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What is Bulimia?

Here's what we believe:  Bulimia is a coping method that develops from a system that enforced the pattern of restrictions and guilt.  Often this pattern disallows people from getting their needs met in healthy ways thus leaving them with this secretive and self-destructive pattern of achieving them. 

Food is an easy target. It’s tangible. It easily tricks someone into thinking that they are satisfied. But it’s an illusion. Bulimics share the common factors of guilt, shame, secrecy, but also the inability to fully express who they are without guilt or fear of being "overindulgent" if you will.  This is why we believe so many more woman suffer from eating disorders.  As young woman we are taught that overindulgence in any form is bad.  And that we should restrict ourselves and be less than we are.  Bulimics also share the overwhelming feeling of being misunderstood and overlooked.  And sadly, the miss-attention from the media only serves to reinforce these feelings. 

The media has focused primarily on the aspect of a distorted Body Image as the driving force behind Eating Disorders. Although most Bulimics do have issues with body image, weight obsession is far from being the core of this disease.  And this constant yet, hypocritical attention by the media to the issue being body image, misses the point and fails to really understand the nature of Bulimia.  

Payson Road takes a creative approach to recovery by encouraging the use of artistic expression. Through writing and other art forms, people with eating disorders learn how to express their passions and interests. By discovering who they are and learning to nurture their interests and needs they slowly take steps toward breaking the cycle.  We are not a treatment center.   We recommend our program in conjunction with therapy.  

In terms of the Risk Factors:  Today there are studies that suggest that there are biological factors involved in keeping one in this cycle.  One such study explores the idea that the cycle of Bulimia (binging and purging) causes a physiological response that makes a person believe that they are hungry when they are not.  Their stomach is literally tricked into believing they are hungry when they are not.  

There's also a growing contingent of researchers who believe that eating disorders are a result of genetic makeup.  Although it is hard to determine the exact origins and risk factors for eating disorders, this is not a theory embraced by Payson Road.  We believe that eating disorders stem from many factors, predominantly social and familial.

Some psychologists even believe that the Bulimia pattern starts at a very young age.  The child's gut instincts in regards to food are interrupted.  They are talked out of their experience and become unsure and unaware of their needs.  Susan Sands, Stanford University and the Wright Institute at Berkeley argues in her paper, "Bulimia, Dissociation, and Empathy: A Self-Psychological View"  that it is not enough to see Bulimia purely as a symptom rather, the bulimic symptomatology must be viewed as the behavioral component of a split-off "bulimic self", with needs, feelings, and perceptions quite different from the person's ordinary self-experience.  One must actively seek out and empathize directly with the bulimic self in order to uncover the archaic needs embedded within it.  

What does that mean exactly?  Basically that Bulimia is a very intricate disease.  It is paradoxical and secretive in nature and therefore we must really dig deep to get in touch with that part that has somehow been lost to Bulimia.  

That said, please keep in mind that definitions can not begin to tell the individual story of each person suffering . If you are seeking information on Bulimia and other Eating Disorders please read The Truth column. Personal stories can educate you far more than these facts.


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Is everything they've told me about Bulimia bull?

No, certainly not everything.  But let's define who "they" are.  In this case, "they" would be the media - magazines, television, movies etc.  

There's something substantially missing from the story "they" have thus far been telling us.   Bulimia is not just about the desire to be thin in a "thin crazy" culture.  It's much deeper than that.  That would be like saying being an alcoholic is only about the desire to be drunk.  Or that being a drug addict is purely about getting high.  We all know it's far deeper than that.  And it's far more personal.  

The point?  Take what you see on television with a big grain of salt.  And take what you read on the internet with a bigger grain of salt.  In all my research, I've found mostly sites and information about "Eating Disorders and the over-obsession with weight loss."  NO NO NO!  That's not what it's all about! 

There are many more stories out there.  

STAY AWAY from Pro-Bulimia (and anorexia) sites.  These are NOT helpful. 

