Debunking 5 common myths about bulimia

For National Eating Disorders Awareness Week, I’m dispelling five common myths about an eating disorder particularly common among late teens and young adults, bulimia nervosa (bulimia).

1.  Bulimia is a disorder of affluent, self-absorbed females.
FALSE.
Bulimia nervosa is not a lifestyle choice or a moral failing. It’s a mental illness that causes significant emotional suffering and health problems. Bulimia affects people of every color, income, sexual orientation, and religion. While the majority of those affected by bulimia are female, notably, as many as 1 in 5 people with bulimia are male.

2.  Bulimia is making yourself “throw-up” after eating.
NOT NECESSARILY.
Here are the main diagnostic criteria for bulimia:

  • Self-worth that is excessively influenced by one’s shape and weight
  • Recurrent binge eating (at least 1x/week, for at least 3 months)
  • Recurrent behavior to “compensate” for the binges (at least 1x/week, for at least 3 months)

Compensatory behavior can include self-induced vomiting, but can also include behaviors such as laxative or diuretic abuse, or compulsive over-exercise. Self-induced vomiting is not specific to bulimia either; a minority of those with anorexia nervosa also engage in this behavior.

3.  The biggest risk of bulimia is malnutrition.
FALSE.
Chronic self-induced vomiting can lead to serious and wide-ranging medical complications including dental erosion, gastroesophageal reflux disease (GERD), and internal bleeding. Purging is dehydrating, and such dehydration can lead to severe electrolyte imbalance. This electrolyte imbalance can then lead to cardiac arrhythmia and even sudden death.

Purging is not only harmful, it’s rather ineffective for weight control. While vomiting and laxative abuse may seem like intuitive strategies for expelling calories, many of the calories have already been absorbed in the digestive tract before vomiting.

4.  Bulimia is continuous overeating.
FALSE
. While bulimia necessarily entails recurrent binge eating, such binges typically occur against a backdrop of ongoing self-starvation. (Binge eating disorder, on the other hand, involves recurrent binge eating without either purging or starvation.) This binge-purge cycle is unfortunately self-perpetuating, whereby:

  • “overconcern” for shape and weight leads to self-starvation;
  • severe hunger then ultimately leads to overeating/binge eating;
  • binge eating then triggers heightened overconcern about shape and weight;
  • overconcern about shape and weight (and fear of weight gain) triggers behaviors to counteract the excess calories (and, in some cases, “escape” the emotional distress).

Treatment for bulimia aims to break this cycle. A principal treatment intervention is the prescription of regular eating at scheduled intervals. Regular, scheduled meals decreases disorganized eating and reduces a significant risk factor for binge eating: hunger.

5.  Ignore bulimia and it will go away.
UNLIKELY.
Bulimia is persistent and spontaneous recovery is rare. Our best data on the natural course of bulimia comes from a rigorous, federally funded study of more than 9000 adults in communities across the United States, the National Comorbidity Survey Replication. This study found that, on average, those with bulimia had suffered with it for over eight years.

Bulimia is a debilitating illness, yet many suffer in silence. Overwhelming feelings of shame and ambivalence about recovery often inhibit individuals from disclosing their symptoms to close friends, much less their doctor.

Common sense tips

If you suffer from bulimia, it’s not your fault. If your child struggles with bulimia, it’s not your fault or theirs. Prolonged efforts to identify “THE Cause” of the eating disorder are not only futile, but potentially treatment-interfering.

Speak candidly with your doctor about your eating disorder behaviors, so s/he can order the appropriate tests and complete a medical evaluation. Disclosing the “secret” helps reduce shame.

Bulimia is not only treatable, but also curable, so don’t wait to get treatment; shorter duration of illness is the best predictor of recovery. Seek a therapist with specific expertise in eating disorders, particularly one that practices cognitive-behavioral therapy for eating disorders (CBT-E). For bulimia, the evidence for CBT-E is stronger than that for medication.

Lastly, educate yourself. This website is a good source of reliable information and provides a referral helpline.

Stacey C. Cahn, PhD is a clinical psychologist at the Wellness Center of Rowan University where she specializes in eating disorders and coordinates their Eating Disorder Treatment Program.

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