What Every Parent Needs to Know About Bulimia Nervosa
by Dr. Tonja H. Krautter
Bulimia Nervosa is a serious psychiatric illness characterized by persistent binge eating (usually starches and sweets) and then inappropriate weight control. The most common type of inappropriate weight control is vomiting or the use of laxatives and/or diuretics. The person may also restrict food intake by fasting for several days after a binge. Or the person might excessively exercise in order to compensate for the high amount of calories ingested. In any case, Bulimia should be taken seriously and treated aggressively, as quickly as possible.
Many people wonder what constitutes a binge. Parents come into my office all the time asking if their child has a problem because they see large quantities of food eaten and no indications of weight gain. If your child is binging on food, two things will be true. First, she/he consumes much more food than most people would in a similar circumstance and in a similar period of time. In other words, eating large quantities of food during Thanksgiving dinner wouldn’t necessarily be considered a Bulimic binge. However, eating an entire box of cereal, a large pizza, or finishing off an entire birthday cake by oneself in a short period of time on a random Monday afternoon after school would constitute a binge.
In addition, when the person is engaged in the binging behavior, she/he feels very much out of control. My patients often state things like “I couldn’t stop myself,” or “It was as if I was driven by a motor.” This is perhaps one of the most distressing parts of this illness—the feeling of being out of control. Imagine a teenager who leaves school, goes to McDonalds, orders a meal deal, then stops by an ice cream shop and gets a double sundae. Next he/she goes home and if the stomach is not completely full yet (it expands with the large quantities it takes in), he/she finds something else to consume. Due to physical discomfort, fear, or even disgust, the person then rids himself or herself of the food—usually by purging.
In order to be formally diagnosed with Bulimia, both of the behaviors mentioned above (binge eating and inappropriate weight control) have to occur at least twice a month for at least three consecutive months. As a warning, I tell parents that if their child is engaging in these behaviors even on an irregular basis, act fast to get her/him into treatment. Bulimia can be highly habit forming. Some research that shows it is addictive. During the purging process, the body is highly stimulated and then feels a sense of calm when the purging is complete. It’s common for infrequent bouts with binging and purging to turn much more frequent. Several of my patients have stated that within a few months, they went from irregular, inconsistent bulimic behavior to binging and purging several times a day.
Bulimia does not have as high of a mortality rate as does Anorexia. Approximately 2 percent die from Bulimia. The person with Bulimia is usually average weight or a little bit above average weight. This makes it much harder to detect by parents and health practitioners since the person is not malnourished. The overall incidence of Bulimia is increasing. There is evidence that the disorder is increasing in females between the ages of thirteen and eighteen. In fact, Bulimia is currently estimated to occur in up to 1 to 2 percent of all teenage girls in the United States and is listed as the fourth most common chronic illness in adolescent females.
There are several medical consequences associated with Bulimia. Unfortunately, the repetitive act of binging and purging affects many of the systems in the body. The most dangerous affect is on the muscles in the body, mainly the heart. Electrolyte imbalance is a common problem for individuals with Bulimia. Low potassium levels are particularly dangerous and could cause heart failure. Binging and purging affect the digestive system. Metabolism slows down to conserve food and energy and the digestive process is often disrupted, resulting in severe bloating and severe constipation. People who engage in purging behaviors may cause ruptures or tears in their stomach and/or esophagus as well as intestinal damage from using laxatives. The purging also causes tooth decay as the stomach acid erodes the enamel on the teeth when it comes up with the food. Dentists are often the first medical practitioners to alert parents of this problem from their visual observations.
Signs often indicated by parents, teachers, coaches, or friends include things like:
- Immediate trips to the bathroom following meals
- The use of running water in the bathroom to hide the noise of vomiting
- Constant sore throats
- Cuts/teeth marks on the forefingers as a result of biting when the person sticks a finger down his or her throat to purge
- Empty wrappers found in hiding places around the house to conceal binges
- Discussion of weight and a focus on body image
- Large quantities of food found missing that nobody in the house claims to have eaten or been aware of
- Actual observation of binges, purging, fasting, and/or excessive exercise
Many patients with Bulimia say it’s a physical way they can handle chaos in their lives. It also helps them take attention off something else in their lives that’s highly distressing, such as a death of a parent, sibling illness, parental conflict, or school failure. By engaging in these behaviors, they literally fill themselves up and then purge away their distress. The binging behavior represents the chaotic feelings they have in their life and the purging or non-purging methods give them back this control. It’s no wonder that this cycle can become highly habit forming.
As a parent, it’s important to know that if your child has an eating disorder, she/he has it for a reason. Do NOT tell her/him to stop the behavior. This doesn’t work and will only cause your child to be more secretive about the problem. On the other hand, it would be completely inappropriate to encourage this behavior in any way. Eating disorders do fulfill some need for the individual, but the goal is to try to understand what that need is so that you can support your child to engage in alternative behaviors that will fulfill the same need. This work should be done in counseling sessions with a trained professional who can work with you and your child.
It’s best to avoid power struggles when trying to obtain information. Don’t minimize the information you receive or deny that there’s a problem. If you’re unsure if there’s a problem, simply let your child know that you’ll be seeking the services of an expert to help assess the severity of the situation. If your daughter had chest pains, you would take her to a cardiologist. If your son had cancer, you take him to an oncologist. Let your child know that all of her/his health care needs will be attended to because you care. When you encourage alternative behaviors such as exercise, make sure you’re not giving permission to do this in excess. Keep an eye on the situation and utilize a treatment team for consultation and decision-making. Keep your own emotions in check. It’s easy to get freaked out by the idea that your child has an eating disorder. Sufferers of eating disorders are often sneaky and manipulative. Your child will not see things clearly and will try to avoid intervention. So trust your instincts and be supportive yet firm.
The greatest resource for children with an eating disorder is often their parents. Don’t minimize the amount of positive influence family may have on the struggling family member. Help your child see that she/he is more than an eating disorder. Helping them to understand and see that their identity is separate from Bulimia is paramount. It’s hard to fight against yourself; it’s much easier to fight against a behavior. The good news is that eating disorders are treatable. The sooner the person enters treatment, the higher the success rates. However, it’s imperative that you find a therapist who specializes in eating disorders and a medical team that is equipped at assessing for safety both physically and mentally. These professionals usually can be found through a resource list at your doctor’s office or local university’s health center.