DO keep searching for information and DO try to get help.  The Resource guide can help with that.  There are many wonderful professionals out there doing incredible healing work with eating disorders.  I highly recommend checking out our Resource guide for our list of preferred treatment centers.  Also. check out the Payson Road Bookstore.  There's a wealth of knowledge in books  and not just eating disorder books.  You can't imagine what a source for inspiration some of these stories can be.  And they may just help you and your eating disorder.  If you let them.

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Am I Bulimic if?

If Recurrent Symptoms include:

eating large amounts of food in a distinct period than forcibly throwing up or binging and purging. 

Other symptoms may include; 

• eating in secret, coupled with a sense of lack of control, feelings of  guilt, 
• misuse of laxatives 
• severe caloric restriction
• diuretics
• enemas
• or excessive exercising, etc. to rid yourself of the perceived excess food intake and obsession with weight loss and body image.  

I am not a therapist.  You should check with a mental health care professional to get the final word on a diagnosis.  

Diagnostic Criteria - 
*(from the Something Fishy website)

1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
   
   • eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
   • a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
   
   • Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
   • Non-purging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas 

Here's what I hate about these lists (like the one above) - they're statis.  And we're not statistics.  Remember that one.  Yes, it's important to get the facts on eating disorders but many sites out there throw out this information like their listing inventory.  But I will note, that Something Fishy is solid source for information.  Just remember to get the whole picture.

Payson Road is not a medical text book, we're a support site and we care about you. 

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Signs and Symptoms of Eating Disorders
*(from the Something Fishy website)

Payson Road is not keen on statistics and fact sheets.  Which is why we have relied on our good friends at the Something Fishy site who do tremendous work in support of eating disorders.  They also have several comprehensive lists.

Keep in mind, your child, or friend or co-worker or loved may exhibit some of these symptoms and still not have an eating disorder - be sensitive of that.  And also, find out more than just these statistics.  Keep reading the site!  

Anorexia/Bulimia

1. Dramatic weight loss in a relatively short period of time.
2. Wearing big or baggy clothes or dressing in layers to hide body shape and/or weight loss.
3. Obsession with weight and complaining of weight problems (even if "average" weight or thin).
4. Obsession with calories and fat content of foods.
5. Obsession with continuous exercise.
6. Frequent trips to the bathroom immediately following meals (sometimes accompanied with water running in the bathroom for a long period of time to hide the sound of vomiting).
7. Visible food restriction and self-starvation.
8. Visible binging and/or purging.
9. Use or hiding use of diet pills, laxatives, ipecac syrup (can cause immediate death!) or enemas.
10. Isolation. Fear of eating around and with others.
11. Unusual Food rituals such as shifting the food around on the plate to look eaten; cutting food into tiny pieces; making sure the fork avoids contact with the lips (using teeth to scrap food off the fork or spoon); chewing food and spitting it out, but not swallowing; dropping food into napkin on lap to later throw away.
12. Hiding food in strange places (closets, cabinets, suitcases, under the bed) to avoid eating (Anorexia) or to eat at a later time (Bulimia).
13. Flushing uneaten food down the toilet (can cause sewage problems).
14. Vague or secretive eating patterns.
15. Pre-occupied thoughts of food, weight and cooking.
16. Visiting websites that promote unhealthy ways to lose weight.
17. Reading books about weight loss and eating disorders.
18. Self-defeating statements after food consumption.
19. Hair loss. Pale or "grey" appearance to the skin.
20. Dizziness and headaches.
21. Frequent soar throats and/or swollen glands.
22. Low self-esteem. Feeling worthless. Often putting them-self down and complaining of being "too stupid" or "too fat" and saying they don't matter. Need for acceptance and approval from others.
23. Complaints of often feeling cold.
24. Low blood pressure.
25. Loss of menstrual cycle.
26. Constipation or incontinence.
27. Bruised or calluses knuckles; bloodshot or bleeding in the eyes; light bruising under the eyes and on the cheeks.
28. Perfectionist personality.
29. Loss of sexual desire or promiscuous relations.
30. Mood swings. Depression. Fatigue.
31. Insomnia. Poor sleeping habits

