Bulimia Nervosa at a Glance

“For me, the bulimia was about stuffing my emotions. So I stopped suppressing my feelings.” ~Cheryl James

My friend’s dad is a dentist; within the first minute of looking into someone’s mouth, he can tell if the person struggles with bulimia nervosa. This is because bulimia–the binging and purging of food–wreaks havoc on a person’s teeth. The acid from the stomach visibly destroys the enamel of the teeth and causes noticeable discoloration. But this particular side-effect of bulimia is only the tip of the iceberg among much more serious consequences that come from this eating disorder and mental illness. Continue reading to learn what it is, what causes it, as well as the symptoms, consequences, and recovery options for bulimia nervosa. 

Even though Derek Zoolander downplays the significance of bulimia nervosa, it is a very serious, potentially life-threatening eating disorder. People with bulimia secretly binge and then purge to get rid of extra calories in an unhealthy and unnatural way. Binging includes discretely eating a large amount of food, within a small amount of time, accompanied by a lack of control during this episode. Purging methods vary from regularly self-induced vomiting, misusing laxatives, weight-loss supplements, diuretics or even enemas after bingeing. Other ways include denying calories to prevent weight gain through fasting, strict dieting or excessive exercise.  The severity of bulimia is determined by the number of times a week that a person purges, usually at least once a week for at least three months. 

The exact cause of bulimia is unknown. Many factors could play a role in the development of eating disorders, including genetics, biology, emotional health, societal expectations and other issues.  Women are more likely to struggle with bulimia than men, but the latter are still susceptible. Bulimia typically begins in the late teens or early adulthood.

Bulimia shares several symptoms with other mental illnesses: Negative self-esteem, problems with relationships and social functioning, difficulty concentrating, poor sleep patterns, withdrawal from friends, etc. Symptoms specific to bulimia nervosa include extreme preoccupation with self-image, body shape and weight; fear of gaining weight; feeling uncomfortable eating around others; trying to “fill up” by ingesting unsubstantial food (ie. condiments), drinking excessive amounts of water or non-caloric beverages, or trying to chew food for an unnecessarily long amount of time; hoarding food in strange places; disappearing after eating (often to purge in a private place); frequently using mints, mouthwash and gum to cover unnaturally bad breath; and maintaining a rigid exercise regimen to “burn off” calories ingested. 

Bulimia nervosa affects far more than how an individual perceives him- or herself or what he/she eats. This eating disorder truly harms a person’s body in the following ways:

  • Unusual swelling of the cheeks or jaw area  
  • Calluses on the back of the hands and knuckles from self-induced vomiting 
  • Bloating from fluid retention  
  • Stomach cramps and other gastrointestinal issues (constipation, acid reflux, etc.) 
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate) 
  • Dizziness 
  • Fainting/syncope 
  • Feeling cold all the time 
  • Dental problems like enamel erosion, cavities, and tooth sensitivity 
  • Dry skin 
  • Dry and brittle nails 
  • Swelling around salivary glands 
  • Thinning of hair on head, dry and brittle hair (lanugo) 
  • Muscle weakness 
  • Yellow skin (in context of eating large amounts of carrots) 
  • Cold, mottled hands and feet or swelling of feet 
  • Menstrual irregularities
  • Poor wound healing 
  • Impaired immune functioning
  • Dehydration (leading to kidney failure)
  • Heart problems, such as an irregular heartbeat or heart failure
  • Severe tooth decay and gum disease
  • Absent or irregular periods in females
  • Digestive problems
  • Anxiety, depression, personality disorders or bipolar disorder
  • Fertility issues (in women)

Many people with bulimia nervosa also struggle with co-occurring conditions, such as self-injury (cutting and other forms of self-harm without suicidal intention), substance abuse, impulsivity (risky sexual behaviors, shoplifting, etc.), and even diabulimia (intentional misuse of insulin for type 1 diabetes). 

