Psychiatrist - Timberline Knolls Residential Treatment Center
Dr. Kimberly Dennis is the Medical Director at Timberline Knolls Residential Treatment Center. She maintains a holistic perspective in the practice of psychiatry, incorporating biological, psycho-social and spiritual approaches…
What is Bulimia?
Posted in Eating Disorder... by Dr. Kimberly Dennis on Dec 30, 2009
If you’ve watched TV or looked in your spam folder lately, you’ve undoubtedly seen one of the numerous ads for Hydroxycut or other fat-burning, muscle-building miracle cures that promise dramatic results in 30 days or less. With these testimonials to quick-fix weight-loss success everywhere, it’s understandable why lots of people – particularly teenagers and women – develop unrealistic expectations about their ability to control their weight and appearance.

Beyond perpetuating the same unhealthy sense of body image and self esteem I talked about in my prior post about anorexia nervosa, these ads can also trigger symptoms of an equally dangerous eating disorder – bulimia (or bulimia nervosa) in persons with certain predisposing biological and life history characteristics.

While bulimia shares many common causes and triggers as anorexia, bulimic symptoms can be quite different. While some patients with anorexia nervosa do have bulimic symptoms as part of their eating disorder, others simply restrict food intake. There is often confusion among the signs and symptoms of bulimia and binge eating disorder, a related but different disease I’ll discuss more fully in a future post. Symptoms of bulimia are most often evident in separate and distinct cycles that can last anywhere from a few hours to several days.

The Binge Cycle
The first cycle is characterized by the rapid consumption of a large amount of high calorie food in a short amount of time. Bulimics often describe their feelings during a binge cycle as being in a trance-like state where they lose track of time, where they are, and who else may be nearby. Food can be consumed so fast that sometimes it’s not even chewed or tasted. An average binge can consist of 1,500 - 3,000 calories, the equivalent of an entire large deep-dish pizza or a full-size birthday cake, although some individuals eat much more during a binge. It’s not uncommon for someone experience symptoms of bulimia to spend hundreds of dollars on food during a very intense binge, which often may only end when their finances are depleted.

The Purge Cycle
Following a binge cycle, those suffering from bulimia nervosa typically experience a wave of guilt, fear or shame that triggers an intense desire to purge the food they’ve just consumed. Seventy to 80 percent of those with bulimia purge by means of self-induced vomiting, though there are several types of purging that I commonly see in patients, each with its own unique dangers:

Self-induced vomiting: The most prevalent form of purging, self-induced vomiting can cause burst blood vessels in the eyes, dental erosion, esophageal tears, increase in size of salivary glands (“chipmunk cheeks”), gastric rupture or potassium depletion, leading to fatal disturbances in heart rhythm.

Laxatives: Some people with bulimia use laxatives to stimulate the bowel, in the misdirected belief that this will rid them of the excess calories from a binge. In reality, if the bowel becomes dependent on the laxatives, any attempt to stop use may lead to temporary constipation, bloating and abdominal discomfort, which often makes them feel worse about their body than before the binge. Longtime use of laxatives can lead to potassium depletion and dehydration, which can make the user feel tired and lethargic, and sap them of the energy needed for work, school and maintaining relationships with friends and family.

Diuretics: Diuretics, or "water pills", ridding the body of water, thus decreasing the sensation of bloating, which may come from the binge itself or from long-term abuse of laxatives. Chronic use of diuretics can lead to kidney damage and/or kidney failure. Similar to laxatives, they can also induce electrolyte or salt imbalances that can lead to fatal disturbances in heart rhythm.

Diet pills/stimulants: Some people purge chemically, by using medications that increase metabolism and/or decrease appetite. Examples of street drugs that do this include cocaine and crystal meth. There are also over the counter diet pills or prescription stimulant medications such as Ritalin. These medications and drugs can lead to potentially fatal heart rhythm disturbances and also have effects on blood pressure.

Excessive exercise: The least understood form of purging, excessive exercise is different from normal attention to fitness when it becomes a preoccupation that interferes with important activities, occurs at inappropriate times or in inappropriate settings, or continues despite injury, illness or bad weather.

With that said, sometimes people with bulimia purge without actually binging first. I see this more commonly in patients for whom the normal consumption of food is associated with experiencing intense feelings such guilt, fear, terror, or anger. Commonly, patients with eating disorders relate these feelings to eating more than they believe they are entitled to, or more than what is required to achieve their ideal body image. This is very different from the restricting form of anorexia, where affected individuals refuse to eat a healthy amount of food in the first place. Some people with anorexia nervosa have a binge-purge pattern of symptoms associated with being extremely underweight.

Why Does it Happen?
The root causes of bulimia nervosa are multi-faceted and a topic for another post, but the most common triggers for binging and purging cycles include:
  • Anxiety stemming from stress at work, school, or in personal relationships

  • Extreme hunger stemming from prior restrictions on food intake, which is how some patients I see with anorexia also begin to show symptoms of bulimia as their disease progresses

  • Shame related to the experience of abandonment, rejection or other life trauma

  • Mood instability, which may be due to depression or other co-occurring psychiatric conditions

If you think you or someone you know might be showing symptoms of bulimia or another eating disorder, contact a qualified professional with experience treating eating disorders and other co-occurring disorders. If you need help locating qualified resources in your area, you can contact the National Eating Disorders Association, or the admissions department at Timberline Knolls Residential Treatment Center, and our staff will attempt to assist you.

Dr. Dennis
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By TimKeys  Feb 12, 2010
Dr. Kim,
Im 45 and never looked at ED from this stand point.
Restriction of food and the abandonment statement really hit home with me.
Growing up there was the restriction then my mother gave me up at age 14.
Im so blessed to have accomplished the things I have in my life, children, farm, professional with a wonderful practice. But it amazes me how that stays with you and you just feel like you are never worth it.
Thank you for helping me see that!!!It actually helped me alot!!
By masso  Jan 08, 2010
this article may be of interest

it shows the link between nutrition and mood disorders (as well as eating disorders)
By raeofsunshine80  Jan 01, 2010
Dr. Dennis, thank you for your posts. They are extremely important. I wish I lived closer and I could come see you for help.
By kayackergirl  Dec 30, 2009
no comments here?
By desrtrse  Dec 26, 2009
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