How would I know if I have bulimia?
Bulimia is characterized by periods in which people binge on food, often in a trance-like state, followed by periods in which people purge with vomiting or laxatives to remove food before it is fully digested. If you are dealing with either of these issues, or you suspect that your eating habits are not quite healthy, it is best to see a doctor for help.
Bulimia is a serious mental health disorder that is often misunderstood.
The main hallmark of this disorder is binge eating that is followed by an effort to rid the stomach of the food ingested during the binge. This elimination process can involve purging through the use of laxatives, vomiting, or excessive exercise.
Stated most generally, bulimia (known clinically as bulimia nervosa) is a disordered relationship with food. According to the National Library of Medicine, a significant number of individuals with bulimia also have anorexia.
Self-Diagnosing BulimiaIndividuals who are questioning whether they may have bulimia have likely progressed from the contemplation phase to actually bingeing and purging. It is important to understand that bulimia is a recognized mental health disorder. The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders–5 (DSM-5), which is considered an indispensable diagnostic tool among mental health clinicians. DSM-5 includes bulimia, and this is important as health insurance providers often rely on this manual to determine coverage benefits. There is treatment available for bulimia, and, for many, rehabilitory services have proven instrumental to their recovery process.
The diagnostic criteria for bulimia in DSM-5 are set forth in a chapter entitled “Eating and Feeding Disorders.” There are four criteria, as follows:
- Ongoing episodes of binge eating; this activity is defined as consumption of a volume of food that is larger than most people would consume during a similar timeframe and under similar circumstances
- Feeling helplessness or having a lack of control during binge eating episodes
- After binge eating, making efforts to compensate in an effort to prevent weight gain, including fasting, excessively exercising, abusing laxatives, misusing diuretics, and/or vomiting
- The binge eating and subsequent purging efforts occur at least once a week for three months
- One constantly evaluates oneself in terms of weight and body shape
Individuals who are concerned that they may be engaging in bulimic behaviors may encounter literature about this condition presenting challenges in treatment. A main reason clinicians and researchers provide this feedback relates to a characteristic of bulimia itself. The thoughts underlying bulimic behaviors relate to a desire to achieve and/or maintain a certain body weight or low body weight.
These thoughts are informed by any number of influences, such as outside standards of beauty as presented in the media or one’s own standards of “perfection.”
Signs and Symptoms of Bulimia
Bulimia affects a person’s body, mind, and spirit. Much attention is paid to the physical aspect of this disorder, in part because bingeing and purging is highly impactful and can even be life-threatening.
The following physical symptoms of bulimia provide insight into the many health dangers this disorder presents:
- Facial swelling
- Presence of blood in vomit
- Sore throat
- Scarring on hands
- Tooth decay
- Irregular heartbeat
- Dry skin
- Dizziness or feeling faint
- Red eyes or burst blood vessels (due to vomiting)
- For females, difficulty conceiving
- Diminished sexual drive
- Complications in childbirth
Bulimia has a strong psychological component. A person’s thought processes both cause and fuel this disorder. The following are some of the psychological symptoms of bulimia:
- Ongoing preoccupation with weight and body shape
- A chronic fear of gaining weight or constant worry about being “fat” or overweight
- Feeling out of control when bingeing
- Getting distorted feedback when looking in a mirror
- Moods determined by food intake levels
- Not wanting to eat in front of people or in public
- A preoccupation with people’s perception of one’s weight or body
- Feeling the need to hide one’s eating behaviors
- A desire to weigh oneself often
- Readings from the scale determining one’s emotions
Some of the behaviors associated with bingeing and purging have been discussed above. Facilitation of this disorder can involve traveling from one location to another to obtain food for the binge and finding a place, inside or outside the home, to engage in the binge. Individuals may even expose themselves to risks, such as going out late at night, even in a high-crime neighborhood, to get to an open restaurant or store. There are costs associated with bingeing as eating larger amounts leads to higher food bills.
On the purging side, if vomiting is the method followed, withdrawing to the bathroom after meals is a common occurrence. Out-of-pocket costs associated with purging include costs for diuretics, laxatives, and other elimination aids.
Maintenance of this disorder requires time, effort, and resources. Individuals who look at an average week may realize they are dedicating a disproportionately large amount of time to this disorder. This realization may alert a person to the need for treatment.
A Day in the Life
The Huffington Post published a personal essay on a day in the life of a person who once struggled with severe bulimia.
A review of this individual’s account can help others to gain some clarity within the scope of their personal questions about whether they have bulimia. While no two personal stories are the same, shared experiences can be comforting as well as serve to motivate a person to seek treatment. Shared stories, however, should never take the place of speaking with a qualified counselor, but these stories can provide encouragement to do so. The author of this personal essay recovered, and she seeks to share some valuable insights about her experience with individuals who may also be experiencing bulimia or want to know more about it.
As the author discusses, bulimia is a complex disorder that most often cannot be stopped at will, despite what other people may think and say. Individuals in the same school, living, or work environment may make comments like “just stop” as if doing so were an easy task. For this reason, it is important to know that there is always professional help available for bulimia. Friends and family members may simply not be emotionally equipped or have the knowledge to effectively help a person get care and initiate the recovery process. In fact, individuals may unwittingly fuel bulimic behaviors by making comments related to the afflicted person’s food intake, weight, or body.
The author shares that bulimic behavior may be motivated by a desire to take one’s mind to a place other than the current reality. Food can become a point of focus and the result can be weight gain. The author had this very experience. She would eat to distract herself from emotional pain, then gain weight, and respond by fasting for days (a compensatory activity after a binge). When she would eat, she would eat excessively.
At first, she only binged, but as she gained weight, her eating disorder changed to bulimia (another form of compensatory behavior). While her particular experience may not mirror that of another person with bulimia, it illuminates that there was an emotional issue at the core of her distorted eating pattern. Mental health services are available to help individuals to express and positively cope with emotional pain or other feelings. Engaging in therapy can help to prevent or treat bulimia.
One of the most engaging aspects of the author’s account of her experience with bulimia is how she communicated her unrelenting thoughts about food. As the author describes, she lived with bulimia throughout her day at work and at home at night. Her compulsion to binge interfered with her ability to concentrate on her work. In turn, her need to purge would take her away from her work obligations. The bingeing and purging cycle drove the author into isolation. She did not want anyone to know about her disordered relationship with food, yet at times it would show, such as when she binged on donuts in the office and then purged in the office restroom.
She describes how she would skip seeing her therapist because she didn’t want to make appointments that might interfere with her bingeing and purging. She stopped dating a guy who she suspected knew about her disorder. Her account of living with this disorder, and how it became a priority in her life, opens a window into a very personal but likely relatable experience for someone who is experiencing bulimia.
The good news is that bulimia can be effectively treated with proper care. While AAC facilities do not treat bulimia, high-quality treatment is available at various centers throughout the US.