Bulimia nervosa, usually abbreviated to bulimia, is an eating disorder in which food obsession becomes the primary coping mechanism during stress situations. Individuals who suffer from bulimia often feel like their entire life is dictated by the need to either eat huge amounts of food in a frenzied manner or to physically get rid of their excessive food intake in an attempt to overcome the effects of their binge.
You think you might have bulimia? Try answering the following questions:
Do you go to the toilet after meals to vomit the food you have eaten?
Do you often feel unable to control what and how much you eat?
Do you eat even when not hungry and at a very fast pace?
Do you regularly hide yourself to eat in a solitary place?
Do you hide or stockpile food to eat later, in secret?
Do you feel guilty or embarrassed by what you eat?
Do you have an intense fear of gaining weight?
Does thinking of food stress you out?
If you can identify to any of the above questions, please book an appointment with your GP to discuss a probable underlying eating disorder. Remember, if left untreated bulimia may be fatal.
I don’t have bulimia: I may binge but I don’t force myself to vomit. So, I don’t fit the pattern! I’m fine!
Many people wrongly believe that bulimia equals the classical pattern of bingeing then throwing up. However, bulimia is a complex eating disorder, which may present itself as one of two major types.
But, first, let’s see what bingeing and purging mean.
Bingeing is an episode of eating an abnormally large amount of food in an exceptionally short period of time, accompanied by the sense of complete lack of control over what and how much is being eaten.
Purging is usually used as a ‘safety-net’ as an attempt to avoid weight gain. It involves trying to get rid of the food ingested during the binge, typically by three main types of inappropriate compensating behaviours:
- Self-induced vomiting;
- Misuse of laxatives, diuretics, enemas, ipecac syrup or illegal drugs (e.g. amphetamines);
- Excessive exercising (exercising right after eating or even when injured/tired or working out even in bad weather);
Purging is often followed by severe food restriction over an extended period of time which may then lead to the next bingeing episode.
Note: Purging is INEFFECTIVE as an attempt to expel all the calories from a binge since about 1200calories will be absorbed by the body.
Now, let’s talk about the two main types of bulimia:
Bingeing-purging bulimia: This accounts for the majority of bulimia cases in which the individual with bulimia may have recurring bingeing cycles followed by purging episodes.
Non-purging bulimia: Those who suffer from this type of bulimia do not engage in self-vomiting practices, misuse of laxatives/enemas/diuretics but will compensate for their bingeing episode by:
- Fasting or extreme food restriction or dieting;
- Excessive exercising.
Bulimia (BOTH types) can KILL you!
How does bingeing harm me?
Usually, food eaten would be high-fat/sugar/calories (cakes, chocolate, ice-cream, pizza etc), which can lead to:
- Excessive body fat accumulation: linked to type II diabetes, gall bladder disease and certain type of cancers.
- Overweight and obesity: related to high blood pressure, muscle and joint pain, increased bone brittleness.
- Gallbladder diseases, high blood cholesterol and heart diseases.
- Various types of digestive disorders.
- The binge typically occurs in secret and is often followed by feelings of disgust, shame, or depression which may lead to purging or substance abuse or suicidal attempts.
What are the effects of bingeing-purging on my health?
The picture below shows how bulimia can affect your body.
How can bulimia affect fertility?
Most women suffering from bulimia experience menstrual irregularities or no menses at all, even though they may have a normal body weight. Irregular periods may make trying to conceive very challenging.
Studies show that reduced calorie intake (during periods of extreme fasting), excessive exercise, purging and/or psychological stress may cause disturbances in the level of hormones that are needed to maintain normal oestrogen levels. Abnormal levels of oestrogen may disrupt your ovulation pattern: you may stop ovulating completely and develop infertility.
Moreover, obesity in young women can result in high levels of androgens, male hormones. Androgen imbalance can cause abnormal menstrual cycles and block ovulation, which results in infertility.
Does this mean I can never have a baby?
If you want to become a mother and give the best start in life to your baby, please seek help and FIGHT bulimia now! Since bulimia during pregnancy can greatly endanger your life and that of your baby, it is highly recommended that you recover from bulimia before you try to conceive. Recovery will also help improve your chances of getting pregnant: a healthy diet may normalise your menstrual cycle.
How does bulimia affect pregnancy?
