Timberline Knolls | Information on Bulimia

Information on Bulimia

What Is Bulimia?

Bulimic behavior has two phases: the binge and the purge.

The Binge

Although there are certainly individual variations, a binge is defined as the rapid consumption of a large amount of high calorie food in a short amount of time. A binge can consist of almost anything. Often it can depend on what is available in terms of food and finances.

Once a binge begins, it is very difficult to interrupt. People often describe feeling in a trance or a stupor; food can be consumed so rapidly that it is not even tasted. An average bulimic binge may consist of about 1,500 kcal to 3,000 kcal, although some individuals have reported eating up to 60,000 calories or more during a binge. Having said this, sometimes people purge without actually bingeing. Unplanned eating creates such guilt and anxiety that those people feel driven to eliminate or undo any food that feels as though it were "too much." Often the binge ends only when food or finances are depleted, leaving the person with bulimia with severe abdominal and emotional discomfort.

The characteristics of binge-eating include the following:

Bingeing usually occurs in secrecy.
Binge episodes may be planned or unplanned.
Usually the episodes are characterized by rapid, frenzied consumption.
Some people report feeling as though they enter into an altered state when the binge begins.
Many people with bulimia report they do not even taste much of what they consume during a binge.

The most common triggers for binge-eating include:

negative mood states
interpersonal stressors
hunger due to dietary restriction
negative feelings related to one's body image

The Purge

Seventy to 80 percent of people with bulimia purge by means of self-induced vomiting, while 30 percent use laxatives.

Risks associated with purging:

Laxatives: There are several dangers associated with laxative abuse. The most frequently used laxatives are those that stimulate the bowel. Some people use large amounts of laxatives following a binge to rid the body of the food. Laxatives are an ineffective means of ridding the body of calories, because most of the calories are absorbed from food before it gets to the end of the intestinal tract. In addition, if the bowel becomes dependent on the laxatives, then stopping use may lead to temporary constipation, bloating and abdominal discomfort, which often compels laxative use and the cycle continues. Longtime use of laxatives can lead to potassium depletion and dehydration. Another risk of chronic laxative abuse is that the bowel can become unresponsive. The best way to deal with laxative abuse is to stop "cold turkey." During this period a person may experience some side effects for a short time (10 days), but then normal bowel functioning should return. Some individuals prefer to use fiber-based laxatives (e.g., Fiberall®, bran) for a short period of time during the transition.
Diuretics: Diuretics, or "water pills", are the least effective means of managing weight. Diuretics work by ridding the body of water, thus decreasing feelings of bloating. Chronic use of diuretics can lead to kidney damage and/or kidney failure. They can also induce electrolyte or salt imbalances that can lead to fatal disturbances in heart rhythm.
Self-induced vomiting: Self-induced vomiting can cause burst blood vessels in the eyes, dental erosion, esophageal tears or potassium depletion, leading to fatal disturbances in heart rhythm.
Excessive exercise: Exercise is excessive if it interferes with important activities, occurs at inappropriate times or in inappropriate settings, continues despite injury, illness or bad weather or becomes a preoccupation

By Sue Craven, PhD, and Toby Goldsmith, MD

Source Reviewed by Steven Batton, DO, associate medical director, ValueOptions Inc.