We’re all familiar with the aftermath of a good holiday meal. You know the one – the kind where you’ve waited all day for that turkey or ham to come out of the oven, along with all the other goodies for side dishes.  By the time you finally sit down, you stuff yourself silly, and then kick back to relax in semi-comatose state.  You’re so full that you can’t move for the rest of the night.

If you suffer from Bulimia Nervosa, none of this happens when you overeat.  And you overeat every day, sometimes several times a day.  But there are no sighs of satisfaction, no feelings of being pleasantly full.  There is only self-hatred for your inability to control your eating.  You have to get rid of what’s making you despise yourself, so you purge your body of the food by causing yourself to vomit, you abuse laxatives and diuretics, and you exercise frantically to avoid more weight gain.  This is the world of the bulimic.

According to the Diagnostic and Statistical Manual of the American Psychiatric Association, Version Four, Text Revised (DSM-IV-TR), the following behaviors are the diagnostic features of Bulimia Nervosa, paraphrased: Frequent binges of very large amounts of food; lack of control over food. “Secret” eating; never binging when others are present, hording food to eat alone. After binge eating, the person then proceeds to engage in compensatory behavior by inducing vomiting, chronic abuse of laxatives and diuretics, enemas, and excessive exercising. Binge foods include great quantities of sweets and other carbohydrates. Binges are rapid – food is consumed very quickly. Intense feelings of shame, guilt, and self-disgust about binges are a direct result.

Co-existing symptoms of depression and/or anxiety manifest themselves. Purging by vomiting provides relief from the physical discomfort of binge eating; vomiting is induced with fingers, an instrument such as a spoon, or ingesting Ipecac syrup.  After an intense binge-purge episode, there may be total fasting for a day or two, combined with excessive, frantic exercise.  The binge and purge cycle begins all over again.

Not all bulimics go through the binge/purge cycle. There is a secondary category of bulimics called “non-purging”. Non-purging bulimics can be overweight or of normal weight; the former is obsessed with losing weight and the latter is deeply afraid of gaining weight. Non-purging bulimics will frequently binge but rather than purge, they will frantically exercise the calories off and then fast for several days before starting the cycle all over again.

Will power and good character have nothing to do with Bulimia Nervosa. Bulimics take no joy in binging and purging, and when you think about it, the act of purging isn’t all that pleasant. The only thing bulimics hate more than them is food. The situation is a constant war and if bulimics knew how to stop, they would. However, bulimics feel powerless to control anything, and the only key to changing the situation is for the bulimic to believe and understand that they do have the power to change their behavior.

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