What is bulimia? Is it the same as anorexia? Can a person have both?

What is bulimia? Is it the same as anorexia? Can a person have both?

Bulimia is characterized by binge eating, which is eating a lot of food in a short period of time (usually less than two hours). Ninety percent of the time, a person with bulimia follows this with vomiting to rid herself/himself of the calories in the food. The vomiting does not result in expected weight loss. Yet, most people with bulimia are normal or slightly overweight.

Bulimia is not the same thing as anorexia which is self-imposed starvation. The person with anorexia is abnormally thin, has a distorted body image and has an intense fear of gaining weight.

Yes, a person can have both bulimia and anorexia. They starve and periodically binge/vomit. They are the most seriously ill, have the hardest time recovering and need the most help quickly before blood electrolytes (sodium, chloride, and potassium) get dangerously low.

Some common foods a person with bulimia will binge on are popcorn, ice cream, doughnuts, candy, cookies, cake, etc. Binge foods are usually high calorie/high carbohydrate foods that can be eaten quickly. They also usually don’t eat food in front of other people, yet seem to maintain their weight. Again, as with people who have anorexia, food is not the problem, but a symptom of psychological issues.

A person with bulimia can usually remember when she or he started bingeing and vomiting. From my clinical experience, most patients remember their parent’s divorce or breaking up with a boyfriend as being the start of the binge/vomit cycle. They can remember overeating a “fattening” food followed by guilt from eating a “forbidden food”.

In the beginning, the vomiting becomes a way to rid oneself of excess calories. The person with bulimia then uses the vomiting as a means to control weight. Other diets have failed and vomiting becomes the weight control method. Vomiting becomes a life preserver that the person with bulimia can’t let go of because they know they have lost control of their eating. If they let go of the vomiting, they fear their weight would overcome them.

But vomiting does not control weight. What happens is that the body adapts. Food is retained longer in the stomach because the body doesn’t think it will get all the nutrients from food. Digestion starts occurring higher in the gastrointestinal tract. People with bulimia have thrown up food they ate more than 24 hours before when the usual stomach empties in about 2 hours.

People with bulimia express guilt and shame about bingeing and vomiting. They usually have a limited number of trusted persons that they tell about their vomiting. In fact, most of the bingeing and vomiting happens in their own home when no one else is home. However, other family members notice missing food and the smell of vomit in the bathroom.

The typical person with bulimia is a white, single, female, high school or college student. The average age is 21 years. Athletes who participate in sports with weight restrictions, like gymnastics, wrestling, football, and boxing, may practice periodic binging/vomiting to control their weight. Sports is no excuse to start vomiting to control weight.

It is not normal to force yourself to vomit after overeating. If this happens at least once a week, you have one of the symptoms of bulimia.

One health problem that people with bulimia have is that by vomiting, they are losing a lot of water, sodium, and potassium. Your body gets out of electrolyte balance quickly and you can become seriously ill. Dehydration is serious for persons with bulimia.

Another health problem people with bulimia have is with their teeth. Because of repeated vomiting, the enamel on their teeth gets destroyed by the stomach acid vomited with the food. The pH of stomach acid is 1.2 which is more acidic than any food you can eat.

How do you help a person with bulimia? First, they need professional psychological help. Food is not the issue. Most can be treated in an outpatient clinic. Professional help is available at most mental health clinics. Also, eating disorder clinics usually advertise in phone books and newspapers. Most college campuses have support groups for persons with eating disorders as well as a counseling office. If the person is someone in your family, remove any foods they usually binge eat. If you are not sure, eliminate sweets, desserts, snack chips, and any food frequently found missing.

A person with bulimia needs to learn healthier ways to control their weight. They need to eat 3 regular meals a day and eat to anticipate hunger. Persons with bulimia also need to learn what situations set them up to binge eat and vomit.