Signs of Bulimia
Typically, a person who is struggling with bulimia has a preoccupation with their weight. Often those with disordered eating behaviors, or an eating disorder, may struggle with being somewhat overweight and trying to lose the weight.
The person may also have a fear of gaining weight or may start to talk obsessively about their weight, appearance, diet, and weight loss. This can all be an indicator of bulimia or another eating disorder.
Bulimia, like other eating disorders, can quickly become a severe health and mental concern. At first, the individual may have disordered patterns of behaviors and eating habits.
As a person begins to lose weight, he or she may hear praise or compliments from peers or loved ones that encourage the behaviors. As the disordered behaviors continue, it strengthens the eating disorder.
Individuals may start to eat alone, especially when engaging in a binge episode. They may hide binges by throwing away all the food wrappers, fast food containers, or replacing some of the food eaten. The person is trying to hide all evidence of a binge.
After binging, the sufferer begins to self-induce vomiting. This may be evident through cuts or scars on a person’s knuckles or small red pinprick marks on their face from burst blood vessels from the forced vomiting.
Someone struggling with bulimia may tend to spend long periods of time in the bathroom after eating. He or she might also tend to purge in the shower. Their loved ones may begin to notice that the shower and toilet are clogging more often than usual due to all the food from vomiting.
When a person is engaging in daily vomiting, it can cause arrhythmia, heart palpitations, heart attacks and even death. Repeated vomiting can erode the enamel of a people’s teeth, leading to yellow teeth, mouth sensitivity, and rapid tooth decay.
Binging episodes can stretch a person’s stomach thus increasing the amount of food a person can eat. Increasing binges can rip the stomach lining causing stomach acid to spill into the body, which can lead to death .
Gastrointestinal problems such as painful stomach issues can result. Gastric reflux, inflammation of the esophagus, and paralysis of the stomach muscles can all occur due to bulimia.
According to the National Institute of Mental Health, 1% of the adult population in the U.S. suffer from bulimia at some point in their life . Women are more likely to develop bulimia than men . Bulimia is recognized as a mental health disorder in the DSM-V defined diagnoseable criteria
Binge eating is defined in the DSM-V as eating a larger amount of food that other people would in a similar timeframe and similar circumstances . A person, when binging, feels helpless and a lack of control over the behavior.
The individual will often state being unable to stop a binge, even if they want to do so. After a binge, the person will then engage in behaviors to prevent weight gain such as throwing up.
A person with bulimia work to gain physical perfection, but the physical effects of binging, purging, and over-exercising can be extremely harmful and life-threatening to the sufferer.
Physical symptoms can include facial swelling, blood when vomiting, complaints of a sore throat, scarring on hands and/or knuckles, and tooth decay. Individuals may also have an irregular heartbeat, hemorrhoids, dry skin, dizziness or feeling faint, especially when standing, rising from laying down or going up or down stairs .
A person may have red eyes or burst blood vessels from vomiting, and difficulty with fertility. Other issues may include reduced sexual drive and complications in childbirth.
Psychological issues usually develop due to the distorted thought process. A person can have a continued preoccupation with body weight and shape, chronic fear of gaining weight, and a fear of becoming fat .
A sufferer may also have a distorted view of self when looking in a mirror or a reflective surface and may try to hide their body through baggy clothing. The person may also isolate themselves socially and not eat in front of others.
Often looking to online tools for assessments can be helpful. Questionnaires through the National Eating Disorder Association (NEDA) offer free; confidential assessment of the eating disorder and can recommend if you need to seek professional help and treatment.
Treatment can come in various forms. Treatment includes psychotherapy, nutritional counseling, psychiatric care, and group and family therapy .
Psychotherapy includes Cognitive Behavioral Therapy which focuses on a person’s thoughts and emotions to change a person’s behaviors to a situation or trigger. This can help with triggers in a person’s environment that can make it difficult to recover from the eating disorder.
Nutritional Therapy can help a sufferer with setting a meal plan to regulate a person’s hunger cues and satiety level. A nutritionist can also work with an individual to dispel food myths and distorted food thoughts.
Meeting with a psychiatrist can help with medication management and co-occurring disorders such as depression and anxiety. Working with a psychiatrist can help manage symptoms and behaviors that might prolong the eating disorder.
Levels of Care
Residential, partial hospitalization, intensive outpatient programming, and outpatient therapy are the various levels of treatment for someone who has bulimia. All levels offer a team approach that works with the individual, family and friends, a medical doctor, therapist, nutritionist, psychiatrist, and group therapy .
Residential care is 24-hour support through an eating disorder treatment facility where all meals, group and individual therapy, nutritional support, and psychiatric sessions are provided. The person stays in the facility, typically for 30 days, depending on insurance coverage.
Partial hospitalization offers the same benefits as residential care except the person goes home at night. This offers the individual to be able to practice skills learned in individual and group therapy at home outside of the group, but to have the full support of meals and group therapy during the day. A typical length of stay at this level is two weeks to 30 days.
Intensive Outpatient Programming
Intensive outpatient therapy is group support. This level of care is offered three hours per day up to seven days per week, depending on the facility. Meals are provided by the client and checked by the eating disorder staff. Individual therapy, nutritional therapy, and psychiatric sessions are done outside of IOP group time. The length of stay at this level can be two weeks to one month.
Regardless of the severity level on the continuum of bulimia that a sufferer is dealing with, it is important to seek treatment. The earlier a person seeks professional care, the earlier they can recover.
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: Find the Best Bulimia Treatment Programs and Dual Diagnosis Rehabs. (n.d.). Retrieved February 06, 2018, from https://www.bulimia.com/topics/bulimia/
 Bulimia Signs and Symptoms – Am I Bulimic? (n.d.). Retrieved February 06, 2018, from https://americanaddictioncenters.org/bulimia-treatment/signs-symptoms/
 Bulimia nervosa. (2017, August 23). Retrieved February 06, 2018, from https://www.mayoclinic.org/diseases-conditions/bulimia/diagnosis-treatment/drc-20353621
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 a 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 April 26, 2018.
Reviewed on April 26, 2018 by Jacquelyn Ekern, MS, LPC
Published on EatingDisorderHope.com