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Bulimia: What Happens When Body Image Goes Wrong

Jessie is a 30-something executive who fought her way to the top of her field. Once a week, she joins a former classmate, Rachel, to catch up on personal news and eat to her heart’s content.

Rachel constantly marvels at Jessie’s weight. It hasn’t changed since high school, where Rachel has slowly added dress sizes. Rachel hasn’t discovered Jessie’s secret and does not know that Jessie, the perfectionist who fought her way to a successful career, will go home to regurgitate the food she enjoyed with her friend. Jessie’s secret? Bulimia nervosa.


Bulimia’s causes are not completely understood, but being female, a perfectionist or having bulimic siblings can predispose you to develop this eating disorder. Today’s social values prizing thin bodies may also be a factor. Advertisements feature images distorted and idealized to boost their appeal and stimulate desire.

This manipulated imagery may trigger dysmorphia, a distorted image of normal human bodies, driving both men and women to pursue an ideal, but unhealthy, appearance. Binge eating may be a reaction to the dietary deprivation necessitated by this quest. In addition to unhealthy body imagery, stressful life events, like a job loss or death can trigger bulimia, as can genetics.

Bulimia may start with severe dieting and skipping meals during the day. Unfortunately, by day’s end, hunger drives you to eat and you binge to compensate for the day’s skipped meals. Once uncomfortably full, and ashamed, you vomit to rid yourself of the calories.

However, vomiting has another effect: It causes an endorphin surge and makes you feel better. Over time, you learn to vomit without having eaten but you crave more endorphins. You start exercising too much, and soon you add enemas, laxatives and diuretics to get that same sense of wellbeing and control.

Signs And Symptoms

People with bulimia overeat, then purge to rid themselves of the added calories and the associated shame from having lost control. While most bulimics maintain an average and acceptable weight, there are signs that can alert friends and family to a growing eating disorder.

Bulimics who purge by vomiting often develop dental problems, like enamel erosion, chronically sore throats from stomach acid and odd callouses and teeth marks on their fingers from stimulating their gag reflex.

Frequent vomiting can also lead to acid reflux disease as a damaged sphincter muscle loses its capacity to hold the stomach closed, allowing food and stomach acid to spill into the esophagus.

Laxative abuse causes intestinal distress, but does not alter the number of calories absorbed from an eating binge. Weight loss attributed to laxatives is actually “water weight” or fluid lost from the intestinal tract. Laxative abuse can also cause repeated bouts of diarrhea, a painfully swollen belly, swollen ankles and hands, and fatigue, along with kidney problems from chronic dehydration.

Regardless of the method used, purging can lead to dehydration and electrolyte imbalances, resulting in a heart attack. Bulimia is a complex and dangerous eating disorder necessitating treatment.


Doctors must treat bulimia’s behaviors while discovering and treating its underlying triggers and any body image issues. As such, treatment includes psychotherapy. Appointments can feature group, family or individual therapy.  During visits, the doctor will analyze behaviors and then devise ways to interrupt their established patterns to replace them with new and healthier actions.

Patients may also have cognitive therapy to explore the negative thoughts triggering harmful behaviors. Doctors also prescribe selective serotonin reuptake inhibitors (SSRI’s) to ease the need to vomit by making more serotonin available for the brain.

Through nutritional counseling, you will get a diet rich in nutrients that are sugar free to improve your physical health, and you will learn to change how you think about food. Nonetheless, there will be setbacks. Bulimia treatment is a long-term project and you may not notice changes for several weeks or months.

Your doctor may want to treat coexisting disorders like panic attacks, clinical depression and substance abuse before tackling the bulimia because these disorders can interfere with bulimia treatments.

While bulimia treatments rarely require a hospital stay, the damage from bulimia may. If you develop esophageal tears or severe dehydration, you may need to stay in a facility specializing in eating disorders.Pin It

Life After Bulimia

You can avoid bulimia and ease recovery. Instead of dieting and skipping meals, plan nutritious meals with lots of colors and textures. Plan coping behaviors for difficult situations that may trigger a relapse, and forgive yourself if the results miss the mark.

Coping with bulimia means being kinder to yourself by remembering what a healthy weight for your own body is and that you are in good company.

Table Of Contents

Katherine Hurst
By Dr. Michael Richardson
Passionate about sharing the latest scientifically sound health, fitness and nutrition advice and information, Dr Richardson received his Master of Science in Nutrition from New York University, and a Bachelor Degree from New Jersey University. He has since gone on to specialize in sports nutrition, weight management and helping his patients to heal physical ailments by making changes to their eating habits and lifestyles.

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