: download their booklet: Binge eating – breaking the cycle – a self help guide to recovery or phone their LoCall helpline on
1890-200-444• www.overeatersanonymous.ie. Overeaters Anonymous uses the AA Twelve-Step programme of recovery to help those who have anorexia, bulimia or who compulsively overeat. • Eating Disorder Awareness Week is 22-28 February 2016.
Bulimia nervosa, the eating disorder characterised by binge-eating followed by self-starvation, self-induced vomiting, laxative abuse and over-exercising, is more hidden than anorexia or compulsive overeating, according to Harriet Parsons, spokesperson for Bodywhys, the Eating Disorders Association of Ireland.
“It’s harder to spot, because often a person who has bulimia will be within the proper weight range for their age, sex and height. Therefore it’s not obvious like with anorexia, where a person’s weight gets very low, or binge eating, where the person gains a lot of weight. It therefore takes much longer before family and friends notice.”
By the time it is noticed the person may be entrenched in the eating disorder, she says.
Repeated purging affects cardiac muscle
“That can be quite problematic as it may have reached a serious stage. Also, even though the person may look physically healthier than the person with anorexia, they are more physically at risk in terms of their health than somebody who is restricting their food.
“That’s because when you purge regularly (vomit up your food), you become very dehydrated, and this upsets your electrolyte and potassium balance. Potassium is one of the things needed for your cardiac muscle to work and there is a very narrow margin of error for that, so if it drops then somebody can have a cardiac arrest.
“The person with bulimia may look fine but they are more at risk than someone who has anorexia and looks emaciated,” explains Harriet.
While figures for eating disorders are limited, the Department of Health estimates that up to 200,000 people in Ireland may be affected by eating disorders.
Eating disorders are most prevalent in females in the 15-40 group. Two percent of those develop bulimia. Recent studies suggest that 25% of these cases are male.
Causes are multi-factorial
There is no single cause that can explain why a person develops an eating disorder, Harriet says. “It is usually a combination of factors: biological, psychological, familial and socio-cultural.
“The disorder usually develops gradually, as a response to an upset in a person’s life: trauma, loss, bullying, stress overload and/or critical comments about weight or shape. Sometimes the trigger is not obvious.”
A person with low self-worth or without a strong sense of identity may be more vulnerable, however. “People who develop eating disorders tend to be overly concerned with meeting the standards and expectations of others and are super-sensitive to other peoples’ feelings.
“Understanding the emotional background of the eating disorder is crucial to developing an appropriate response and treatment approach.”
Recovery is possible
Bodywhys research shows that a full recovery from bulimia is possible. “Recovery can only begin when a person is ready to change, though, but change can be made easier for a person if those around them inform themselves about bulimia and about how they can offer support and show understanding.
“We’re saying that a person will reach a stage where they no longer engage in the disordered eating behaviours, where their thinking is no longer distorted and where they are able to feel free in their life, able to live spontaneously, tolerate anxiety and emotions, happiness, sadness, and not translate them through controlling their food in their body.”
Many people with bulimia manage to recover on their own with the right level of support.
“Nowadays, there are many self-help programmes available. These can be used on their own or under the guidance of professionals, if needed.
“The Bodywhys booklet Binge eating – breaking the cycle – a self-help guide towards recovery offers information and suggestions for breaking out of compulsive behaviours and taking back control. A combination of nutritional advice and psychotherapy can also provide powerful support to facilitate the changes needed for full recovery.”
CBT or cognitive behavioural therapy is known to be effective, she says.
“This form of therapy helps a person to look at the false beliefs that underlie their sense of self and their behaviour. Family therapy can help identify and resolve problems within the family that may be contributing to the eating disorder too.
“Sometimes anti-depressants are prescribed to help with the depression and reduce the frequency of bingeing and purging.
Difficult for family
Harriet agrees that an eating disorder like bulimia can affect a family greatly. “It’s very difficult, and how difficult it is depends on age of the person. If it’s a child or teenager the parent has more power and the ability to step in and act a bit more.
“If the person is an adult, however, they have to reach the stage where they acknowledge to themselves that they have bulimia before they can start the process of recovery.
“You can’t make somebody do it, but you can think about how you communicate with, to allow space for that acknowledgement to happen.”
