Clinically Clueless: Bulimia

Your mother, father, daughter, brother, neighbor, friend or colleague all could have an eating disorder. You might never know it and be unaware of the turmoil that follows every day throughout the day. On the outside, he/she may be normal weight or slightly overweight, seem successful, happy and have an enviable life. But, looks can be deceiving. Watch this video for some basic statistics. (Please, if you have an eating disorder there are images that may be triggering, so make sure that you are safe!

Somewhere within a month’s period it is a National Eating Disorder’s Week wherever you live. Today (2/24/08) is the beginning of the U.S.'s National Eating Disorder’s Awareness Week which is a collective effort of primarily volunteers, eating disorder professionals, health care providers, educators, social workers, and individuals committed to raising awareness of the dangers surrounding eating disorders and the need for early intervention and treatment.

Eating disorders are mental illnesses. They are generally defined as a broad range of disorder where preoccupation with food and/or weight takes primary focus in ones life that they can hardly focus on anything else. They become obsessed about food, weight and body shape.

The three primary types are anorexia nervosa, bulimia nervosa and binge eating. There are also a range of sub-categories that you may have heard like anorexia athletica, compulsive exercise, orthorexia, body dysmorphic and compulsive over-eating. There are specific diagnostic criteria for the three eating disorders as defined by the DSM-IV-TR. Please visit the sites below for more information.

Anorexia Nervosa is basically starving yourself, keeping yourself below 15% of your normal weight and they may exercise excessively. Body weight is of thin appearance. Emotional and behavioral symptoms include refusal to eat, denial of hunger, lack of emotion,

difficulty concentrating, skipping meals, having “safe” foods, food rituals (cutting into tiny pieces), elaborate cooking for others, repeated weighting, distorted body image, hoarding food, wearing baggy or layered clothing, complaining about being fat and depression or anxiety.

Bulimia Nervosa is eating large quantities of high calorie foods sometimes for hours and

then getting rid of it afterwards through laxatives, vomiting or exercise. Body weight can be normal to slightly over weight. Emotional and behavioral symptoms include constant dieting, feeling that you cant control your eating behavior, eating to the point of pain, unhealthy focus on body shape or weight, distorted body image, going to the restroom after or during eating or meals, hoarding food and depression or anxiety.

For both anorexia and bulimia, medical symptoms may include abnormal bowel function, bloating, dehydration, fatigue, dizziness, irregular heart beats or rhythms, dry skin and irregular or loss of menstruation in women and girls. There are many more. Please, see references below for more details.

Compulsive over-eating/Binge eating is impulsive gorging or continuous eating. It is the number one eating disorder. While there is no purging, there may be sporadic fasts or repetitive diets. Body weight may vary from normal to mild, moderate, or severe obesity. Emotional and behavioral symptoms may be eating to the point of discomfort or pain, eating much more food during a binge episode than a normal meal or snack, eating faster during binging, feeling eating behavior is out of control, frequent eating alone, frequent dieting without weight loss, hoarding food, hiding empty food containers, and depression and/or anxiety.

What causes eating disorders? It is three-pronged. There is a biological component. Studies are finding genetic links and chemical commonalities. Second is the sociocultural component. The media and peer pressure has given the message that thin is successful, popular, perfect, loved, strong, sage and beautiful. As a result self-worth becomes linked to size and weight. Third is the emotional and psychological component. They tend to be perfectionists both physically and academically, have low self-esteem, have high body dissatisfaction, and have periods of depression. Being sexually abused as a child is often a contributing factor to the development of an eating disorder.

Eating disorder are common in individuals in sports or professions where there is a high value on being thin. Athletes, actors and television personalities, dancers, and models are at higher risk of eating disorders. Eating disorders are particularly common among ballerinas, gymnasts, runners and wrestlers. Eating disorders are more common in industrialised societies where there is an abundance of food and where there is a cultural ideal for women to be thin there is an increased risk if a parent or sibling has had an eating disorder, mood disorder or alcohol or drug problem

The earlier treatment is sought the better the chances at full recovery. :-) Please go to the links below for more on treatment and prevention.

What I haven’t covered and why I know so much is that I’ve had an eating disorder for 30 years with varying degrees of recovery. I am diagnosed with Eating Disorder, Not Otherwise Specified, which means I don’t meet the criteria for one of the categories, but my internal life with food and eating and my weight effects impacts my physical and mental health significantly. So, I know a bit more from the insiders point of view that what has already been written. :-) Secrecy often keeps an eating disorder going.

However during my recent psychiatric hospitalization my diagnosis became, once again, a point of contention. Although I tend toward anorexia, I am not diagnosable as such, but my therapist really pushed the point. He basically said that he didn't care what the DSM said, but that I have anorexia. I made a feeble attempt at saying that my weight was normal and maybe a little overweight. Then, I just had to laugh because I know that has nothing to do with it because my thought patterns and behavior are the same. Also, if it weren't for the medications, I would be underweight.

Eating disorders are highly addictive mental illnesses. They are an expression of deep self-hatred, lack of self worth, and unknowingly a lack of control. I know that I feel in control when I lose weight, but in reality it has control over me. I know that once I reach my goal, it will be lowered, I’ll reach it and it will lower. There is no end to it until I require hospitalization.

Somewhere, I read, that “it is a desperate attempt at making sense of the world.” Well, in the world of chaos and abuse I grew up in, I really was set up for an eating disorder. It is also my way of handling my anger of not being able to self-nurture or feeling in control of events and intense feels that occur. It is the first thing that I run to when I am under emotional stress. I hate the feeling of being full and love the feeling of being hungry and overcoming it.

It makes me feel in control, but control really is an illusion. It is secretive and mine. No one else can stop me, so I am in control. Recently, I just barely began to speak about my eating disorder rather talk around it which is, in part, why I decided to write this post.

However, it has been painful to write and especially painful to find a video because it triggers me. In looking at the pictures and videos, I feel fat, hate how I look and want to lose weight even more. My sense of reality becomes distorted. What I think I look like is not reality. The scale is my best friend and worst enemy. If the numbers are lower then I feel good for a brief moment and then I wish it were lower. At one point I was weighing myself 4-5 times per day. My self-esteem goes up and down with the numbers on the scale. But, no number would be lower enough.

I absolutely hate people talking behind my back instead of to me or comments that like “I wish I had an eating disorder, so I could be as thin as you.” It is painful and makes me realize how hard it is to give it up. It isn’t a glamorous thing. It is an illness.

It isn’t about self-control, it is about lack of it. It is a tough thing to overcome, but I know that there is hope and healing. But it is tough, painful work. It also requires giving up one of my best friends, “control.” My distorted thinking still thinks that I am in control as does my deep denial. It was quite therapeutic writing this post, so thank you!! :-) This was a good experience. I hope this post helps you or someone that you love.

Eating disorders are extremely complicated and there is much more information available. For more details and for help for yourself or someone else, please visit the following sites: