Bulimia Nervosa – Breaking the Binge Purge Cycle
Bulimia nervosa is an eating disorder characterized by patterns of consuming a large amount of food in a short amount of time (bingeing) and eliminating calories consumed (purging). The most common compensatory behavior is vomiting. Other compensatory behaviors are using laxatives or diuretics, excessive exercise; extreme fasting; and manipulating insulin or other medications. Someone with Type 1 diabetes who controls insulin struggles with “diabulimia.” Diabulimia is extremely dangerous, and an individual with diabulimia should obtain a medical assessment immediately.
Bulimia is a debilitating condition that is often accompanied by other mental health conditions. And although someone with bulimia may experience initial weight loss, that process is often not as dramatic as the individual with anorexia nervosa. Therefore, those with bulimia may appear more “normal” but will present in a variety of body types. About 40% of the individuals who seek treatment for bulimia are male. The onset of bulimia may be a bit later than anorexia, first appearing in the mid to late teens. The behaviors occur in secret, so individuals may eat normally or even skip meals with others but engage in binge/purge behaviors in secret. Food may disappear, or there could be laxative wrappers in the garbage or signs of vomiting.
Individuals with bulimia also have significant body image dissatisfaction. However, their body image disturbance is not as severe as individuals with anorexia. In other words, they will be unhappy with weight and depend too much on weight as a measure of self-worth but may not be as driven to lose weight. In addition, they may appear to be socially connected but not have good quality relationships due to the amount of time and energy devoted to worrying about eating and food.
Dietary chaos means a lack of essential nutrients, so even though the individual may appear fine, semi-starvation can still occur. There can be a loss of dental enamel due to repeated vomiting. In addition, these individuals are at higher risk of other impulse control behaviors: substance use, self-harm and suicidal gestures, shoplifting, or sexual promiscuity. If the electrolytes in the blood are disturbed, seizures, heart palpitations, or even heart failure can result.
Secrecy and Shame
There is secrecy and shame about the behaviors, and often the individual knows the behavior is unhealthy but feels helpless to stop the binge/purge cycle. Because denial is not as pervasive, these individuals often request treatment for themselves. The initial goals are to interrupt the compensatory behaviors, establish more consistent eating patterns, and learn ways to manage the accompanying discomfort. Accomplishing these goals can be successful on an outpatient basis, but if the cycles of binge/purge behaviors are increasing or if there are worrisome signs of medical complications (fainting, repeated need for rehydration, blood when vomiting, heart palpitations), seek an assessment by your physician and consider whether a higher level of care may be needed.
Eating disorders can occur in individuals of all ages, genders, and body types. At Sanford CTED, we treat both adolescents and adults and offer outpatient (OP), intensive outpatient (IOP), partial hospitalization (PHP), and residential treatment (for adult women). Our continuum of care allows the individuals we treat to enter a program at the level that is appropriate for their symptoms. In-person and telehealth options are available.
Don’t be afraid to reach out. At Sanford CTED, we transform lives and offer hope to those with eating disorders.
Eating Disorder Programs
- Partial Hospitalization (Day Programs, PHP)
- Intensive Outpatient (IOP)
- Outpatient Groups
- Outpatient Psychiatry
- In-Person and Telehealth Programs
- Experiential and Exposure Therapy
What We Treat
- Anorexia Nervosa
- Avoidant Restrictive Food and Intake Disorder (ARFID)
- Bulimia Nervosa
- Binge Eating Disorder
- Other Specified Feeding and Eating Disorders (OSFED)
- On-site Psychiatrist, Internists, Physician Assistants, Nurse Practitioners, RNs
- Executive Director, Doctor of Clinical Nutrition
- Psychotherapists with specialized training in treating eating disorders
- Registered Dietitians/Clinical Nutrition Specialists
- Certified Recreation Therapists
- Recovery Support Specialists