Bulimia is an eating disorder that means that you eat hot and then try to get rid of the food, for example by vomiting or using laxatives. Bulimia can cause mental illness and serious bodily harm if you are not treated. Most people who receive treatment become healthy.

Here you can read about bulimia or bulimia nervosa as the disease is called in medical language. If you are a parent or relative of someone who has an eating disorder, you can  read more here. 

How do I know I have bulimia?

It can take time to develop an eating disorder, and sometimes it can be difficult to know when it has become a disease. You have bulimia if you have any of these problems:

  • You eat frequently and regularly in an uncontrolled way, which means that you get large amounts of food in a short time. It is called hot eating. The foods you eat are often those foods that you would otherwise try to avoid, such as those that contain a lot of sugar, salt and fat.
  • After you have eaten, you get rid of what you have eaten by, for example, vomiting, taking laxatives, fasting or exercising hard.
  • You are often plagued by anxiety and feel disgusted guilt, and shame for your behavior.

If you recognize in the descriptions above, you may have bulimia or some other eating disorder. Then it is important that you seek professional help. The earlier you seek care, the better. There is good help to be had.

Usually to hide the problems

If you are very ashamed of your behavior, you can try to hide the problems and pretend that everything is fine. You may begin to isolate yourself so that no one will understand what you are doing. Then it can take an unnecessarily long time before you seek help.

If the decision to seek help feels great and difficult, it may be good to start by talking to someone you trust. Read more about what you can do in the chapter on seeking care.

What is bulimia?

Bulimia is a common form of an eating disorder. You can get bulimia regardless of gender and age. Unlike anorexia, bulimia is not as noticeable to the surroundings as the weight is often not affected so visibly.

Heat sealing and weight control

Bulimia is an eating disorder that means you eat hot and then get rid of what you have got in you. How you do to try to get rid of or compensate for, what you eat is different, but regardless of the method, it is harmful to the body. The illness also involves a mental illness that can be difficult to break on your own. It is also common for you to follow a strict diet and try to lose weight, sometimes even with the help of hard workouts.

Bulimia has a lot in common with eating disorders, anorexia. Sometimes you may develop bulimia after previously having anorexia. You may have a form of anorexia that means you both starve and have bulimia at the same time. It can seriously damage your body.

What is hot eating?

Hot-eating means that you feel that you lose control and in the short term eat extreme amounts of food. It may be food that you otherwise avoid in order not to gain weight. For example, it can be chips, sandwiches, ice cream or sweets.

When you ban yourself from eating certain things, your body gets a craving for just such food. The craving for the forbidden food can provoke an attack of hot eating.

A pattern that is repeated

If you have bulimia, hot flashes usually follow a certain pattern, which is often repeated several times a week. Here is a typical process:

  • Before the heat, you can feel an increasing craving for “forbidden” food and the thought of eating it comes more and more often. Thoughts can cause anxiety.  
  • During the heat session, it may feel like you are losing control, and you get the feeling that you will not be able to stop the heat eating once you have started.
  • After the heat eating, you will feel guilt and anxiety over everything you have eaten and that you have lost control. The feeling that everything that has entered the body must be removed is reinforced. You long to be “clean” by doing away with what you have eaten.
  • When you get rid of what you have been eating, by vomiting or in some other way, it is called you compensating. The compensation can relieve acute anxiety and first give a feeling of relief. Afterward, you may be physically exhausted and filled with disgust and disdain for what you have done. Feelings of sadness, emptiness, and hopelessness grow and make it even more difficult for you to get out of bulimia.

Anxiety and craving

In simple terms, the psychological course of the heat sentence can be described as follows:

  1. Anxiety and a craving for the forbidden create a need to heat up.
  2. The heat-setting forces the need to compensate.
  3. After the compensation comes to the anxiety and the craving back.

This pattern takes a lot of power and can be difficult to break on your own. Therefore, you need to seek help.

Self-feeling is affected

If you have bulimia, your self-esteem is excessively dependent on body shape and weight. You are often dissatisfied with yourself. Thoughts constantly revolve around food, your ability to concentrate is affected and you sleepless.

You can switch between hopes of finally being able to take control and being happy with yourself, and a sense of hopelessness when you think it will never happen.

Common with mental illness

If you have bulimia, you are usually depressed or depressed. As you feel ashamed of your behavior, you can start to avoid socializing and have an increasingly negative self-image. It is common for you to get anxiety and phobias. You can also get suicidal thoughts.

In order to dampen feelings and appetite, it is common to start injuring oneself or using alcohol or drugs. It is a risky behavior because anxiety can be aggravated and can lead to the development of an addiction.

Need for control

To gain control over your inner feeling, bulimia becomes a way to dampen your emotions rather than deal with them. In the short term, anxiety can be stunted by the heat, but in the long run, your problems worsen because you do not deal with the difficult feelings or address the causes of them.