Compulsive Overeating/Binge Eating Disorder

1. Fear of not being able to control eating, and while eating, not being able to stop.
2. Isolation. Fear of eating around and with others.
3. Chronic dieting on a variety of popular diet plans.
4. Holding the belief that life will be better if they can lose weight.
5. hiding food in strange places (closets, cabinets, suitcases, under the bed) to eat at a later time.
6. Vague or secretive eating patterns.
7. Self-defeating statements after food consumption.
8. Blames failure in social and professional community on weight.
9. Holding the belief that food is their only friend.
10. Frequently out of breath after relatively light activities.
11. Excessive sweating and shortness of breath.
12. High blood pressure and/or cholesterol.
13. Leg and joint pain.
14. Weight gain.
15. Decreased mobility due to weight gain.
16. Loss of sexual desire or promiscuous relations.
17. Mood swings. Depression. Fatigue.
18. Insomnia. Poor Sleeping Habits.

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Risk Factors

This is what they tell us in ED's 101: 

• Cultural - Social Pressure to be thin
• Depression
• Trauma 
• Familial
• Peer Groups 
• Puberty 
• Temperament
• Genetics

The truth is, no one can put a blanket statement out there on what really causes bulimia in an individual.  Because it is so individual.  There are common risk factors.  Just keep in mind, you have your own personal story.  So don't despair if you can't find the answers to why you throw up on the above list.  It's much deeper and more complicated.  The best place to start is to seek out a therapist who will take the time to understand you and not just your eating disorder. 

My personal feeling is that Bulimia is a cycle, a pattern of using food as a substitution for what is lacking in life.  Food becomes the metaphor.  

Many of the people I have been dealing with who suffer from Bulimia experience the same issues of not being able to fulfill a need.  They feel trapped and unable to really feed themselves.  There is an immediate sense of power involved after an episode of binging and purging that we don't feel in life.  Unfortunately it is  soon followed by shame and guilt.  And of course many other problems relating to health and depression.

A lot of things can cause or contribute to this cycle.  Certainly cultural issues. I think more than the issue of weight consciousness is the issue that many women face of not being able to truly express who they are,  their wants and desires, openly.  

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What can happen to me?

Here's the scary truth.  

Vomiting:

• Stomach acid dissolves the enamel on teeth causing cavities, root canals, yellow color and brittle consistency
• Puffy face (due to swollen salivary glands)
• Broken blood vessels on face 
• Irregular heartbeats
• Muscle weakness
• Kidney damage
• Epileptic fits
• Hair can become brittle and lose it's shine
• Immune system problems  - easy receptiveness to colds

I  can tell you first hand that many of these things do in fact happen.

Over a period of 20 years I have suffered from:

• Ulcers
• Kidney Stones
• Broken limbs
• The enamel on my teeth has worn down and my teeth are yellow
• Constant colds, flu, canker sores

and the latest which is a result of all the years of bulimia

• root canals

and another

• gallstones

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So what can I do?


Strategies and Methods of Coping with Eating Disorders

Check out Carolyn Aldwin's page on Payson Road,  Coping with Eating Disorders.  There's some incredibly useful ideas and information on how to cope and recover.  Also, use the resources on this site, there are many!   

Therapy 

Most experts in the field of eating disorders do recommend some sort of therapy whether it be group, or individual.  Find out what works for you.

Therapy did help me tremendously.  But it's because I found the right therapist.  Someone who really took the time to focus not on my eating disorder but on me.  

Before I found this therapist I had years of bad experiences that almost made me lose faith in the profession. If it wasn't for my sister, who happens to be a therapist, urging me to keep looking  I never would have kept looking.  And it would have been to my detriment.

Don't let that happen to you.  There are many professionals out there doing great healing work.  People who will take the time to understand you not just your eating disorder. But don't be afraid to shop around for therapists.  The right fit is crucial.  

If you can't afford therapy but want it, check your local resources.  Most hospitals have referrals to groups or clinics that will work with a budget.  You may even be able to find a free clinic or get information on free resources.  

We now have a treatment center referral section on our Resources page.  I highly recommend The Monte Nido Treatment Center run by Carolyn Costin.  They are compassionate and completely dedicated.  They are doing some incredible healing work.  

