The self esteem of a bulimic is centered on his/her perception of their body image; specifically weight and shape. Binge eating is not caused by hunger; it is a response to feelings of depression, anxiety, or worthlessness. Binge eating temporarily calms these emotions. Bulimics report feeling out of control during a binge. Favorite foods are consumed rapidly and in excess, these foods are usually high in calories and fat. Following a binge, the individual feels deeply ashamed and/or guilty for their inability to control their food intake, and engages in actions to prevent the consequences of the binge, weight gain.
Signs and Symptoms of Bulimia
Bulimics know that they have an eating disorder and frequently go to great lengths to hide it. They are successful for a while. Although there may be frequent fluctuations in their weight, they appear to be of normal weight or slightly overweight. However, bulimics have an obsession with their weight, their caloric intake and fat content of foods. They read cookbooks, magazines, and self-help books and search the Internet for information on weight loss, recipes and even eating disorders. They are frequently on a diet, may abuse diet pills, and go on periodic fasts. The bulimic knows the caloric content of every food. They may keep meticulous food diaries or lists outlining their intake and output. Some will actually weigh their vomit or feces. Signs of binge behavior include shopping at different markets, wanting to eat in privacy, late night errands, and hoarding food. Friends and family members may notice that the individual can eat an unusually large amount of food with no obvious change in weight. Food disappears from the home, wrappers are found in stash areas. The bulimic rarely eats normal meals, except in social situations. Bulimics tend to be overachievers with a perfectionist type personality. Their self-esteem is extremely low.
After a meal the purging type bulimic retreats to a bathroom to vomit, and may run the faucet to disguise the sounds. She may use an emetic, stick her fingers down her throat, or has trained herself to be able to vomit at will. To cover up the odor she will use mouthwash, gum, mints, perfume, or air freshener. Empty laxative packets, syrup of Ipecac or diuretic bottles, as well as enemas may be found in the trash or the secret stash. Or she may engage in strenuous aerobic workouts after eating. Friends and family members may see certain physical signs of bulimia; puffy cheeks caused by repeated vomiting; ragged or discolored teeth caused by stomach acid while throwing up, or calluses/sores on their knuckles from sticking fingers down her throat. Bulimics may complain of sore throats, swollen glands, diarrhea, or fatigue. They are usually depressed, and often have suicidal ideation. Studies have shown that the suicide rate for females with an eating disorder is between 50-75 times greater than for those who do not. Bulimics frequently have co-existing mental health disorders including; anxiety personality, and/or impulse control disorders. They are at greater risk for developing other impulsive and self-destructive disorders such as self harm/mutilation and/or alcohol or substance abuse.
Physical Consequences of Bulimia Nervosa
The binge-purge cycle of bulimia nervosa can be fatal. Purging can lead to electrolyte imbalances causing chronic dehydration, cardiac arrhythmias, heart failure, seizures, coma, and even death. Repeated vomiting can tear or rupture the esophagus and stomach. It also increases the likelihood of lung aspiration of the vomit which can lead to pneumonia. The individual may develop peptic ulcers or pancreatitis. Bulimics usually have menstrual irregularities and a decrease in their sex drive. Vomiting also causes the gums to recede and erodes tooth enamel.
Laxative and diuretic abuse also leads to severe dehydration and electrolyte depletion. Additionally, chronic abuse of laxatives can lead to irritable bowel syndrome, a ruptured colon, constipation, infections and colon cancer.
Other physical effects include skin rashes, broken blood vessels in the face or a pale complexion, dry skin, changes in the hair and nails, low blood pressure, swelling of the lower legs/feet, or a decrease in sensation of the hands or feet.