binge and bust

by Jenny Bryan

Look at someone with bulimia nervosa and there may be no tell-tale signs of an eating disorder. Most people with bulimia aren't thin. They sit down to meals and seem to eat quite normally. It's only later, when no one's around to see, that they binge on enormous amounts of food, and they may then throw up or take laxatives to avoid putting on weight.

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Many people with bulimia are high achievers who appear confident and successful, and that makes it even harder to recognise that there is something deeply wrong. Like those with anorexia, they use food to help deal with emotional problems. But, because they aren't thin and look well, they can cover their tracks for many years.

how does bulimia start?

Bulimia tends to start later than anorexia – in a person's late teens or early 20s. So it is unlikely to be linked to any desire to delay puberty and the problems of adolescence, like anorexia. However, up to half of people with bulimia have had anorexia in the past.

'It's much more a way of coping with stress and has more similarities with alcohol and drug abuse,' explains Professor Hubert Lacey, from St George's Hospital, London.

Just as sadness and anxiety are normal responses to everyday events, so occasional binge, or comfort, eating is a natural way of helping us to feel better, he says. It's when these things start disrupting lives that they become an illness and, in the case of binge eating, that means bulimia nervosa.

'Bulimia nervosa means repeated episodes of binge eating that are life disruptive and associated with low self-esteem. Some people with bulimia need to have a means of dealing with the excess food, such as vomiting or excessive exercise, others don't,' Professor Lacey points out.

Bulimia may be continuous or cyclical. In the early stages, people may only have a bout of bingeing with or without purging every few months. Those who are severely affected may do it several times a day. Some people eat normally in social situations and only binge at home, making it even more difficult for friends or family to see that they have a problem.

what harm is there?

Bulimia may seem less serious than anorexia and is rarely fatal. But it can still be very harmful. Vomiting makes the throat sore and inflamed and swallowing becomes difficult, so people choke. Breath smells foul and glands in the neck may become swollen.

Acid in the food brought up from the stomach damages the oesophagus and may make it bleed. The acid also erodes tooth enamel, leading to decay. If the intestine is repeatedly forced to expel partly-digested food, it may stop working properly. In extreme cases, the stomach may rupture.

Frequent vomiting and abuse of laxatives and diet pills also leads to dehydration as fluids are brought up with the food. This upsets the balance of chemicals in the blood and makes people dizzy and confused. It can also affect the heart rhythm and lead to heart attacks, breathing problems and kidney failure.

getting treatment

Like anorexia, treating bulimia nervosa isn't just about getting people to eat normally. It means helping them to understand why they use food so destructively. It means breaking the cycle of unhappiness that leads to bingeing and the resulting guilt which leads to purging or over-exercising.

Cognitive behavioural therapy is widely used in the treatment of bulimia. This is slightly different from analytic therapy in that there is less emphasis on linking the bulimia with problems in earlier life. Instead, it aims to identify and change the unhealthy patterns of thinking and behaviour, such as low self esteem and negative outlook, that led to and maintain the bulimic eating pattern.

Another option is interpersonal therapy – a technique which aims to help people with bulimia to communicate better and largely ignores weight, shape and food. Though effective, interpersonal therapy tends to take longer to produce improvement.

Once people with bulimia recognise their problem, treatment is usually easier and more successful than for anorexia. Outpatient programmes lasting 10-16 weeks have been developed which have high success rates.

'By the end of the programme, about 80% of people have stopped their bulimic behaviour and five years later two thirds are still well,' says Professor Lacey.

In more severe cases, or where the bulimia is complicated by other self-destructive behaviours such as drug or alcohol misuse, inpatient treatment is effective.

It takes motivation and commitment but, by getting effective help (see help me please) thousands of people who use binge eating as a way of coping with stressful lives and low self esteem do make a full recovery.

help and info

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organisations

Centre for Eating Disorders (Scotland)
10 Carment Drive
Glasgow G41 3PP
Tel: 0141 632 6663
Independent private practice set up by Mary Hart, Edinburgh and Grace Coia, Glasgow, which offers a counselling service to those who suffer from eating disorders.

beat (formerly Eating Disorders Association)
103 Prince of Wales Road
Norwich NR1 1DW
Adult Helpline: 0845 634 1414 (Mon-Fri 10.30am-8.30pm and Sat 1-4.30pm)
E-mail: help@b-eat.co.uk
Youthline: 0845 634 7650 (Mon-Fri 4.30-8.30pm and Sat 1-4.30pm)
E-mail: fyp@b-eat.co.uk
Website: www.b-eat.co.uk
Campaigning organisation that provides information, advice and publications on all aspects of eating disorders. Operates a UK-wide telephone helpline and a youthline for information, help and support if you're aged 18 years and under. There is also a webzine, message board and chat room on the website.