Eating Disorder Referral and Information Center has a very comprehensive list of therapists and treatment centers across the country. They provide assistance FOR FREE in finding eating disorder treatment in your area - eating disorder practitioners, treatment facilities, and support groups. 

Rosewood Women's Center for Anorexia and Bulimia is also an excellent source for seeking out therapists, treatment centers and/or groups in your area.

And also the Finding Stone Counseling Center is a great source for finding a clinic, therapist, or group.  It also has information on Depression, Sleep problems, Women's Issues, Drugs and Alcohol.  There's also a great source on the site called the Reading Room.  It's got wonderful books that are inspirational and resourceful.  Check them out.

If you don't want therapy but DO want help - don't give up!  Take a step.  Find a book, write your story on this site and read other's stories.  Check out online chat rooms, talk to someone that you can trust.  Ask for help.  You are not alone.

Alternative Therapy - Mind and Body Healing

The mind and body connection can be very powerful.  Check out our Mind and Body section that deals with this and shows you ways to use your body to reconnect you to yourself and ultimately help point your in the direction of recovery.

Get Creative!

At Payson Road we believe whole heartedly in the old cliché, Art Heals.  Traditional treatment is not enough.  We believe that the soul is unleashed through creativity.  And so we're giving you  many different opportunities to unleash yours.  Writing can be therapeutic in many ways and if nothing else, can help you to see yourself for who you are and not through your disease.  

We've got four columns to choose from; 

• The Truth is dedicated to sharing personal experiences and stories about eating disorders in editorial format.  This column is truly where you can lay it all on the line.  Articles can be submitted anonymously.  It can be viewed as almost a formal journal entry, yet one that can be shared with others who understand.  There's an incredible sense of freedom that comes with stepping into our truth. 
  
• the Corner features editorial articles from varied topics, local-national-to world wide. The column's focus is widespread so to give people the opportunity to flex their creative muscles which we believe is an important part of the recovery process.  We encourage people to write about things that inspire them or make them feel--whether it's positive or negative.  That feeling of being alive again helps once re-discovering their sense of self. 
  
• The Voice is a socially, politically and culturally driven editorial column. It is an opportunity for you to use your voice for new and thought provoking discussions.  The idea behind The Voice is to expand the mind through political and social consciousness. Persons struggling with eating disorders often get stuck in their own world of their disease, unable to see the world around them.  Writing about issues that affect everyone and being able to think critically about the world at large helps take the focus of being a victim of a disease.   
  
• Payson Road Poetry Wall.  This section has been incredibly successful.  Updated quarterly, contributors can submit as many poems as they like.   You don't have to be a poet to write a poem.  You won't believe how expressive poetry can be.  It's a genuine healer. 

Reach Out and Connect with Others

Talk to others.  This really helps.  Especially when you find out that your not alone.  

Even if you don't venture into group therapy, finding one person who has suffered from the same disease can really help.  There's strength in numbers.  Don't be ashamed to admit it.  Read what some of our support group members say about our recovery group.


 

Nix the Media

Don't  look for answers in the fashion mags.  Give me a break.  The same magazines that feature very young women so thin that the g-string they're wearing covers their entire body want to help us learn how to stop throwing up?  Come on now!

What Not to Do:

1. Don't Only Rely on Statistics!!!  Stats are stats.  In your search for information, particularly if you are trying to help a loved one, don't search for the answer to your problem or a loved one's problem through statistics. The answer is much more complicated then a list of ingredients.
   
2. Get the 411 on Eating Disorders. Check our Resource guide for help with that.  You should know as much as you can about your/their disease. Just remember the search is within.  Don't put all your energy into researching the disease and ignore yourself/them as a result.  The individual story is the key. 
   
3. Stay away from Pro-Anorexia or Bulimia websites.  There are many groups out there that care about you and your recovery.  These groups are not amongst them.  So if you go shopping around and see posts teaching people how to starve or purge, run don't walk!  You deserve more than that.
   Check out Payson Road's Online Group. 

