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Like anorexia, bulimia is a very secretive illness but unlike anorexia, it can be hidden from the outside world since sufferers are frequently a normal weight. Many anorexics fear that they will turn from anorexia to bulimia as they recover and start eating. Although some people suffer from both bulimia and anorexia, they are in fact two separate illnesses and research has shown that one does not necessarily lead to the other. Certainly in my case, I suffered from anorexia for fourteen years but never had any bulimic episodes.

Bulimia usually develops later than anorexia. Whereas anorexia is often present in young girls aged between 10 and 16, bulimia rarely takes hold until the late teens. Unlike anorexics, who maintain a strict control over their food intake, bulimics find it harder to limit the amount of food they eat. Quite often, feelings of hunger cause them to binge on large quantities of the food they so desperately want. This is the food that they have denied themselves while on their ‘restricted’ diet. It is usually high in fat and sugar such as chocolate, cookies and crisps. A binge can last for a long time but on average, bulimics say they binge for around two hours. During that time a large amount of food can be eaten, for example as much as 30,000 calories during just one binge. This is the equivalent of about 15 day’s food.

Many bulimics say they feel totally out of control during a binge and simply force extra food into their mouths without even tasting what they are eating. It is not unheard of for bulimics to eat frozen or uncooked food, stale food from dustbins or even pet food. Following a binge, bulimics usually suffer tremendous guilt as well as physical pain from the large amounts of food they have eaten.

This guilt, together with a fear of gaining weight, leads the sufferer to find ways of getting rid of the food they have so recently eaten. Self-induced vomiting is common and is when sufferers force themselves to be sick. Some people may take medicines called emetics to make themselves vomit. Another method used to dispose of the food is purging. This is when bulimics take laxatives to cause food and drink to pass through their body much faster. Both vomiting and purging are extremely dangerous ways of ‘dieting’ and can lead to serious medical problems or even death.

Although bulimia nervosa is the most hidden of all the eating disorders, there are telltale signs that show a person is suffering from this illness. Their skin often has a pale green tinge due to the constant vomiting. Teeth can also suffer and frequent dental appointments may be needed. When a person vomits, their teeth come into contact with stomach acid, which is very harmful. Tooth enamel is gradually worn away until the teeth themselves start to decay. Many sufferers brush their teeth immediately after vomiting, to remove any telltale smell on their breath. However, this is unwise because it spreads the acid around all the teeth. Rinsing with antiseptic mouthwash or fresh water is considered a safer option although this is still unlikely to stop the decay caused by vomiting.

Small red spots appearing around the eyes due to broken blood vessels are another sign of bulimia. A puffiness of the cheeks (often known as “chipmunk cheeks”) can occur because of the constant vomiting. The sufferer’s throat is usually sore and mouth ulcers can form. Stomach and bowel problems may also be very common, due to both the vomiting and purging. In addition, the sufferer’s hair often starts to fall out although doctors are unsure why. As with anorexia, there are also long-term effects such as bone damage caused by a change in the level of female hormones in the body. Bulimia can affect a woman’s monthly period and it may become heavier and irregular.

Depression, moodiness and irritability are also symptoms of bulimia. Obviously there are exceptions to every rule but there are certain characteristics bulimics tend to have. They are often bubbly, warm and social people but can change when they are trying to cope with their feelings after a binge. They may become irrational, angry, withdrawn or depressed. This means they often have stormy relationships with friends and family, as their moods can prevent people getting close to them.

Bulimics often feel confused about their feelings and emotions. They no longer eat simply because they are hungry but to fill an emotional need instead. For them there are only extremes. They are either totally empty and starving hungry, or uncomfortably full following a binge. Recovery from bulimia is all about learning to eat a normal amount each day without feeling a need to vomit. Like anorexia, bulimia is a very dangerous illness that requires medical attention and it is very important to contact a doctor if you are exhibiting any of these symptoms.

Evaluation of both anorexia and bulimia Unfortunately the activity of being bulimic often actually works against the body becoming slim, healthy and fit, For example, someone with bulimia and worried about their weight will often skip breakfast. If they were to eat something like porridge then their metabolic rate would increase and they would more effectively burn calories, and foods like porridge provide a long term energy release so that the person isn’t ‘starving’ by lunchtime. Almost invariably when the person stops being bulimic and starts to eat a healthy balanced diet they usually find it astonishingly easy to lose excess weight. Most bulimics know more about nutrition than many nutritionists.

Some anorexia nervosa suffers show some symptoms of bulimia. The fact that some categories of anorexia and bulimia nervosa overlap has convinced a number of researchers to start questioning whether they might in fact be one single disorder. Bulimia nervosa is not usually regarded as life threatening when compared with anorexia nervosa, however it takes longer to manage and overall it is worse in the long term it is an ongoing disorder (Russell 1979). Bulimic behaviours are more common in the general public than anorexia.

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