Bulimia Nervosa: So Empty, Yet So Full

Deputies respond to a local grocery store for a report of a petty theft. A young woman had been detained by management after entering the store's bathroom with a shopping basket containing several food items; she had left the bathroom empty handed 35 minutes later. In the trash can employees had found the wrappers of a box of a dozen Entenmann's Country Powdered Donuts, a pint of Ben and Jerry's Chocolate Chip Cookie Dough Ice Cream, and two TWIX Caramel Cookie Bars. The rest of the evidence, shall we say, was flushed. The suspect, Katie, was sobbing, very ashamed, and extremely remorseful. Katie, a student at a local community college, related that she suffered from bulimia. She had not intended to engage in theft while in the store, but became overwhelmed by anxiety and had an unignorable craving to eat the sweets. She then was compelled to rid herself of the calories and had induced vomiting in the employee's bathroom. Katie 19 years old, 5'7" and weighed more than her DL indicated, 150 lbs vs. 135 lbs. She was more than willing to pay for the loss, but states she was too embarrassed to go to the checkout stand with the empty containers. The cost of the theft was just over $10.00. Katie had consumed 4016 calories in just over a half an hour. She was cited for petty theft; but perhaps a more appropriate charge would have been for vandalism, as she never actually left the store with the items. In fact, the merchandise exited the store by a device installed by the merchant. One of my partners suggested the charge should have been for illegal dumping. All kidding aside, bulimia nervosa is a complicated and potentially deadly psychiatric disorder.

You are hungry, you eat. You feel satiated, you stop eating. Sounds simple enough; but not to the 10 million Americans who have eating disorders. An individual with an eating disorder eats or refuses to eat to satisfy emotional not physical needs. He/she consumes insufficient or excessive amounts of food. The three main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder, which is also referred to as a compulsive overeating disorder. These disorders manifest themselves as abnormal eating patterns, which can have severe medical and emotional consequences. Eating disorders have the highest mortality rate of any mental illness; without treatment (20%) of people with serious eating disorders will die. Unfortunately, only 1 in 10 people with eating disorders will receive the treatment they need.

Bulimia Nervosa

Bulimia is the most prevalent eating disorder; affecting 1 in 7 females aged 12-25. Ten percent of college aged women in the Unites States have engaged in this dangerous eating disorder of binging and then purging. Only 10% of individuals diagnosed with bulimia are male. The peak onset for bulimia is between the ages of 16-18. Unfortunately the physical and psychological consequences of the disorder are immense, including death related to medical consequences or suicide. There are two types of bulimia nervosa: purging and nonpurging. A purger regularly engages in self-induced vomiting (90% of all cases) or abuses laxatives (50-100 tablets at a time), diuretics, or enemas. A nonpurger uses other inappropriate compensatory behaviors such as fasting, severe diet restrictions, diet pill abuse, or excessive exercise.

The normal food intake for women and teenagers is between 2,000-3,000 calories per day. Bulimic binges average approximately 3,400 calories in 75 minutes. However, some bulimics consume up to 20,000 calories in binges that can last up to 8 hours. 20,000 calories is the equivalent of: 100 Krispy Kreme doughnuts, 4½ gallons of vanilla ice cream, 10-13 cakes, or over 8 pounds of potato chips. You do the math, binges can be very expensive. Now add the costs for emetics (syrup of Ipecac), laxatives, diuretics, enemas, and gym memberships, and it's clear why many young women may resort to stealing or fraud to support this highly addictive disorder.

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.

Treatment

Eating disorders, such as bulimia, are treatable diseases. If bulimia is treated within the first 5 years of onset, the recovery rate is 80%. Treatment is very similar to that for substance abuse. The most successful treatment is a combination of counseling, behavioral therapy, education, and frequently antidepressant medication (Prozac, Zoloft, Paxil, or Luvox). Eating disorders are really not about food, but about self worth, perception and esteem. The goal of therapy is to change the subject's attitudes about eating, weight, and body image. Serious medical complications may require hospitalization related to cardiac, gastrointestinal or respiratory injury, or to restore hydration and regulate electrolytes. The subject may require ongoing medical attention related to stomach and esophagus injuries, as well as colon and kidney damage. Bulimics often need extensive dental work as well.

Eating Disorders and Western Culture

Annually, Americans spend over $35 billion on dieting or diet related products, and $13 billion on cosmetic surgery. 80% of all ten year olds are worried about being fat. Many girls begin playing with Barbie dolls as toddlers. If Barbie was a real person she would 5'9", weigh 101 pounds, and have a 36-inch bust, an 18-inch waist, and 33-inch hips. Open any woman's magazine and you will find an article on dieting. Thin actors and actresses dominate movie and television screens, and are invariably the stars. The media message is crystal clear: thin people are happier, more popular, powerful, and successful. Lose weight; get a makeover; some plastic surgery and your life will be rosier. Any consequences are generally viewed as inconsequential.

Referrals

If you encounter a citizen, suspect, friend or family member who shows the symptoms of bulimia nervosa you should refer them to both a primary care physician and mental health care professional. If you struggle with your weight or self image, seek professional treatment. Ideals about weight and body image are frequently quite different than reality. There are many ways to identify your ideal weight based on gender, age, etc. For the most comprehensive web calculation for ideal weights including BMI, medical recommendations, and life expectancy I suggest that you visit the Ideal Weight website below.



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