An eating disorder can be like a comfort blanket or safety net for the person, she says. “If you approach them and say: ‘That’s destroying your life, you need to give it up,’ they cling to it more, or they hide it. But if you try to create a space where they don’t feel threatened or that they have to defend their eating disorder, they will then open up.
“They can then talk about it and how it’s affecting their life, because a part of them would definitely know that the eating disorder is destroying their life. It is scary for them to articulate that,” Harriet explains.
Starting the conversation
To create a space where conversation can start about the bulimia, as a family member, you don’t focus too much on the food, she says.
“You don’t focus on what they’re eating and not eating and what they’re doing, but on how they are feeling and how they are coping with life. Find little openings for conversations around that and try to have the patience to keep plugging away at it.”
Families of those with eating disorders need a lot of support, she says. “Bodywhys runs four-week family support courses to help families understand what an eating disorder is.
“We explain the mindset the person has and how they can live with that and try and change it and cope with it. We also try and support their person into a place where they will accept they have an eating disorder and do something about it. CL
How would you know someone has bulimia?
Main features:
• repeated binge eating;• compensating for binges: vomiting up, laxative abuse, fasting, diuretics, over-exercising;• preoccupation with body weight, shape and size;• self-evaluation affected by weight, shape and size;• irregular menstruation.Physical signs
• frequent changes in weight;• lethargy, tiredness and insomnia• dehydration;• digestion problems (cramps, wind, constipation, diarrhoea);• poor skin condition;• headaches, tension;• sore throat and mouth ulcers, husky voice;• calluses on fingers;• enlarged salivary glands;• erosion of tooth enamel (acid from stomach affecting teeth when purging).Psychological signs:
• feeling emotional, irritability, mood swings;• dissatisfaction with body image;• feeling out of control;• feelings of inadequacy and worthlessness;• feelings of guilt and shame;• depression;• anxiety.Behavioural signs:
• preoccupation with dieting;• regular binges (uncontrolled
eating);• being sick after meals;• disappearing to the lavatory after meals to get rid of food;• secret hoarding of food;• secret disposal of vomit (eg bags of vomit hidden in bedroom);• lying;• abuse of laxatives;• excessive exercising;• risk-taking behaviours such as alcohol or drug misuse, shoplifting, promiscuity, self-harm;• problems dealing with social situations and interaction with others.Story of recovery
Alf doesn’t remember how or when he began bingeing and purging. “The word ‘purge’ is the perfect description of it,” he says. “When I threw up, I was purging myself of the anxiety, of the unease.
“Over time, my family noticed, and the comments started about bulimia, but I ‘knew’ I wasn’t bulimic. For a long time I ‘knew’ I wasn’t.
“My dad broke down in tears one day, because he was worried about me. He had found remnants of food in the drain outside the bathroom. I ‘admitted’ it to him, but I hadn’t actually admitted it to myself.
“Blood tests showed that I had dangerously low potassium, which regulates the heart, so I was hospitalised for that. Doctors couldn’t figure out the reason for it, as I hadn’t been truthful answering their questions.
“The next morning, I did tell a doctor about the throwing up, and a weight started to lift. I was referred to a consultant who specialised in eating disorders. I told my wife everything after that. I wanted to be 100% open. The more transparent I could be, the better for both of us.
“I started cognitive behavioural therapy (CBT). It’s a year since my last session of CBT, and my relationship with food is moving towards normal.
“It will take some time, and I know there will be times that will test me, but I’m confident I can deal with those.
“Having admitted where I was and having gone through the treatment, I feel so much more comfortable in myself. I’m happier because of it and the people around me are happier.”
Helen who has recovered
from bulimia:
“Eating disorders are horrible diseases. They twist up your self-perception, cause you to push away the people closest to you and overshadow everything good in your life.”
get help
• www.bodywhys.ie: download their booklet: Binge eating – breaking the cycle – a self help guide to recovery or phone their LoCall helpline on
1890-200-444• www.overeatersanonymous.ie. Overeaters Anonymous uses the AA Twelve-Step programme of recovery to help those who have anorexia, bulimia or who compulsively overeat. • Eating Disorder Awareness Week is 22-28 February 2016. 
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