Bulimia during pregnancy can cause the following problems:
- Compulsive eating may cause excessive weight gain during pregnancy which could lead to the onset of gestational diabetes mellitus or pre-eclampsia (pregnancy onset hypertension).
- Poor nutritional status, especially if you purge or exercise excessively, which may cause miscarriage, still-birth, post-partum depression and difficulties in breastfeeding.
- Complications during delivery: a caesarean section might be necessary.
How can bulimia harm my baby?
- If you purge or exercise excessively during your pregnancy, you will be losing vital nutrients and fluids: you may deplete the nutritional reserves on which your baby is TOTALLY dependent. If your baby does not have enough nutrients, he/she may become malnourished, a condition that may lead to improper or delayed growth and development, low birth weight (associated with several diseases at birth and later in life) and intellectual disabilities.
- Laxatives, enemas and diuretics may also cause birth defects and mental retardation if used during pregnancy. In some cases, diuretics proved to be fatal for both the mother and foetus.
- Your baby may be born prematurely and is more likely to suffer from liver problems (jaundice), breathing and respiratory distress and feeding and digestive disorders (which may lead to malnutrition and failure-to-thrive).
How can bulimia worsen my health if I’m pregnant?
Your baby is totally dependent on YOU for his/her supply of nutrients essential for growth and development. So, if you are purging, exercising too much or restricting your food intake, you may be at risk of the following:
- Osteoporosis, or increased bone loss and brittle teeth – your baby will be taking the calcium needed from your diet but if this is insufficient, your bones and teeth will become the calcium ‘sources’.
- Anaemia, which can cause extreme weakness and difficulties in performing daily tasks such as walking – your baby will be taking ALL the essential iron from YOUR stores and red blood cells.
- Severe malnutrition, which may worsen existing damage to vital organs like your heart, kidneys or liver. This may lead to spontaneous abortion.
What challenges will I have to face during pregnancy if my bulimia is active?
- You will need to put on weight during pregnancy (between 6 to 19kg, depending on your pre-pregnancy BMI) and the pregnancy hormones will cause fat deposits in your breasts, hips and thighs. This can be very unsettling.
- Usually, pregnancy results in a decreased activity level which might lead to boredom, anxiety and obsessive thoughts of food, all of which can trigger a binge.
ALL challenges have obstacles – and this is no different. BUT you CAN overcome these obstacles!
I’m pregnant and I have bulimia, what can I do?
- A problem shared is a problem halved: seek medical help to reduce the risks associated with bulimia. The following websites may help you:
Beat: www.b-eat.co.uk – a network of UK-wide self-help groups with lots of information on eating disorders and where to get help, including support groups, help lines and online self-help courses for carers.
Freelance Dietitians: www.freelancedietitians.org – database of experienced registered dietitians who can help you with your health problems.
National Centre for Eating Disorders: www.eating-disorders.org.uk/treatment-and-recovery-help.html – Provides support for individuals suffering from eating disorders.
Anorexia and Bulimia care: www.anorexiabulimiacare.org.uk – Provides personal advice and support to anyone affected by eating distress.
- Request to be referred to a specialist dietitian who will help you to:
- Adopt healthier eating habits for you and your baby;
- Sooth your cravings in a safe and healthy manner;
- Change the way you think about and relate to food.
- Seek individual and group therapy sessions to tackle your eating disorder and any underlying concerns. Keep going to these sessions even after delivery; this can prevent you from relapsing.
- STOP purging, exercising excessively, fasting or restricting your diet: your baby NEEDS you to.
Learn to love your body… let your bump be your source of motivation and inspiration.
If you are pregnant and suffer from bulimia, this could be a golden chance for you to recover. Befriend your body, focus on how great a mum your CAN and WILL be. Be kind to yourself and swap your focus from your weight to your health.
Look at any weight gain as ‘recovery weight’ and a sign that your baby will be healthy.
Take one step at a time, and savour this special moment in your life to the fullest…
NHS Choices (2012) Bulimia (Accessed August 2013).
Stark C (2000) All about bulimia nervosa: a booklet for those anting to know more about bulimia nervosa (Accessed August 2013). The Mental Health Foundation.
U.S. Department of Health and Human Services, Office on Women’s Health (2009) Bulimia Nervosa (Accessed August 2013).