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Helping a Friend or Loved One

Interact with others who are desperately seeking understanding and support of their loved ones eating disorder.  Join the Payson Road Family and Friends Support Group.

I hear from many teenagers who want therapy but are afraid to tell their parents or their parents don't want them to go into therapy.  This is a tough one.  

To you parents out there,  I know this is tough on you but remember, it's about your child and maybe the best thing you can do for them is to support them by just letting them know you're there.  You may not understand, you may be angry and confused.  It's about your child.  And although you know that you love them and you have their best interest at heart, that may not translate to them.  Often times your fear and anxiety is what translates. Right now they really need support.  They may not know what kind of help they need.  But maybe a third party that can listen and help them sort it all out is the best solution.  Be patient.  

Eating Disorders are a secretive disease.  Many times the person or persons struggling with their eating disorder DON'T want you to know or are afraid to tell people for fear of shame and abandonment.  They're apt to be very defensive if you come on strong about how they need to stop.  The last thing they need right now is to take on your feelings about their disease.  

Be patient, be compassionate, be their friend.  Don't take on the role of being their therapist. Talk to a professional about how you can help. Find out as much as you can about the disease but be careful, don't forget that your friend or loved one with an eating disorder is not a statistic.  Whatever brought them to their current situation is different for everyone no matter what the similarities may be.

There's nothing worse then feeling ashamed and guilty because of your eating disorder then having people chase you around telling you who and what you are and how and why you need to stop.  We know the love and good intentions are there, but that's not the way to help.  

The best you can do is support their dreams and don't make them feel ashamed.  Eating disorders, like other diseases are often a sign of something missing in someone's life -  the inability to feed one's desires or needs.  Help them find out what those desires are and support them.

Just remember that you're searching for help for someone you love.

Also check out this link to Something Fishy's Resources on helping friends or loved ones. 

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Information on Other Eating Disorders

Anorexia Nervosa Individuals with anorexia nervosa are unwilling or unable to maintain a body weight that is normal or expectable for their age and height (most clinicians use 85% of normal weight as a guide). Individuals with anorexia nervosa typically display a pronounced fear of weight gain and a dread of becoming fat although they are dramatically underweight.  This fear grows the more they lose weight. Concerns and perceptions about their weight have a extremely powerful influence and impact on their self-evaluation. The seriousness of the weight loss and its physical effects is minimized or denied (women with the diagnosis of anorexia nervosa have missed at least three consecutive menstrual cycles).

Binge Eating Disorder is sometimes referred to as compulsive overeating. Some researchers believe it is the most common of the eating disorders affecting millions of Americans. Similar to bulimia nervosa, those with binge eating disorder frequently consume large amounts of food while feeling a lack of control over their eating. However, this disorder is different from bulimia nervosa because people with binge eating disorder usually do not purge (i.e. vomiting, laxatives, excessive exercise, etc) their bodies of the excess food they consume during a binge episode

EDNS (Eating Disorders Not Otherwise Specified) There are variants of disordered eating that do not meet the diagnostic criteria for anorexia nervosa or bulimia nervosa. These are still eating disorders requiring necessary treatment. A substantial number of individuals with eating disorders fit into this category. Individuals with eating disordered behaviors that resemble anorexia nervosa or bulimia nervosa but whose eating behaviors do not meet one or more essential diagnostic criteria may be diagnosed with EDNOS. Examples include: individuals who meet criteria for anorexia nervosa but continue to menstruate, individuals who regularly purge but do not binge eat, and individuals who meet criteria for bulimia nervosa, but binge eat less than twice weekly, etc. Being diagnosed as having an "Eating Disorder not Otherwise Specified" does not mean that you are in any less danger or that you suffer any less.

