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Bulimia Nervosa: Violent Self-Contradiction

Bulimia is perhaps the most common eating disorder seen in figure skaters and one of the more common seen in general society. Its true prevalence both in and out of the skating world may never be known, however, because it's also the eating disorder which is easiest to hide.

Clinical definition

Bulimia Nervosa as defined by the DSM-IV is characterized by episodes of binge eating (uncontrolled consumption of a large amount of food in a relatively short period of time) followed by an inappropriate "compensation" such as forced vomiting, laxative or diuretic abuse, a subsequent fast or period of food restriction, or excessive exercising. The last is sometimes called "exercise bulimia" and is probably more common that people think.

The DSM-IV requires that this cycle of binge eating and subsequent compensatory behaviors occur on an average of at least two times a week for three months or more (otherwise it will probably be diagnosed as ED-NOS), but any sort of binge/purge cycle is effectively bulimia. Don't kid yourself that you don't have a problem just because you haven't been doing it that long or that often. Keep it up long enough, and it becomes a serious, potentially deadly problem

The DSM-IV also has two sub-types of bulimia nervosa: purging and non-purging. Forced vomiting, or abuse of laxatives or diuretics, is considered "purging" by DSM-IV standards. Fasting or engaging in excessive exercise after a binge to compensate for the calories consumed is considered "non-purging." A person who regularly binge eats, but does not purge or otherwise compensate for the excessive intake, is generally classified as having binge eating disorder (another form of ED-NOS). Sometimes it can be sort of a fuzzy line between bulimia and the binge/purge type of anorexia. However, if a patient meets all other criteria of anorexia nervosa, that is generally the diagnosis which is made.

Why would someone do this?

The binge/purge cycle is difficult to understand if you don't have an eating disorder yourself. The "logical" way to maintain weight is to just eat a healthy diet and exercise in moderation. (Then again, who ever said eating disorders were logical?) But incredibly, some statistics show that about one in four women has tried to use binge eating and purging to lose weight at one time or another. Even if they "only" do it once, that's a pretty frightening thought.

A person may binge eat as a way to cope with stress and/or anxiety, or to fill an emotional void. It also might be due to legitimate hunger, if the person has previously been restricting food intake. This is why even people with anorexia may develop bulimic tendencies. Subsequent "compensation" (the throwing up, taking laxatives or diuretics, obsessive exercise) is sometimes a way to punish themself for the binge, or as a way to assert control over themself...especially since during a binge, they may feel out of control). Purging may also be "symbolic" of getting something bad out of their bodies... abuse victims who were forced to perform oral sex on others, for instance. Again, although on the surface it may appear to be all about food, it is mostly due to underlying issues.

Studies have been done as to the chemical aspect of purging. The stimulants in laxatives are physically and psychologically addictive. Also, chemicals called endorphins are released when a person throws up, which might also be a reason that persons with bulimia may feel euphoric after purging.

Bulimia is not "better"

Some people also think that it's "better" to have bulimia (as opposed to suffering from anorexia) because "at least they are still getting some nutrition" and "they're still maintaining their weight." Nothing could be further from the truth! Just because the consequences aren't always as obvious as those of anorexia doesn't make them any less severe. For one thing, bulimics often binge on not-so-nutritious foods, which should throw THAT rationale right out the window. Second of all, not all people with bulimia maintain weight... the binge/purge cycle usually causes very large fluctuations in weight that wreak havoc on the person's metabolism...not to mention their psyche.

Frequent purging can also do a tremendous amount of damage to a person's body, anything from electrolyte imbalance, to severe dehydration, to dental cavities, to gastric or esophogal rupture, to acid reflux, to heart failure. Bulimia is just as dangerous as anorexia or any other eating disorder. It could almost be argued that bulimia is actually more dangerous.

It also saddens me to hear people saying that bulimics are just "gross" or that they should just diet "the right way" so they don't have to purge. Even if a person with bulimia does not dramatically lose weight, this doesn't mean they are not suffering terrible physical and psychological consequences from their eating disorder. You can't measure a person's pain on a scale any more than you can determine their worth by how much they weigh. A person with bulimia needs and deserves just as much care and attention as any other eating disordered patient.... or anyone else in the world.

Evan Keraminas

Links specific to bulimia Bulimia Nervosa
In the Mind of a Bulimic
Beyond Mirrors (personal story)
DSM-IV diagnostic criteria for bulimia
Bulimia Nervosa Main Page
Bulimia and related disorders
Princess Diana's struggle with bulimia article on bulimia
Bulimia Fact Sheet
The Bulimic Dance

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Why figure skaters? ED questionnaireBooks on eating disorders Eating disorder links
Issues of diagnosisSubmission formHealthy coping skillsBody image links
Healthy eating/Nutrition Self-injury

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