пʼятниця, 3 вересня 2010 р.

Bulimia Nervosa . Signs, Symptoms, Treatment, and Help

We’ve all been there: turning to our kid’s Halloween candy stash when feeling lonely or impulsively indulging in too much fast food when stressed. But when you suffer from bulimia, the now-and-then impulse is more like a compulsion. And instead of eating sensibly to make up for it, you punish yourself by purging, fasting, or exercising to get rid of the calories. 
This vicious cycle of binging and purging takes a toll on the body, and it’s even harder on emotional well-being. But the cycle can be broken. Effective bulimia treatment and support can help you develop a healthier relationship with food and overcome feelings of anxiety, guilt, and shame.

What is bulimia?

When you suffer from bulimia, life is a constant battle between the desire to lose weight or stay thin and the overwhelming compulsion to binge eat. You do your best to keep the cravings at bay. You don’t want to binge—you know you’ll feel disgusted and ashamed afterwards—but you can’t fight the urge. All you can think of is food, and in the end, you give in.
You eat whatever you can get your hands on, binging until you’re so stuffed you feel like you’re going to explode. Then the panic over all the calories you’ve eaten sets in. Terrified of gaining weight, you turn to drastic measures to “undo” your binge, purging, fasting, or exercising to get rid of the calories. And all the while, you feel increasingly out of control.

The three key features of bulimia

  • Regular episodes of out-of-control binge eating
  • Inappropriate behavior to prevent weight gain
  • Self-worth excessively influenced by weight and physical appearance
It’s important to note that bulimia doesn’t necessarily involve purging — physically eliminating the food from your body by throwing up or using laxatives, enemas, or diuretics. If you make up for your binges by fasting, exercising to excess, or going on crash diets, this also qualifies as bulimia.

Am I Bulimic?

Ask yourself the following questions. The more “yes” answers, the more likely you are suffering from bulimia or another eating disorder.
  • Are you obsessed with your body and your weight?
  • Does food and dieting dominate your life?
  • Are you afraid that when you start eating, you won’t be able to stop?
  • Do you ever eat until you feel sick? Do you feel guilty, ashamed, or depressed after you eat?
  • Do you vomit or take laxatives to control your weight?

The binge and purge cycle

Dieting triggers bulimia’s destructive cycle of binging and purging. The irony is that the more strict and rigid the diet, the more likely it is that you’ll become preoccupied, even obsessed, with food. When you starve yourself, your body responds with powerful cravings—its way of asking for needed nutrition.
As the tension, hunger, and feelings of deprivation build, the compulsion to eat becomes too powerful to resist: a “forbidden” food is eaten; a dietary rule is broken. With an all-or-nothing mindset, you feel any diet slip-up is a total failure. After having a bite of ice cream, you might think, “I’ve already blown It, so I might as well go all out.”
Unfortunately, the relief that binging brings is extremely short-lived. Soon after, guilt and self-loathing set in. And so you purge to make up for binging and regain control.
Unfortunately, purging only reinforces binge eating. Though you may tell yourself, as you launch into a new diet, that this is the last time, in the back of your mind there’s a voice telling you that you can always throw up or use laxatives if you lose control again. What you may not realize is that purging doesn’t come close to wiping the slate clean after a binge.


Purging does NOT prevent weight gain

Purging isn’t effective at getting rid of calories, which is why most people suffering with bulimia end up gaining weight over time. Vomiting immediately after eating will only eliminate 50% of the calories consumed at best—and usually much less. This is because calorie absorption begins the moment you put food in the mouth. Laxatives and diuretics are even less effective. Laxatives get rid of only 10% of the calories eaten, and diuretics do nothing at all. You may weigh less after taking them, but that lower number on the scale is due to water loss, not true weight loss.

Signs and symptoms of bulimia

If you’ve been living with bulimia for a while, you’ve probably “done it all” to conceal your binging and purging habits. It’s only human to feel ashamed about having a hard time controlling yourself with food, so you most likely binge alone. If you eat a box of doughnuts, then you’ll replace them so your friends or family won’t notice. When buying food for a binge, you might shop at four separate markets so the checker won’t guess. But despite your secret life, those closest to you probably have a sense that something is not right.

