Symptoms of bulimia nervosa, while painfully apparent to women and men suffering from the eating disorder, often go unnoticed by family and friends. The cycle of binge eating and purging produces feelings of shame, self-loathing and guilt in bulimics. In response to these feelings, bulimics often are secretive about their binge eating and deny health complications.
Bulimia and the Binge Eating/Purging Cycle
The classic symptom of bulimia is a persistent cycle of binge eating and purging. To qualify as bulimic, a person must exhibit binge eating and purging behavior at least twice a week for three months. The frequency of binge eating and purging varies widely in bulimia cases; some bulimics may binge and purge up to ten times a day.
Binge Eating Symptoms
Bulimics describe feeling out of control during an episode of binge eating. While binge eating, bulimics consume exceptionally large quantities of food. Calorie counts range into the thousands for a single episode of binge eating.
Favored foods for binge eating are usually high fat, high carbohydrate products such as ice cream, donuts and other junk food. Many of these foods are popularly considered “comfort food” (consider the common media image of upset women consoling themselves with ice cream or similar products).
Binge eating is often triggered by stress, depression, or other negative emotions. Bulimic women have distorted, negative views of their weight and body shape, and often binge eat due to negative thoughts about their own weight. Attempts to lose weight through purging behavior or extreme diets (a health risk in themselves) can cause intense hunger that may also trigger binge eating.
Once an episode of binge eating starts, bulimics continue to eat either until interrupted or until their stomachs are uncomfortably, painfully, overfull. Binge eating is usually performed in secrecy and isolation, as bulimics are aware their eating habits are abnormal. Food is consumed rapidly, with little concern for taste, quality, or nutritional value.
Binge eating appears to temporarily calm and negate the emotions that trigger a binge. This emotional relief is short-lived. Shame, guilt, and self-loathing at uncontrolled eating quickly overwhelm bulimics after an episode of binge eating.
Purging behavior is as important a bulimia symptom as binge eating. Purging describes any behavior used to counteract the calories consumed while binge eating. Some women describe purging as a method of regaining control of themselves after binge eating.
Purging often takes the form of self-induced vomiting, either by pressing fingers to the back of the throat or using ipecac syrup. Scars and calluses on the back of the knuckles develop due to long term self-induced vomiting, and some bulimics learn to vomit automatically after eating.
Acid from vomit eventually destroys dental enamel, causing multiple dental cavities and a sensitivity to hot and cold foods.
Other methods of purging include abusing laxatives (sometimes consuming up to fifty laxative pills a day), and misusing diuretics, enemas, and diet pills. Abusing laxatives and other medication while purging can have serious health effects. Abusing laxatives and other medication while purging can have serious health effects.
Not all bulimics use purging techniques. Excessive exercise and fasting are also used to prevent weight gain. Both calorie-burning techniques can have negative affects on women’s health. Bulimics may exercise in spite of exhaustion or injuries, and severe fasting borders on self-starvation.
Mental Health and Bulimia Nervosa
Symptoms of depression and anxiety often accompany bulimia in men and women, as do feelings of helplessness, low self-esteem, and low self-worth. Bulimics, like anorexics, base their self-worth almost entirely on body image.
Other mental health problems common to bulimia include substance abuse, sexual promiscuity, self-mutilation and impulse control disorders. An obsession with food may lead bulimics to hoard or steal food for later consumption.
Bulimia Nervosa and Menstruation
Bulimia symptoms specific to women’s health may include menstruation problems. Bulimic women experience amenorrhea in fifty percent of cases. The remaining fifty percent retain their menstrual cycles and can conceive children.
General Signs of Bulimia Nervosa
Detecting symptoms of bulimia in others is difficult, due to the secrecy that surrounds binge eating and purging. Bulimics can be very good at hiding health problems and symptoms. Some bulimics keep their disorder secret even from family and friends. Possible clues a person may have bulimia include:
- eats in isolation
- enjoys talking about dieting
- has frequent sore throats from vomiting
- has frequent bloating, constipation, or flatulence
- is highly impulsive
- hoards food
- is an overachiever
- has a perfectionist-type personality
- reads recipe books
- reads books on dieting or eating disorders.
Bulimia in Men: Living with a “Women’s” Disease
Cases of bulimia in women far outnumber bulimia in men. Most studies indicate the ratio of bulimic women to men is 10:1. As a result, bulimia is seen primarily as a women’s health issue. This perception makes it difficult for men with bulimia nervosa to seek and receive help. In addition to the shame associated with bulimia, men feel shame because they suffer from a “women’s” health problem, and may feel their manhood is under attack.
The view that bulimia is solely a women’s health issue also means bulimia in men often goes undiagnosed. Diagnosis, treatment, and support groups are usually aimed at women, leaving those suffering with male bulimia feeling marginalized. Expressing these feelings and concerns to physicians may help some men overcome the “women’s health” hurdle.