Bulimic behavior has two phases: the binge and the purge.
Although there are certainly individual variations, a binge is defined as the rapid consumption of a large amount of high-calorie food in a short amount of time. A binge can consist of almost anything. Often it can depend on what is available in terms of food and finances.
Dr. Goldsmith has been active in the mental health care of women since 1995. From 1996 to 1999, she was the director of the Women’s Mental Health Program at the University of Cincinnati, and continued in a similar position at the University of Florida from 1999 to 2005. She joined the Emory Women’s Mental Health Program in 2006 and became its director in 2013.
Editor: Saad Shaheed
Once a binge begins, it is very difficult to interrupt. People often describe feeling in a trance or a stupor; food can be consumed so rapidly that it is not even tasted. An average bulimic binge may consist of about 1,500 to 3,000 calories, although some individuals have reported eating up to 60,000 calories or more during a binge.
Having said this, sometimes people purge without actually bingeing; unplanned eating creates such guilt and anxiety that those people feel driven to eliminate or undo any food that feels as though it were “too much.” Often the binge ends only when food or finances are depleted, leaving the bulimic with severe abdominal and emotional discomfort.
Characteristics of Binge Eating:
- Bingeing usually occurs in secrecy.
- Binge episodes may be planned or unplanned.
- Usually the episodes are characterized by rapid, frenzied consumption.
- Some people report feeling as though they enter into an altered state when the binge begins. Many bulimics report that they do not even taste much of what they consume during a binge.
The most common triggers for binge eating include:
- Negative mood states
- Interpersonal stress
- Hunger due to dietary restriction
- Negative feelings related to one’s body image
As many as 70 to 80 percent of bulimics purge by means of self-induced vomiting while 30 percent use laxatives.
Risks associated with purging:
- Laxatives—There are several dangers associated with laxative abuse. The most frequently used laxatives are those that stimulate the bowel. Some people use large amounts of laxatives following a binge to rid the body of the food. Laxatives are an ineffective means of ridding the body of calories, because most of the calories are absorbed from food before it gets to the end of the intestinal tract. In addition, if the bowel gets used to the use of laxatives, then stopping the laxatives may lead to temporary constipation, bloating and abdominal discomfort, which often compels laxative use and the cycle continues. Longtime use of laxatives can lead to potassium depletion and dehydration. Another risk of chronic laxative abuse is that the bowel can become unresponsive.The best way to deal with laxative abuse is to stop “cold turkey.” You may experience some side effects for a short time (10 days), but then normal bowel functioning should return. Some individuals prefer to use fiber-based laxatives (Fiberall , bran, etc.) for a short period of time during the transition.
- Diuretics—Diuretics or “water pills” are the least effective means of managing weight. Diuretics work by ridding the body of water, thus decreasing feelings of bloating. Chronic use of diuretics can lead to kidney damage or kidney failure. They also can induce electrolyte or salt imbalances that can lead to fatal disturbances in heart rhythm.
- Self-induced vomiting—Burst blood vessels in the eyes, dental erosion, esophageal tears or potassium depletion leading to fatal disturbances in heart rhythm.
Exercise is excessive if it:
- Interferes with important activities.
- Occurs at inappropriate times or in inappropriate settings.
- Continues despite injury, illness or bad weather.
- Is a preoccupation.