Binge eating signs and symptoms

  • Lack of control over eating: Inability to stop eating. Eating until the point of physical discomfort and pain.
  • Secrecy surrounding eating: Going to the kitchen after everyone else has gone to bed. Going out alone on unexpected food runs. Wanting to eat in privacy.
  • Eating unusually large amounts of food with no obvious change in weight.
  • Disappearance of food, numerous empty wrappers or food containers in the garbage, or hidden stashes of junk food.
  • Alternating between overeating and fasting: Rarely eats normal meals. It’s all-or-nothing when it comes to food.

Purging signs and symptoms

  • Going to the bathroom after meals: Frequently disappears after meals or takes a trip to the bathroom to throw up. May run the water to disguise sounds of vomiting.
  • Using laxatives, diuretics, or enemas after eating. May also take diet pills to curb appetite or use the sauna to “sweat out” water weight.
  • Smell of vomit: The bathroom or the person may smell like vomit. They may try to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.
  • Excessive exercising: Works out strenuously, especially after eating. Typical activities include high-intensity calorie burners such as running or aerobics.

Physical signs and symptoms of bulimia

  • Calluses or scars on the knuckles or hands from sticking fingers down the throat to induce vomiting.
  • Puffy “chipmunk” cheeks caused by repeated vomiting.
  • Discolored teeth from exposure to stomach acid when throwing up. May look yellow, ragged, or clear.
  • Not underweight: Men and women with bulimia are usually normal weight or slightly overweight. Being underweight while purging might indicate a purging type of anorexia.
  • Frequent fluctuations in weight: Weight may fluctuate by 10 pounds or more due to alternating episodes of bingeing and purging.

Effects of bulimia

When you are living with bulimia, you are putting your body—and even your life—at risk. The most dangerous side effect of bulimia is dehydration due to purging. Vomiting, laxatives, and diuretics can cause electrolyte imbalances in the body, most commonly in the form of low potassium levels. Low potassium levels trigger a wide range of symptoms ranging from lethargy and cloudy thinking to irregular heartbeat and death. Chronically low levels of potassium can also result in kidney failure.
Other common medical complications and adverse effects of bulimia include:
  • Weight gain
  • Abdominal pain, bloating
  • Swelling of the hands and feet
  • Chronic sore throat, hoarseness
  • Broken blood vessels in the eyes
  • Swollen cheeks and salivary glands
  • Weakness and dizziness
  • Tooth decay and mouth sores
  • Acid reflux or ulcers
  • Ruptured stomach or esophagus
  • Loss of menstrual periods
  • Chronic constipation from laxative abuse

The dangers of ipecac syrup

If you use ipecac syrup, a medicine used to induce vomiting, after a binge, take caution. Regular use of ipecac syrup can be deadly. Ipecac builds up in the body over time. Eventually it can lead to heart damage and sudden cardiac arrest, as it did in the case of singer Karen Carpenter.
Source: National Women's Health Information Center

Bulimia causes and risk factors

There is no single cause of bulimia. While low self-esteem and concerns about weight and body image play major roles, there are many other contributing causes. In most cases, people suffering with bulimia—and eating disorders in general—have trouble managing emotions in a healthy way. Eating can be an emotional release so it’s not surprising that people binge and purge when feeling angry, depressed, stressed, or anxious.
One thing is certain. Bulimia is a complex emotional issue. Major causes and risk factors for bulimia include:
  • Poor body image: Our culture’s emphasis on thinness and beauty can lead to body dissatisfaction, particularly in young women bombarded with media images of an unrealistic physical ideal.
  • Low self-esteem: People who think of themselves as useless, worthless, and unattractive are at risk for bulimia. Things that can contribute to low self-esteem include depression, perfectionism, childhood abuse, and a critical home environment.
  • History of trauma or abuse. Women with bulimia appear to have a higher incidence of sexual abuse. People with bulimia are also more likely than average to have parents with a substance abuse problem or psychological disorder.
  • Major life changes: Bulimia is often triggered by stressful changes or transitions, such as the physical changes of puberty, going away to college, or the breakup of a relationship. Binging and purging may be a negative way to cope with the stress.
  • Appearance-oriented professions or activities: People who face tremendous image pressure are vulnerable to developing bulimia. Those at risk include ballet dancers, models, gymnasts, wrestlers, runners, and actors.

