Urge to purge

Those affected with bulimia eat all they want and then take it all out fearing weight gain

Woman eating popcorn

Mr X’s 21 year old daughter had been suffering from severe stomach ulcers for two years. Her condition improved a bit but only after a horrifying year and a half of emergency hospitalisations. As Mr X began reading more about stomach ulcers, he discovered that stress and emotional ill health were principle causes of ulcers.

As a concerned father, he consulted a psychiatrist for his daughter’s problem. During counselling, he came to know that his daughter was bulimic and regularly indulged in binge eating. He and his wife were a health-conscious couple that made sure that their kids lead a healthy life. But they never realised that their obsession with health put severe pressure on their daughter. They never allowed her to eat junk food or sweets and restricted her diet. Hence, she binged when she went out with friends. But she also feared putting on weight and having to answer her parents. So, she would vomit or use laxatives to get the food out of her system after her binges.

Mr X’s daughter opened up to her parents during the family therapy session. She admitted feeling stressed about her outward appearance because of her parents. She had poor self-worth and low confidence. She longed for a normal childhood eating pizzas, chocolates and wafers, like her friends. Her fear about her weight and inability to have an open and honest relation with her parents was what lead to her condition, which is known as bulimia nervosa.

What is bulimia?

Bulimia nervosa is an eating disorder that involves ‘binge eating’ and ‘purging’. A person follows this cycle several times a week. Most eating disorders stem from the fear of gaining weight. The hype over size ‘zero’ has caused a lot of anxiety amongst young women. Physical appearance has become the top priority resulting in unhealthy ways of losing weight, quick. Inability to sustain healthy measures of weight loss may lead one to follow a bulimic pattern.

Bulimia is more common in women than in men and often coexists with mild depression and other mood, anxiety and personality disorders. The binging is emotional eating, precipitated by stress or other emotional concerns. For the affected individual, food is the only immediate source of satisfaction and happiness. The person is often impulsive about food and is unable to control how much she eats. This results in overeating unhealthy food. However, once the person has eaten, she experiences immense guilt since appearance and hence, weight is also a concern. This leads such individuals to induce purging either by vomiting or by using laxatives. Also, while binging, such people tend to eat at a hurried pace. All this often leads to conditions such as: Peptic ulcers, hyperacidity, constipation, dehydration, electrolyte imbalance, inflammation or rupturing of the food pipe [eosophagus], infertility, low immunity and teeth erosion. Moreover, purging harms the digestive system and reduces metabolism over time. The increased use of laxatives too leads to severe gastric complications.

Unfortunately, most people suffering from bulimia are aware of the harmful effects of binging and purging but choose to look at the present gains rather than future complications. They are so habituated to the practice of throwing up after eating that they even try to avoid attending social dinners or lunches as they fear they won’t get a chance to purge in privacy.

What causes bulimia?

Watch out for these triggers of bulimia:

  • Depression is a common cause of bulimia as in depression there is either a significant loss or an increase in appetite.
  • Life events and situations such as break-ups, loss of loved ones, divorce, failure, or any other factors that may precipitate low self-confidence may cause eating disorders such as bulimia. Those with personality disorders such as borderline and histrionic personality often develop bulimia.
  • Individuals with a pessimistic attitude, insecurity, and low self-worth are at a higher risk of developing bulimia. This is so because these individuals compare their physical appearance to others and presume that losing weight would make them look and feel better, increasing their social acceptance
  • Those who are always on rigid weight loss diets often deprive themselves of foods they like. They suppress their cravings but can’t do so for long. When they let their guard down, they binge on all the fattening and unhealthy food they can lay their hands on and then guilt follows. Only purging helps appease the guilt.
  • Individuals working in industries that lay emphasis on looks, commonly purge food to avoid putting on calories. It’s a common practice.

How is it treated?

Actually, it’s a matter of being aware. Awareness of what you’re doing in the initial stages and some self-control will prevent the tendency from turning into full-blown bulimia. However, once you cross this stage, you need professional help. A counsellor or a therapist will help you deal with not just the tendency but also the underlying emotional issues effectively through the Cognitive Behavior Therapy. The therapy helps individuals think in a rational manner. It gives them greater control over their urges and impulses, which makes them emotionally stronger. This leads lead to healthy behaviours.

Sometimes, the family may be involved in therapy as close relationships play a big role in one’s feeling of security, self-confidence and self-worth. Enhancing the support system enhances one’s confidence and self-esteem. In some cases, medicines [mostly anti-depressants] may be prescribed along with the counselling.

But it’s observed that once the underlying cause is treated, the bulimic tendency disappears too.

Do you eat and then remove it all out?

  • If you are in the habit of purging after eating, even if it’s only occasionally, accept that it’s not normal. Confide in a family member or a friend and then work out a plan to deal with this concern.
  • Learn to differentiate between physical and emotional hunger—emotional hunger can be a serious problem causing weight gain resulting in regular cycles of binging and purging. You could note down emotions that trigger the urge to eat junk food. Get more aware about your eating pattern and gradually find an alternative healthy activity to help divert your mind.
  • Identify any emotional issues that you may be having and seek professional help for the same; food is never a solution to emotional baggage.
  • When you get the craving to binge, consciously hold back for five minutes. This will help you control the impulse and think more rationally. If you aren’t able to follow these self-help measures, consult a professional.

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Anjali Chhabria
Dr Anjali Chhabria is the founder of Mindtemple, a counseling centre in Mumbai. Having completed her MBBS, M.D., and Diploma in Psychotherapies, she has been a practicing consultant and psychiatrist for 25 years. An ex-President of Bombay Psychiatric Society from 2001-2002, she has been expressing her views on mental health issues on multifarious media platforms.


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