Bulimia is a common eating disorder among college-aged students. Bulimia symptoms include episodes of binge-eating followed by purging through self-induced vomiting, over-exercise, or laxative abuse to ‘rid’ the body of the food ingested.
What is Bulimia
Bulimia is a severe eating disorder and a mental health diagnosis. Typically a person will become obsessed with body image, a desire to lose weight, and have intense fears of becoming overweight. It includes cycles of binging and purging. Binging episodes can last from minutes up to 2 hours, with large amounts of food being consumed during the binge.
Immediately following a binge, the purge cycle begins where several rounds of self-induced vomiting, abusing laxatives or diuretics, over-exercising or a combination of all these methods are used to rid the body of the food ingested.
Signs and symptoms include buying and hiding large amounts of food or hiding food wrappers and containers. Often, a sufferer will eat other people’s food during a binge episode.
The person may frequently be seen going to the restroom following a meal to purge.
Other signs include increasingly bad breath, swelling under the cheeks and jaw, tooth discoloration, complaints of throat pain, gastrointestinal distress, or acid reflux. Also, knuckle calluses can develop from self-induced vomiting and can be apparent.
The individual may also obsessionally talk about weight, body shape and size talk. They may compare themselves to other people’s body and may continuously feel that their body does not meet their unrealistic standard.
Many times, social, academic, and daily interference from the bulimia occurs. The sufferer may start to isolate themselves by not attending parties, avoiding activities they used to enjoy, or not go to events so they can be alone to binge and purge.
If the sufferer is in college, often their grades may begin to drop, and they start to drop out of typical college life activities. However, if the disorder is severe, they will withdraw from school to attend treatment.
Bulimia affects up to 3% of the female population . It can create significant medical and psychosocial issues as well as develop underlying co-occurring disorders.
Those who have bulimia can eat thousands of calories in one binge episode . Self-induced vomiting or other compensatory behaviors are used to try to prevent weight gain and regain control of the situation.
These events can occur every few days, daily, or even multiple times per day. If bulimia is left untreated, it can lead to significant medical issues and death.
Self-induced vomiting affects the teeth, the esophagus, and the gastrointestinal tract . Some individuals will have tooth erosion on the enamel as acid comes back up into the throat and mouth. Other individuals will experience ulcers or gastroesophageal reflux disease.
As vomiting continues, the esophagus becomes raw and inflamed, and forcing oneself to vomit can rupture the esophagus.
In some severe cases, over-stretching the stomach can cause a gastric rupture were the contents of the stomach spill out into the abdominal cavity creating a dangerous medical emergency.
Diuretic abuse can cause damage to the kidneys and lead to dehydration. Laxative abuse can cause gastrointestinal issues, such as recurrent diarrhea and constipation.
Up to 2% of people who have bulimia abuse ipecac, which is an over-the-counter medication that helps induce vomiting  This medicine can have toxic effects on the heart, weaken the muscle and potentially damage ventricles within the heart.
Abuse of these drugs can also lead to electrolyte imbalances which can also affect the function of the heart and other major organs.
Why Some People Have to Change Focus
With the hefty medical consequences of bulimia nervosa, many college students either have to leave school or not attend school to get treatment for their eating disorder.
Often, residential treatment is the first line of intervention that a person may receive due to the complicated nature of treatment.
Residential treatment requires that the sufferer attends treatment 24-hours per day and stays in a residential facility. All meals and snacks are provided and, a staff member supervises all bathroom visits. Often residential stays can range from 30 to 90 days or longer depending on the severity of the bulimia.
Partial hospitalization treatment is another level of care, directly below residential care. At this level, the individual stays 12-hours per day and receives all meals, snacks, and treatment they would in residential, but can go home to sleep in the comfort of their own home.
After these levels of care, there is Intensive Outpatient Programming and Outpatient Therapy. These are typical levels that an individual steps down into as their recovery progresses. People can also move up in the levels of care as well if their symptoms become worse or a relapse occurs.
College is Triggering
Often eating disorders do not begin at college age. Typically an eating disorder starts around the age of 8-12 when a child is exposed to environmental, genetic, biological, and social factors that ‘trigger’ the beginning of an eating disorder.
It is a time of transition to go from high school to college. When a teenager heads off to school, they are faced with challenges, a new school, new peers and friends, new academic challenges, and being away from home for the first time.
They can be exposed to and engage in various types of behaviors that may be detrimental to their well being. With transition can come stress which can trigger the use of unhealthy coping skills, such as turning to bulimic behaviors, to help the sufferer to feel more in control.
As behavior patterns develop into bulimia nervosa, it may not be apparent or noticeable to friends and family at first. Often, it goes unrecognized until there is an interference with daily functioning, grades, or loss of interest in activities.
At that point, medical treatment and psychological treatment are necessary, often resulting in the student withdrawing from the university.
Recovery can take months to years to achieve, but even though the person may have dropped out of college, they can continue to acquire an education as many universities now offer online degrees.
Sufferers may be able to enjoy the benefit of earning their degree while practicing recovery.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
References: Rae Jacobson . (n.d.). Signs a College Student May Have an Eating Disorder. Retrieved December 09, 2017, from https://childmind.org/article/signs-a-college-student-may-have-an-eating-disorder/
 Berner, L. A., & Marsh, R. (2014). Frontostriatal Circuits and the Development of Bulimia Nervosa. Retrieved December 09, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233924/
 Medical Issues From Anorexia, Bulimia and Other Eating Disorders. (n.d.). Retrieved December 12, 2017, from https://www.bulimia.com/topics/medical-issues/
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on January 3, 2018.
Published on EatingDisorderHope.com