Bingeing and purging

2014-11-06 00:00

OVER the past few weeks, we have taken a closer look at the mental-health aspect of eating disorders, what they are and what red flags or warning signs we can look out for in our friends, children and other loved ones.

As we have discussed before, eating disorders are characterised by extremes. An eating disorder is present when a person exhibits severe disturbances in eating behaviour or feelings of extreme distress related to their body weight or shape.

Spurred on by these desperate feelings, one seeks to regain some form of control that often results in severely altered food intake and behaviour after eating.

Bulimia nervosa is characterised by frequent episodes of binge eating. A binge is considered eating a larger amount of food than most people would eat under similar circumstances. For instance, the person suffering from bulimia nervosa will readily eat an entire cake, rather than just a slice or two.

Eating may often continue to the point of feeling painfully full. These binges are followed by a type of behaviour which compensates for the binge known as purging (for instance, vomiting after eating, using excessive laxatives or diuretics, fasting and/or exercising excessively).

Bingeing and purging cycles occur frequently and cause the sufferer to feel out of control. Bulimic behaviour is usually secretive and accompanied by extreme feelings of guilt, shame and disgust.

This eating disorder often goes unnoticed as the person may be of a normal weight, or even overweight. Bulimic patients experience the same intense fear of gaining weight and obsession with losing weight as anorexic patients. They are unhappy with their body size and shape, and usually have a negative self-image.

Many physical symptoms result from purging, including electrolyte imbalances, gastrointestinal problems, and dental complications (bulimia is often first detected at a dental visit).

The following are common signs associated with bulimic behaviour:

• chronically inflamed and sore throat;

• swollen glands in the neck and below the jaw;

• swollen salivary glands in the cheeks;

• damaged teeth and gums (due to exposure to stomach acids);

• altered and abnormal bowel function;

• kidney problems from diuretic abuse;

• severe dehydration due to purging;

• irregular heart beat; and

• irregularities in menstruation.

Treatment of bulimia nervosa

As is common across all eating disorders, people with bulimia nervosa frequently have co-existing depression, anxiety and/or substance-abuse problems. This necessitates a broad approach to treatment drawing on a combination of professionals. Improving self-image is essential for long-term correction of this disordered eating behaviour.

Nutritional counselling to address eating attitudes is best given in combination with psychological assistance where rational thinking is addressed (usually cognitive behavioural therapy). Antidepressants and mood enhancers may be useful to treat depression and reduce anxiety.

The support of family and friends is essential to conquering bulimia nervosa. A healthy self-esteem must be fostered, and food can no longer used as an emotional support.

Some red flags which could alert you to disordered behaviour in a friend or family member include:

• persistent comments about being fat;

• not wanting to eat in public or in front of others;

• use of dietary supplements or herbal products for weight loss;

• excessive exercising; and

• the use of laxatives or diuretic medications

Bulimia nervosa does not respect any age or gender. Teenagers, adults, men and women have all suffered this disease. If you recognise any warning signs in friends and family members, discuss your concerns with them. Doing this in a non-threatening manner without making a diagnosis or labelling them is most likely to open the channel for further assistance and professional support.

• Sharon Hultzer is a consulting dietitian. She can be reached at eatsmart@

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