Five Myths About Bulimia
Bulimia is a serious mental health disorder characterized by a cycle of binges and purges that can cause severe physical and mental health concerns. Although it affects up to 4.7 million females and 1.5 million males in the United States, there are still many myths perpetuated about this eating disorder that contribute to a general misunderstanding.
By: Nicki Parlitsis
Below are five myths about bulimia followed by the facts. (There are many more that are not listed here.)
Myth 1: All cases of bulimia use vomiting as a form of purging.
Fact: There are various types of purging behaviors, including but not limited to self-induced vomiting.
Purging is the act of expelling food from the body. It is a behavior used in bulimia to rid the body of food after a binge episode. While vomiting is likely the most well-known purging behavior used in bulimia, other purging types can be equally dangerous. Behaviors that occur after a binge episode may include over-exercising, vomiting, abusing laxatives, diuretics, enemas, or colonics.¹ All of these types of purging can cause serious, life-threatening complications.
Myth 2: Bulimia is not as harmful as other eating disorders.
Fact: Bulimia can have severe physical effects on the body.
Regardless of the type of purging used, these behaviors can have severe detrimental effects on the body. Vomiting results in stomach acid making its way up through the esophagus and through the mouth, which deteriorates tooth enamel and may cause tooth decay, chemical burns, and sores in the mouth.¹ This exposure to stomach acid can lead to Barrett’s esophagus, which is associated with an increased risk of developing esophageal cancer.² The sudden increase in pressure while purging may even lead to vision loss caused by ruptured blood vessels in the eye. Chronic vomiting reduces the pressure of the lower esophageal sphincter, which normally works to contain acid within the stomach. Consequently, repeatedly engaging in purging behaviors can lead to the stomach’s contents flowing back into the esophagus, a phenomenon known as heartburn or acid reflux. Bleeding of the upper GI tract may also result in painful swelling of the parotid and salivary glands (located on the sides of the jaw below the ears).
Purging through laxative abuse can lead to constipation, diarrhea, and laxative dependency (in the case of stimulant laxatives). Laxative overuse may also cause severe nausea, cramps, pancreatitis, or kidney stones. Severe dehydration is most common among patients who purge through laxatives. Vomiting or laxative abuse can lead to serious electrolyte imbalances and dehydration that may result in life-threatening cardiac arrhythmias.¹
Myth 3: By looking at a person’s body type, you can tell what type of eating disorder they have.
Fact: Eating disorders affect people of all body types, genders, and ethnicities.
It is very difficult to determine a person’s health status by simply looking at their outer appearance – the same goes for eating disorders. There is no typical body type of someone living with bulimia.³ This can add to the secrecy surrounding the eating disorder and may prevent someone from feeling “sick enough” to seek treatment. As discussed in Myth #2, there are numerous complications caused by bulimia that may be life-threatening, regardless of the number on the scale.
Myth 4: Purging is an effective means of getting rid of calories eaten.
Fact: The body still retains energy from food (calories) after purging, even when done immediately after eating.
Even after purging through vomiting or laxatives, the body still retains calories from food.⁴ The body is very efficient at extracting calories (energy) from food for survival. This process begins in the mouth during the chewing process, as enzymes break down nutrients in our saliva. Even in the case of purging through laxative abuse, “fecal calorie loss increased only slightly” in studies.⁵ The intestines have an enormous capacity to absorb calories from food, even when transit time (the time it takes for food to move through the GI tract) is sped up through stimulant laxatives.⁵ Taking into account all of the body’s abilities to absorb nutrients from food, purging mechanisms are not an efficient means of reducing intake and pose a big risk of life-threatening fluid and electrolyte losses that can result from repeated vomiting or laxative use.
Myth 5: Once the purging behaviors stop, a person is fully recovered from bulimia.
Fact: Recovery is a long process that requires a coordinated approach by a specialized treatment team.
While removing purging behaviors is certainly a step in the right direction, that does not mean a person is recovered from bulimia. There are many other symptoms of the eating disorder, including disordered thoughts surrounding food, patterns of binge-restrict cycles, and other psychological manifestations. Bulimia is first and foremost a psychiatric diagnosis, which means that a therapist or psychiatrist is an essential member of the treatment team. These providers, along with a Registered Dietitian, can help someone with bulimia to improve their relationship with food while providing coping skills for the emotional triggers that may have given rise to the eating disorder behaviors in the first place.
It takes at least one year of being symptom-free for the body to reach homeostasis (stability), and the entire recovery process can take many years. Relapse is also common and may be a part of the recovery process.⁶ However, it is important to note full recovery is possible. BALANCE can help someone struggling with bulimia to rediscover their healthy self and live a life full of joy and food freedom.
At BALANCE eating disorder treatment center™, our compassionate, highly skilled team of clinicians is trained in diagnosing and treating the spectrum of eating disorders, including anorexia, bulimia, binge eating disorder, compulsive overeating, and other disordered eating behaviors and body image issues. In addition to our full-time Day Treatment Program and Weeknight Intensive Outpatient Program, we offer nutrition counseling with a licensed dietitian, meal support, and various other groups and resources to assist those seeking help for food concerns.
Our admissions team would be happy to answer any questions you may have regarding our programs and services. Book a call below, or read more about our philosophy here.
This post was written by BALANCE Dietetic Intern, Nicki Partitsis (she/her).
Nicki is a Nutrition & Dietetics Masters student at NYU, currently in her Dietetic Internship clinical rotations. She graduated from the University of Miami with a Bachelor’s degree in Exercise Physiology and a minor in Sports Medicine. Nicki is currently a virtual personal trainer who uses a weight-inclusive approach to help clients increase their energy, strength, and confidence. When she’s not studying nutrition, she enjoys weightlifting, spending time outdoors, and hanging out with friends. She plans to specialize in helping people navigate the intersection between nutrition, fitness, and disordered eating.
References
1. Gaudiani, J. L. (2019). Sick enough: A guide to the medical complications of eating disorders. Routledge.
2. Mayo Foundation for Medical Education and Research. (2022, March 5). Barrett's esophagus. Mayo Clinic. Retrieved April 18, 2022, from https://www.mayoclinic.org/diseases-conditions/barretts-esophagus/symptoms-causes/syc-20352841
3. Rettner, R. (2015, January 13). Bulimia nervosa: Symptoms and treatment. LiveScience. Retrieved April 18, 2022, from https://www.livescience.com/34702-bulimia-nervosa-eating-disorder.html
4. Centre for Clinical Interventions. (2018, January 25). Vomiting and your health - cci.health.wa.gov.au. Centre for Clinical Interventions. Retrieved April 18, 2022, from https://www.cci.health.wa.gov.au/-/media/CCI/Mental-Health-Professionals/Eating-Disorders/Eating-Disorders---Information-Sheets/Eating-Disorders-Information-Sheet---30---Vomiting-and-Your-Health.pdf?tag=makemoney0821-20
5. Bo-Linn, G. W., Santa Ana, C. A., Morawski, S. G., & Fordtran, J. S. (1983). Purging and calorie absorption in bulimic patients and normal women. Annals of internal medicine, 99(1), 14–17. https://doi.org/10.7326/0003-4819-99-1-14
6. Families Empowered And Supporting Treatment for Eating Disorders. (2020, August 30). Defining recovery. FEAST. Retrieved April 18, 2022, from https://www.feast-ed.org/defining-recovery/#:~:text=And%20although%20it%20has%20become,weight%20goals%20should%20be%20reexamined.