Understanding Disordered Eating: Bulimia Nervosa.

Understanding Disordered Eating: Bulimia Nervosa.

Understanding disordered eating is essential to breaking the cycle of silence, self-judgement and shame that characterises it.

Bulimia is a disorder that largely affects women (90% of bulimics are women), and is a disorder that can be hidden relatively easily. If you understand it, you can recognize it in a friend or loved one, or yourself, and get help.

What is bulimia?

Bulimia Nervosa affects 5% of the population in Australia. According to the Butterfly Foundation, “Bulimia Nervosa is characterised by recurrent binge-eating episodes followed by compensatory behaviours such as self-induced vomiting, misuse of laxatives, diuretics, fasting and over exercising.”

Bulimia is a psychological disorder that is characterised by feelings of intense guilt and shame, low self-worth and a feeling of lack of control. Some of the physical complications that are typical of the behaviour are significant damage to the teeth and oesophagus, clammy hands and tremors, anxiety and heart palpitations, risk of osteoporosis, puffy skin, menstrual irregularity, constipation.  Bulimia can be split into the purging and non-purging type. The purging type will compensate for the binges with vomiting, diuretics or laxatives. Non-purging type will compensate with fasting or excessive exercising.  Bulimics are often normal weight or only slightly under or over weight, so can often mange to keep their disorder hidden for a long time.

Bulimic behaviour is typically a compensation for some other deeper issue related to the persons self-worth and can be an unconscious way of feeling in-control, loved, or accepted. In this way it is the far end of the psycho-eating scale. Psycho-eating means eating for psychological reasons rather than physiological ones. The only true physiological reason to eat is to nourish and fuel the body. Many people psycho-eat, very few “normal” eaters do not eat t some times for some psychological reason, however bulimics will continue to eat when others would stop, and then feel such intense self-judgement, shame and guilt they need to compensate in extreme and unhealthy ways for the food consumed. When you eat for psychological reasons then the normal signals to stop, (your belly being full and hunger hormone turned off) do not apply. If you are eating to fill a psychological hole, it can never be satisfied by food.

From a coaching perspective bulimia is the most extreme and disordered end of the internal pain / external pleasure cycle. The internal pain of low-self worth, extreme self-judgement and/ or unresolved past trauma, drives the external pleasure of the bingeing behaviour, then cycles back down to shame and guilt of the binge, and then to the external pleasure of the purging. This is a vicious cycle, and can only be completely healed by dealing with the underlying self-worth, self-judgement, body-image and past trauma.

A learned behaviour.

Bulimia often begins with body consciousness as a teenager, usually beginning with a strict deprivation diet in the pursuit of thinness, resulting in a starvation response and uncontrollable hunger, which often creates a binge.  Usually the purging behaviour is learned, many young girls have been shown how to purge by a girlfriend while in high school. When the many body changes of puberty hit, you’re reading beauty magazines with slim, photoshopped models, and the sense of being judged by your appearance in school cliques is at its most influential, the conditions are ripe for this disordered thinking and behaviour.

With the social acceptance of the secret girlfriend group, the bingeing/ purging behaviour is anchored to feeling cool, accepted, part of a group, keeping slim, and being desirable. So even though the behaviour of self-induced vomiting is painful, difficult and unnatural, the psychological pleasure that it evokes can be stronger than the pain of the behaviour.

The behaviour is also driven by many unconscious limiting beliefs including one’s like these…

  • Being slim is better.
  • Only thin girls are attractive.
  • I’m not good enough.
  • My thighs / bum / arms are gross.
  • I’m fat and disgusting.
  • I must be thin.
  • I’ve eaten too much, I have to fix it.
Check my previous post on cognitive distortions to help unravel these kinds of limiting beliefs…


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What is normal eating anyway?

Many women who are overweight or dieting will exhibit some similar behaviours to bulimics, including seeming to be obsessed with food and the health values of food, weighing themselves, exercising a lot,  having low self-esteem, and being judgemental of their bodies. This is why it is essential if you want to shape your body to do it through self-love and adopting healthy lifestyle practices instead of extreme diets. However, bulimia is much more extreme, anti-social behaviour and is typically accompanied by secrecy and shame, regular toilet visits after meals, excuses not to eat, avoidance of social occasions with food. Normal eating does not have the same feelings of shame and secrecy and uncontrollable desire to binge and then compensate for the binges in some way.