While bulimia nervosa is a very serious mental illness, the good news is that it is not a life sentence. There are many options available for treatment, including medication, support groups and group therapy, and individual therapy. By identifying your triggers, I can help you manage stress and avoid the cycle of binging and purging. Getting support and help often gives you extra strength to fight your eating disorder.  Because bulimia is related to self-image–and not just about food–bulimia can be hard to overcome on your own. Effective treatment can help you feel better about yourself, adopt healthier eating patterns and reverse serious complications. Contact me today to get started.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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Intuitive Eating: Giving Your Body What It Wants

“Eating today has become this idea that the food on your fork can either kill you or cure you. It’s gotten to a point of almost religious fervor.” ~ Evelyn Tribole

Babies cry, eat, and then stop sucking when they have had enough milk. Children naturally balance their food intake from day to day — eating when they are hungry and stopping when they feel full. But adults have all types of stipulations on when they can eat, what they can eat, and how much they can eat. At some point, we stop letting their internal clocks guide us in feeding our hunger, and instead rely on society’s norms to guide our nutritional intake. Children have something to teach us about what, when, and how much we eat: It’s called following our intuition or intuitive eating.

In honor of March being National Nutrition Month, I want to talk about our relationship with food. There are so many diets today; Keto diet, Nutrisystem, Weight Watchers, South Beach, Dukan, Paleo, Vegan, low-carb and Atkins diets to name a few. There are all sorts of “fad diets” out there that eliminate certain food groups, have you count carbs, measure waistlines, and include a range of rules to achieve weight loss. And while [temporary] success may come from these diets, many individuals and dietitians in the country have found that more often than not, weight that has been lost that way does not stay off forever.  

Have you heard of intuitive eating? In 1995, two dietitians in Southern California grew tired of watching their clients see success in weight loss through dieting, only to gain it back over time. One of these dietitians, Evelyn Tribole, said, “We were banging our heads against the wall because the way we were working wasn’t working. We were sick of the insanity [our clients] were going through: They’d restrict themselves and lose weight, but then they’d gain it back and they’d blame themselves.” So she and her colleague, Elyse Resch, went back to the drawing board and their book, “Intuitive Eating A Revolutionary Program That Works” was born.  

At the time, Americans were just starting to realize how tiresome the shame and fear around food and ineffective weight loss was. In their book, Evelyn and Elyse encourage readers to do something that might sound backwards and dangerous:

Eat what you want, with no rules about what to eat, how much of it, or when.

Intuitive eating has 10 tenets, which I urge you, my readers, to read, ingest (pun), and practice. In a future blog post, I will go over these 10 principles of intuitive eating in greater detail and offer actionable steps. For the purpose of this overview post, I wish to focus only one of these 10 tenets, the one that may surprise you the most about intuitive eating: No foods are off limits, and there is no such thing as a “good” or “bad” food.

I imagine you are thinking, woah woah woah, this just sounds like a free-for-all. I see where you are coming from and I validate that concern. But step back and allow me to explain. Often times, the reason you and I crave pizza is because we tell ourselves it is a wonderfully delicious sinful indulgence. But if we look at pizza as what it truly is (bread, tomato sauce, cheese, and pepperoni)–not necessarily anything good or bad…just food!–then the guilt associated with pizza evaporates. Sure, you may gorge on pizza for the first couple days of eating intuitively (and preliminary studies have found this occurs frequently for those new to intuitive eating), but eventually the body will tell you it has had enough pizza and wants something else. It may surprise you how quickly your body will tell you to pass up the post-workout donut and instead eat something nutritious!

It is undeniable that different foods have different nutritional benefits. Tribole and Resch are not aiming to tear down public-health initiatives that tell society to eat vegetables. At the very root of intuitive eating is the training to teach you to pay attention to how food makes your body feel.  If you untangle food from the stress, shame, and labels that society has put on things you eat, how do you really FEEL eating that donut or that celery juice? The fact is that while you may fill up on Five Guys, if you truly pay attention to what your body wants, you will inevitably crave the variety and nutrition represented by the “healthy” foods you once had used as punishment in your dieting days.

Intuitive eating means breaking free from the yo-yo cycle of dieting and learning to eat mindfully and without guilt. Intuitive eating is about trusting your inner body wisdom to make choices around food that feel good in your body, without judgment and without influence from diet culture. You were born with the skill to eat, to stop when you are full, to eat when you are hungry, and to eat satisfying foods. Intuitive eating is a return to that instinctual skill.

Intuitive eating is not a weight-loss program. It is not a diet. It is a way of life, a complete paradigm shift with what you eat and why you eat it. It has been found to improve body image, to promote mindfulness practices such as meditation, and encourage exercise — all of which is intended to better attune people to their bodies. This will allow you to mitigate binge- and emotional-eating tendencies…by listening to your body!