First Steps to Freedom
PO Box 476
Newquay TR7 1WQ
Helpline: 0845 120 2916 (Mon-Thurs 10am-10pm; Fri-Sun 10am-midnight)
E-mail: first.steps@btconnect.com
Website: www.first-steps.org
Offers a confidential helpline, counselling and befriending, telephone self-help groups plus leaflets and audio tapes.

Mental Health Foundation
9th Floor, Sea Containers House
20 Upper Ground
London SE1 9QB
Tel: 020 7803 1101 (Mon-Fri 8.30am-5.30pm)
E-mail: mhf@mhf.org.uk
Website: www.mentalhealth.org.uk
WWorking to improve the support available for people with mental health problems offering information and literature on all aspects of mental health. Unable to offer advice on an individual basis.

Overeaters Anonymous
PO Box 19
Stretford
Manchester M32 9EB
Tel: 07000 784985
Website: www.oagb.org.uk
Fellowship aimed at men and women whose lives have been affected by compulsive behaviour around food such as overeating, anorexia and bulimia. Offers encouragement and advice to anyone affected by an eating disorder. For details of support groups, please write or contact the 24-hour answerphone.

websites

Anorexia and Bulimia Care
www.anorexiabulimiacare.co.uk
An organisation run by Christians for sufferers of anorexia, bulimia and compulsive eating disorders, their families and carers. Can point people towards support groups or put them in touch with ex-sufferers. Website has useful resources, plus a guide for parents.

Anorexia Nervosa and Related Eating Disorders, Inc
www.anred.com
American-based website containing information about anorexia nervosa, bulimia nervosa, binge eating disorder, compulsive exercising, and other less well-known food and weight disorders, and includes statistics, warning signs, personal stories and links.

Eating Disorders Resources
http://edr.org.uk/
Informative website with resources on eating disorders including anorexia nervosa, bulimia nervosa, compulsive eating and binge eating, with details of organisations, publications and links to other websites.

National Centre for Eating Disorders
www.eating-disorders.org.uk
An independent organisation set up to provide solutions for all eating problems, compulsive or binge eating, failed or 'yo-yo' dieting, bulimia and anorexia. Offers information, counselling, and professional training.

Something Fishy Website on Eating Disorders
www.something-fishy.org
Pro-recovery website dedicated to raising awareness about eating disorders, providing support and information for those with eating disorders, and their family and friends.

reading

	Binge No More by Joyce Nash (New Harbinger Publications, 2000) A practical guide that aims to help readers to understand their bingeing and offers pro-active ways for overcoming it. The author provides a programme to help readers change their behaviour and cope with thoughts and emotions that accompany binge-eating. Get this book
	Bulimia Nervosa by Peter Cooper (Constable Robinson, 1995) A source of information and understanding for sufferers as well as for those, such as family members and friends, who need to develop a better understanding of the illness. Get this book
	Bulimia: a guide for family and friends by Roberta Trattner Sherman and Ron Thompson (Jossey-Bass, 1997) This book reveals the complex nature of the disease and answers the questions most frequently asked by the families and friends of bulimics. Get this book
	Getting Better Bit(e) by Bit(e) by Ulrike Schmidt and Janet Treasure (Psychology Press, 1993) The aim of this self-help book is to empower sufferers to take control of their own lives and tackle their eating difficulties in their own home. Addresses the problems faced on a daily basis by bulimia sufferers, providing detailed step-by-step advice. Get this book
	How to Cope with Bulimia by Joan Gomez (Sheldon Press, 1995) This book looks at the problem of bulimia in all age groups and also covers pregnancy, parenthood and male bulimics. Get this book
	Conquering Anorexia: The Route to Recovery by Clare Lindsay (Summerdale Publishers, 2000) This book provides an insight into anorexia, offers reassurance for sufferers and their families and advice on steps to overcome the emotional and physical problems of living with this illness. Get this book
	Anorexics on Anorexia edited by Rosemary Shelley (Jessica Kingsley Publishers, 1997) Recovering sufferers of anorexia nervosa describe their personal experiences of this illness, providing not only support for fellow sufferers but also valuable insights for the families of sufferers and for carers and professionals. Get this book

Check out the help and info section at the end of help me please for details of other organisations, websites and further reading on eating disorders.

(July 2001, resources updated October 2005)