Bulimia treatment and recovery 

If you are living with bulimia, you know how scary it feels to be so out of control. Knowing that you are harming your body just adds to the fear. But take heart: change is possible. Regardless of how long you’ve had bulimia, you can learn to take charge of your behavior and experience a full and successful recovery.
Taking steps toward a healthier you is tough. It’s common to feel ambivalent about giving up your binging and purging, even though it’s harmful. If you are even thinking of getting help for bulimia, you are taking a big step forward. Remember, in order to be your best self, you have to make a change.

Therapy for bulimia

Poor body image and low self-esteem are at the core of bulimia, therefore, psychotherapy is an important part of recovery. Here’s what to expect in bulimia therapy:
  • Breaking the binge-and-purge cycle – The first phase of bulimia treatment focuses on stopping the vicious cycle of bingeing and purging and restoring normal eating patterns. You learn to monitor your eating habits, avoid situations that trigger binges, cope with stress in ways that don’t involve food, eat regularly to reduce food cravings, and fight the urge to purge.
  • Changing unhealthy thoughts and patterns – The second phase of bulimia treatment focuses on identifying and changing dysfunctional beliefs about weight, dieting, and body shape. You explore attitudes about eating, and rethink the idea that self-worth is based on weight.
  • Solving emotional issues – The final phase of bulimia treatment involves targeting emotional issues that caused the eating disorder in the first place. Therapy may focus on relationship issues, underlying anxiety and depression, low self-esteem, and feelings of isolation and loneliness.

The importance of deciding not to diet

Treatment for bulimia is much more likely to succeed when you stop dieting. Once you stop trying to restrict calories and follow strict dietary rules, you will no longer be overwhelmed with cravings and thoughts of foods. By eating normally, you can break the binge-and-purge cycle and still reach a healthy, attractive weight.

Overcoming bulimia

It may seem like there’s no escape from your eating disorder, but recovery is within your reach. With treatment, support from others, and smart self-help strategies, you can overcome bulimia and gain true self-confidence.

Helping a person with bulimia

It’s painful to know your child or someone you love may be binging and purging. You can’t force a person with an eating disorder to change and you can’t do the work of recovery for your loved one. But you can help by offering your compassion, encouragement, and support throughout the treatment process. Here are a few ideas for what you can do today to help make a difference for tomorrow.

Do:

  • Be a cool customer. No matter how worried you are, approaching your loved one with alarm is not the best approach. Stash away the eating disorder articles for now. Find a neutral place to chat and: (1) calmly say what you’ve noticed, and (2) explain why you’re worried.
  • Talk and listen. Let compassion be your guide. Make sure they know you intend to listen. Keep in mind they might feel defensive or angry. It’s embarrassing to talk about binging and purging. But if they do come to you for a listening ear, show no judgment, even if they sound unstable.
  • Take “solve” out of your vocabulary. As a parent or friend, there isn’t a lot you can do to “fix” your loved one’s bulimia. They must decide on their own when they are ready to move forward.
  • Set an example of healthy eating, exercising, and body image. Never make negative comments about your own body or anyone else’s.
  • Be good to yourself. Know when to seek advice for yourself from a counselor or health professional. Keep your friends and relatives involved in the support network.

Don’t:

  • Be the food police. A person with bulimia needs kindness, not nutritional advice.
  • Use insults, fear, guilt, or embarrassment. Since bulimia is often a caused by a form of stress and self-hate, negativity will only make it worse.
Let kindness, compassion, support and empathy be your guide. Support from friends and family is always helpful for recovery.

http://helpguide.org/mental/bulimia_signs_symptoms_causes_treatment.htm

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