Calorie counting, carb avoiding, and waistline measuring are miserable lifestyles. The lifelong pressure to diet wears people down and does not lead to a healthy relationship with food. Though I am not a certified dietitian, I have experience in helping clients struggling with rules and negative beliefs around what they eat. I have seen firsthand how effective and life-altering intuitive eating can be. If you need help working through unhealthy eating habits, I would be happy to assist you and point you to helpful resources. Please contact me or schedule a session today to get started on the path to a healthier relationship with both food and your body.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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Eating Disorders 101

Eating Disorders - Cluff Counseling, Denton TherapistUp to 30 million Americans suffer from an eating disorder. According to the National Eating Disorder Association, anorexia nervosa has the highest mortality rate of any mental disorder. Understanding this epidemic is the first step to getting help–either for yourself or for someone you care about.

Everywhere we look we see ads, movies, tv shows, billboards, and models all flaunting perfect bodies: skinny legs, impressive thigh gaps, flat tummies, chiseled abs, massive biceps. With social media at our fingertips, it is easy to compare our body to what we see in the media. Other times, social comparisons are not at the root of an eating disorder–it may be that you are watching you parents go through a divorce, or you did not make the cut onto the Varsity team, so you look for an outlet to feel some sort of control over your life. When controlling your food intake becomes extreme or obsessive, it is called an eating disorder.

Eating disorders are very serious; many young women and men die each year from complications associated with their disorder. Both genders can develop an eating disorder, although rates among women are higher than among men. Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life.

Eating disorders are psychological conditions with both physical and emotional symptoms. The three most common eating disorders include anorexia nervosa (voluntary starvation), bulimia nervosa (binge-eating followed by purging), and binge-eating disorder (binge-eating without purging). Today, we will take a deeper look at each of these three types of eating disorders and discuss how to overcome them.

Anorexia nervosa
Those with anorexia nervosa see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa weigh themselves repeatedly, severely restrict the amount of food they eat, and eat tiny quantities of a small variety of foods.  They relentlessly pursue thinness–it consumes their life. Common symptoms seen in those with anorexia is an intense fear of gaining weight, distorted body image, low self-esteem (one that is heavily influenced by perceptions of body weight and shape), and a denial of the seriousness of his/her low body weight. The long-term effects of anorexia include but are not limited to infertility, thinning of the bones, anemia, muscle weakness, brittle hair and nails, severe constipation, low blood pressure, damage to the heart, brain damage, and multiorgan failure.

Bulimia nervosa
The next eating disorder I would like to discuss is bulimia. This is where the individual eats excessively large amounts of food and then purges by vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike anorexia nervosa, those with bulimia nervosa usually maintain a healthy or relatively normal weight. Their binging and purging behavior gives them a feeling of control. Some of the negative symptoms include an inflamed sore throat, swollen salivary glands, worn tooth enamel (plus increasingly sensitive and decaying teeth as a result of exposure to stomach acid), acid reflux disorder, gastrointestinal problems, intestinal distress and irritation from laxative abuse, dehydration from purging of fluids, and electrolyte imbalance (which can lead to stroke or heart attack).

Binge-eating disorder
Like the other types of eating disorders, binge-eating disorder involves a person completely losing control over his/her food intake. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. Thus, those with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the United States. Symptoms include eating unusually large amounts of food in a specific amount of time, eating even when he/she is full or not hungry, eating fast, eating until he/she is uncomfortably full, and eating alone or in secret to avoid embarrassment.

An eating disorder is considered a process addiction, meaning the person is dependent upon a behavior– instead of a substance– for power, control, or satisfaction. I have worked with many patients who struggle with various types of addiction, and I know that recovery is possible. When a mental illness (such as depression or anxiety) is present along with the eating disorder, medication may be needed. Lasting recovery for eating disorders may also include regularly working with a dietician in order to establish and maintain a personalized, healthy goal for caloric intake. These actions, coupled with regular counseling from a qualified therapist, will address the physical and emotional factors of the eating disorder, and can lead to a full recovery.

The earlier an eating disorder is detected and the sooner help is sought, the greater the chance for a full recovery. If you or someone you care about struggles with an eating disorder, now is the time to make a change. Health, happiness, and recovery is possible, and I am here to help. Please contact me today or click here to set up your first session.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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