Counseling Services of Barbara Reade, L.C.P.C.
Bel Air, Maryland 21014

Phone: 410-803-1510

Email: reade.lcpc@yahoo.com  

Teens and Bulimia

By Barbara Reade, L.C.P.C., COPYRIGHT 2/2009

Bulimia in Adolescence

Bulimia is a very common psychological disorders affecting young females. The most significant characteristic of the condition is the consumption of large amounts of food, usually junk food rather than healthy fruit and vegetables. At the time of eating the teen has the experience of being and feeling completely out of control, and consequently the person cannot control the binging incident at the time. Often to compensate, the teen uses a form of purging, where the food consumed is expelled by a variety of means. Each person with bulimia defines a binge for herself.  Because of distortions in thinking about food, as little as one doughnut may be thought of as a binge by one person while an entire package of cookies may constitute a binge for another. The longer the purging behavior continues, the easily it becomes for the teen to do.

The DSM-IV outlines the following criteria for the diagnosis of bulimia nervosa:

1.” Recurring episodes of binge eating in which the following occurs:

 a) Consuming an amount of food in a particular block of time (say two hours) which considerably exceeds that which most people would eat in an equivalent timeframe.

b) During the bingeing episode, there is a sense of lack of control over the eating process. The person cannot control how much they eat or willingly stop eating under the episode is completed.

2. The use of behaviors to counteract the effects of the binge eating. For example, the use of laxatives to flush out the system, the inducement of vomiting to immediately remove the food from the stomach, the use of fasting to control food intake, and excessive exercise to remove any weight gained from the bingeing behavior.

3. The binge eating and behaviors aimed to counteract the binge eating (i.e. vomiting, purging, laxative use, diuretic use to remove excess water, and excess exercising) occur at least twice a week over a period of three months.

4. The person is obsessed by bodily appearance and shape.”

Physical Symptoms can include:

• Cracked, damaged lips 
• Tooth damage
• Throat irritation
• Esophageal inflammation (the above symptoms are caused by exposure of tissues to acidic vomit)
• Callused hands (from contact with teeth when used to stimulate vomiting)
• Swollen salivary glands (caused by acid reflux or constant stimulation)
• Broken blood vessels in face (from the force of vomiting)
• Rectal bleeding (caused by overuse of laxatives)
• Fluctuations in body weight

Sufferers of bulimia often are found to have anxiety disorders like social phobia or generalized anxiety disorder. Over 75% of those with bulimia experience other anxiety-related problems. Mood disorders, especially depression, are also commonly present in suffers of bulimia. This may be due to lowered self esteem from guilt about this out of control behavior, or a motivating cause for the presence of the bulimia. Substance abuse is also found fairly frequently in this group of teens.

Causes?

The causes of bulimia have not been scientifically proven or determined. However, there are several many factors that sufferers of bulimia often have in common including:

1)     The effect of the media on the self-esteem of young women in regard to their body shape, and resulting issues of peer pressure around this

2)     Poor interpersonal relationships, particularly among family members

3)     Stressful events in the life of an adolescent

4)     A strong desire by the adolescent to be "perfect"

Treatment for bulimia includes both physical and emotional aspects and involves psychiatrists, psychologists, dieticians, and social workers. Hospitalization may be required if health problems are occurring. This can only be determined by an M.D.

A holistic approach to eating disorders has been used in recent years that attempts to resolve the underlying belief systems that cause the problem to develop in the first place. Rather than utilizing the often emotionally difficult setting of a hospital unit, this alternate recovery approach involves providing unconditional love and support to sufferers. This helps the bulimic to begin learn how to love themselves, often for the first time in their lives, and by doing so, to cease the self-harming behaviors like bulimic behaviors.

It is so important for family and friends of the bulimic sufferer to understand the condition, and to realize that this is a legitimate medical disorder shared by tens of thousands of other young women. It is essential that families come to understand the unconditional patience and love that these teens need to help overcome this difficult condition.

Statements such as "Why don't you just eat like everyone else? or "Just pull yourself together" are both devastating to the sufferer, and do not reflect a true understanding of this disorder. Bulimics do attempt to control their eating patterns but the truth of the disorder is that the teen is profoundly out of control. Understanding and compassion are the roots to unraveling the challenges surrounding bulimia and helping to support recovery for the bulimia sufferer.

Symptoms and confusion: The adolescent who has bulimia nervosa frequently maintains close-to-normal weight-for-height-for-age. However they are often eat abnormally large amounts of food, (known as binge eating) and then regularly purge voluntarily vomiting or laxative use.  Or a teen may also use fasting or extreme forms of exercise rather than vomiting and/or purging Teens with bulimia nervosa may have somewhat less severely distorted perceptions of their body and less restrictive weight goals compared with those suffering from anorexia nervosa, however distorted body perception is still usually prevelant. Teens with bulimia nervosa are often older at age of onset.

Bulimia: Social Characteristics

Bulimia is a serious eating disorder. It indicates important psychological difficulties in the adolescent.  Her self-esteem is often extremely low and tied to her feelings about certain characteristics of her body that are inherited traits, and factors overwhich she cannot have control. A self image of being physically unattractive is behind this, even though others may observe her as well groomed, normal, and attractive.  Normal weight adolescents with bulimia do not tend to have the seriously compromised nutritional status of those starving with anorexia nervosa, however only a medical doctor can conform this.

You may see your adolescent with bulimia keeping a heavy social schedule, but in reality she may have few close friends. Young women with bulimia often demonstrate poor impulse control. By all accounts, gorging, vomiting, and purging serve as tension relievers for the sufferers.  Bulimics often describe feeling “numbed out” during a binge.  A large problem occurs after the purging event when the bulimic’s feelings of guilt inadequacy bring back more tension that then helps to spur on more uncontrolled cycles.  Social isolation is also sometimes present because they don’t want others to know their secret.

Life-threatening situations are rarer in adolescents with bulimia nervosa than with anorexia nervosa. They are:

• Dehydration and electrolyte imbalance 
• Ruptures in the upper gastrointestinal tract 
• Kidney disorders

Treatment:

Psychotherapy: A combination of individual and family therapy is important in treating bulimia. The teen will be dealing with issues of learning to increase her self esteem, decrease guilt, learn to deal with anxiety issues and stresses, and to challenge ideas related to perfectionism and unrealistic body image expectations.

Medical : As well as psychotherapy, a medical doctor should be monitoring the teen’s health, and helping to determine if medications for depression or anxiety might be helpful to treatment success. Psychiatrists handle more difficult medication management issues and therefore may be helpful for some teens with this disorder. Nutritional therapy and education is also essential to help the teen learn more effective ways to food and weight management. Licensed nutritionists can be very helpful in this aspect of a teen’s recovery program.