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Some Alarming Facts:

• According to the National Association of Eating Disorders, in the United States, as many as 10 million females and 1 million males are fighting a life and death battle with an eating disorder such as anorexia or bulimia. Approximately 25 million more are struggling with binge eating disorder (Crowther et al., 1992; Fairburn et al., 1993; Gordon, 1990; Hoek, 1995; Shisslak et al., 1995).
• Since the 1960's incidents of eating disorders have doubled increasing in all ethnic groups.  
• Bulimia Nervosa accounts for the highest number of eating disorder incidents among adolescents and adults.
• Eating Disorders have the highest mortality rate of any other mental illness at 20% 
• 40-60% of high school girls diet
• 13% of high school girls purge
• 30-40% of Junior High School girls worry about weight
• 40% of all 9 year old girls diet

Risk Factors: are a combination of things depending on the person.  Here are some. 

• Cultural
  Social Pressure to be thin
• Depression
• Trauma 
• Familial
• Peer Groups 
• Puberty 
• Temperament
• Genetics

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Discrimination and Eating Disorders

To many people, including health care professionals, eating disorders are taboo.  And as a result, many of us experience a type of discrimination spawned from ignorance.

Women in particular experience this form of modern day witch hunting.  Throughout our history we have constantly been labeled and discriminated against for any sign of "mental health" problem.  And as a result, people are often misdiagnosed, not taken seriously or remanding the charge of an institute whether it be necessary or not.

We are all in danger of being misunderstood - those of us, men and women who suffer from eating disorders.  

Men who suffer from eating disorders suffer a particular type of cruelty as they are overlooked in the community.  The percentage of men with eating disorders although far smaller than women, exists and is sadly growing.  

My bulimia has led to some rather unfortunate health problems including a bleeding ulcer.  The ulcer was treated with medication but the pain was not going away.  I pleaded with my doctor telling him there must be something else wrong or maybe the ulcer needs to be treated differently.  He admitted me into the hospital and ordered every test imaginable.  He had a neurologist see me, a cardiologist and finally a psychiatrist.  The psychiatrist had never met me before nor I him.  I had been given Demerol shortly before his visit.  I was in pain, heavily medicated and scared.  He asked me questions about my past and I guess Demerol must act as a truth serum for me because I unloaded all my baggage about the eating disorder and early suicide attempts.  

After his visit my doctor came up to see me and aggressively yanked me out of the bed and disconnected me from my IV.  He brought me and my husband to a small conference room where he proceeded to tell us that I was imagining my pain and in effect burdening the health care system with my lies.  it was his view that someone with an eating disorder could not be trusted when complaining of medical conditions because they brought it all themselves and were so mixed up psychologically that they merely wanted attention.

He told me to go to church and to pray.  And then he discharged me from the hospital.  

My pain did not go away.  And I was so confused and manipulated by this doctor and his psychiatrist.  I wasn't sure myself if I was making it up or not. 

Then a  friend suggested that I take a visit to the gynecologist - an exam he failed to order for me.  The gynecologist discovered that I had a severe case of endometriosis.  Something I had never even heard of.  But apparently it was in fact VERY real and very much the cause of my pain.  And completely unrelated to my eating disorder.

I was able to get the treatment I needed but I've never gotten over the scars from that episode.  And it fueled my anger which I've tried to redirect into my passion for ending the ignorance by building awareness so that no one has to experience that kind of shame.

To end the ignorance we must work toward a better perception of eating disorders through education and compassion.  And first and foremost, not discriminate amongst ourselves.

DO NOT FORGET!  Health care professionals are NOT GODS.  They are human beings which means they are capable of misdiagnosis.  It is your right to get a second, third, fourth and fifth opinion.  

DO YOUR HOMEWORK!  Don't allow yourself to be a victim.  You may be suffering but it's your body and your mind.  Take involvement in both.

Your eating disorder may have caused many health problems.  However, that DOES NOT mean you have lost the right to be treated with the respect and understanding that every patient deserves.  

ASSERT YOURSELF!  Take action and KEEP THE FAITH!  

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For great suggestions on books on eating disorders.

If you have information, facts or links to suggest, by all means do it!  Email us.  We greatly appreciate your suggested resources and information.

Website designed and administered by Sarah Mason. Website Logo and  Graphics Designed by Tahara Hasan. Payson Road was created Copyright © June 2, 2000.  All rights reserved. Copyright © 2005 [Payson Road].  All rights reserved. Revised: November 18, 2005 .

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