“Normal eating includes the ingestion of healthy foods, the intake of a mixed and balanced diet that contains enough nutrients and calories to meet the body’s needs, and a positive attitude about food (no labelling of foods as “good” or “bad,” “healthy” or “fattening,” which can lead to feelings of guilt and anxiety). Normal eating is related not only to health maintenance, but also to acceptable social behaviour, and is both flexible and pleasurable. It is important for people to understand that normal eating fluctuates; however, it should not fluctuate to the point of leading to a nutrient deficiency or excess weight loss or gain. Thoughts about desired foods and meal planning should be part of person’s daily life, but should not dominate it.”
– Perieira, R.F. & Alvarenga, M. (2007). Disordered Eating: Identifying, Treating, Preventing and Differentiating it from Eating Disorders. Diabetes Spectrum, 5, 141-148.

How to build healthy self-esteem and body image.

Body image is not what you weigh, or what you look like, but what you feel and think about your body.  You can build a healthy body image with acceptance, self-love, affirmations, coaching and counselling, and having a critical eye for mass marketing, magazines and media images of slimness and beauty. In a heartening move from a fashion media giant, VOGUE banned the use of girls under 16 or those who appeared to have an eating disorder.

“Today’s fashion models weigh 23% less than the average female, and a young woman between the ages of 18-34 has a 7% chance of being as slim as a catwalk model and a 1% chance of being as thin as a supermodel. However, 69% of girls in one study said that magazine models influence their idea of the perfect body shape, and the pervasive acceptance of this unrealistic body type creates an impractical standard for the majority of women. Perhaps if we become a little more aware of what effort and enhancements go into a photo shoot – we can enjoy the image for its beauty, yet not use it as a means to measure ourselves.”

Self-Loathe to Self-Love.

If you suffer from bulimia this message is for you… Ultimately bulimia is a disease that stems from self-loathing and damages and undermines your health. It may have begun as a protection mechanism or to fulfil a psychological need to feel loved and accepted. Bulimia does not love your body. It does not help or heal your body, it does not allow you and your uniqueness and beauty to shine. You are worthy of true self-love, loving yourself through your choices for nourishment. Please love the behaviour that loves you back. Choose to serve your body and your body will serve you. You can heal and release the emotions from whatever trauma has caused this behaviour to begin, You deserve to be loved and you can love yourself.

Coaching questions for bulimics.

Reflect on when you first learned or began this behaviour. Write out the answers to these questions to understand more fully why this behaviour began and to gather the strength to decide to change it.

  • What was going on at the time you began this?
  • Who was with you? Did you learn from a friend?
  • What feelings did you associate with the behaviour at the time?
  • What did you decide about this?
  • What did you think of or decide about your body at the time?
  • Did you experience a negative comment or judgement from someone about your body?
  • How did you feel before, during and after your first episode?
  • How do you feel now, before, during and after an episode?
  • Do you compare yourself to unrealistic photoshopped images of female beauty in magazines? What do you think about this behaviour? Does it help or hinder your self-esteem?
  • Do you realise that you are more than this bulimic behaviour?
  • How else do you identify yourself? (friend, daughter, mother, artist,???)
  • Do you know that you are more than even these labels?
  • What do you miss out on because of this bulimic behaviour?
  • Do you want to continue to suffer the pain and physical consequences of this behaviour?
  • What would happen if you never solved this?
  • What would you miss out on if you were never able to create a healthy body and healthy eating behaviour?
  • Are you willing to work to create a positive body image for yourself?
  • Are you willing to be accepting, compassionate and forgiving of yourself as you learn to change this behaviour?
  • What rituals and habits can you dedicate yourself to, to build your self-esteem and healthy body image?

If you have bulimic episodes or behaviour it is essential to get help to change the behaviour, as it is physically and emotionally damaging and unhealthy. If you have questions about this, feel free to contact me directly or please seek help through ones of these community organisations.

The Butterfly Foundation

Join the conversation.

Please feel free to post your comments anonymously if you suffer from this and  would like to share your story. The more we understand, the more we can help each other. (the facebook commenting is not anonymous)

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