Sarah Lucas, LMFT

Bulimia nervosa has only recently been recognized as an official eating disorder, thus there is not as much research information available to us as there is for anorexia nervosa. The term, bulimia nervosa, means literally “the hunger of an ox for nervous reasons”. As in anorexia nervosa, this term is misleading because it implies that the illness is only about eating. The real“hunger” in bulimia is actually emotional need that can never be satisfied by food, which helps in understanding the pattern of the disorder: after bingeing, or impulsively eating a large quantity of food, the person will immediately rid themselves of the food they have consumed by vomiting or taking laxatives (or both), or they will work off the calories with exercise. This is an attempt to “undo” the binge and to prevent gaining weight.

As with anorexia nervosa, people who develop bulimia nervosa rely on the control of food and eating as a way of coping with psychological pain. But in bulimia nervosa, food itself is used to numb the pain. Unbearable feelings like rejection, shame, anger, or fear are transformed into a more “tolerable” form: an uncontrollable urge to numb oneself through stuffing the body with large amounts of food - often “bad” or “forbidden” foods like sweets or junk food. A huge sense of relief is felt when the “bad” food is purged from the body, especially when the purging method is immediate, like vomiting. The resulting sense of numbness acts to protect the sufferer from the painful feelings, at least until the next cycle begins.

The frequency of these bulimic cycles varies: some will suffer from an episode every few months while others may binge and purge several times a day. There are other differences in the way the illness affects people: some may vomit automatically after they have eaten any food, some may appear to eat normally, but may binge and purge in private. Many people do not regard their illness as a problem, whilst others despise and fear the scary and uncontrollable cycle.

Bulimia nervosa usually begins in adolescence or early adult life, and may start as a desire to lose weight due to body dissatisfaction and low self-esteem. The binge eating often begins after a period of restrictive dieting or even anorexia nervosa. However, because many people with bulimia nervosa weigh within the normal range for their age and height (unlike people with anorexia nervosa), and often binge and purge in secrecy, the disorder may go undetected for a long time. Yet, unfortunately, even at normal weights, people with bulimia nervosa may have serious complications like fluid imbalances, amenorrhea, electrolyte imbalances, cardiac complications, gastric bleeding, and severe malnutrition.

Treatment for bulimia nervosa can be very effective if it occurs early in the illness, however, if left untreated, the success rate for recovery drops significantly. Relapse is very common with bulimia nervosa, this it is imperative to seek treatment as early as possible, and to continue in treatment until recovery can be maintained over a substantila period.