Instead, feelings of despondency, anxiety, and obsession return, often even stronger than before. Every time you heat up and then do away with what you have eaten, you keep the emotions away. Then the thoughts are reinforced that the only thing that is important is to compensate for the heat sentences.

You can get this help. Read more in the chapter on treatment.

What happens in the body?

Experiences of hunger and satiety are controlled by a signal system in the brain. Metabolism is affected by what and how much you eat and how much you move. If everything works as it should, bodyweight is automatically adjusted to the life you live. Bulimia interferes with this regulation.

The body settles on starvation

Eating habits that fluctuate between starvation and hot eating cause the body’s energy consumption to change. During a period of strict diet, the body adjusts to starvation by reducing energy consumption.

When the heart attack comes, the body has become accustomed to coping with less energy. Therefore, the body’s natural reaction is to store the calories from the heat eating instead of burning them. This can lead to attempts to reduce their weight instead of lead to the opposite.

Vomiting can cause burns

If you get rid of the food by vomiting, the salt balance in the body can change, which can cause heart problems. It can cause irritation and bleeding in the mucous membranes and the esophagus. If you vomit frequently for an extended period of time, the stomach acid can cause you to burn to the teeth.

You can also get cracks in the mouth pipes, so-called mouth angle cracks, inflammation of the esophagus and swollen salivary glands. If you use your hands to induce vomiting, you may get ulcers on your fingers or back of your hand.

Solvents can cause major problems

If you abuse laxatives or liquid drugs, your body’s salt balance can be affected. It can be harmful to the heart. If you have very low body weight, it can be life-threatening to overeat and then vomit or abuse laxatives.

Using laxatives as compensation for what you have eaten does not work. The laxative acts in the large intestine, where no energy is absorbed. Instead, energy absorption is already taking place in the small intestine where laxatives have no effect.

Instead, the weight loss that occurs is due to fluid loss. Therefore, the body’s reaction will be to collect fluid as quickly as possible. It can be mistakenly interpreted as having accumulated fat and causing you to use even more laxatives.

Stomach pain and iron deficiency

If you avoid certain foods for an extended period of time, you may be deficient in various substances that your body needs. Stomach and bowel problems are common.

You may get stomach upset, constipation, gasification or other problems with the stomach and intestines. Anemia due to lack of iron can make you tired.

If you have menstruation, it may disappear or become irregular. Most side effects of bulimia disappear when you start eating regularly again.

When should I seek care?

To find out if you have bulimia, you need to seek care. Sometimes there may be bodily illnesses that cause symptoms similar to eating disorders. Therefore, it is important that you get a proper investigation. 

If you are under 18 years of age

You who are under 18 can contact a health care center, a  youth clinic, student health or child and adolescent psychiatry, bup. At some bup-clinics, you need a  referral from the health center.

If you are over 18 years of age

If you are 18 years of age or older, you can book time at a  health care center, psychiatric clinic or occupational health care if you work. You who are up to 20-25 years can also contact a youth reception.

The age limit varies between different youth centers. You who are studying can contact student health if the problems are related to the studies of the university. 

Special receptions

More and more county councils have special eating disorders. At some clinics, you need a  referral from the student health or medical center, but in several places, you can contact yourself.

Try again if the help didn’t work

If you have previously received help somewhere but do not think it worked, try again somewhere else.

Talking to different people can work well. It is also different from how it feels during different periods. Sometimes it may take time before it feels right to receive help.

What can I do for myself?

You can start by finding out as much as possible about bulimia and how it is treated. This can be a first step towards seeking help.

Start talking to others

There are various associations on the net that offer support and assistance via telephone, chat or email. You can also start by talking to a good friend or someone you trust, so you don’t have to be alone with what’s difficult.

If you have questions about bulimia or other eating disorders, you can contact the National Association for Eating Disorders, Healthy, and Free. They have local associations in several locations and can help you answer questions and refer you further. You who identify as a girl and are between 10 and 25 years can also email or chat with a volunteer at the  Eating Disorder Zone.

Another association that is knowledgeable in both eating disorders and self-harm behavior is SHEDO. At  SHEDO.se  you can read more, chat or email to tell and get support and help. 

Dare to talk about difficult feelings

You are worth feeling well and feeling happy with who you are. It is important to socialize with people who help you appreciate and develop yourself. To start talking about what you have held for yourself and ashamed of can feel both difficult and a relief. How it will feel to start talking about difficult feelings is hard to know in advance. Sometimes it can be easier than you think.

Get new perspectives

When you start talking to others, you will automatically start to think and feel differently, because you are no longer alone with your thoughts. Often thoughts about weight, body, and food have taken a lot of space. Maybe you’ve forgotten what other things you think are important in life?

By talking to others, you can gain new, healthier perspectives than if you go along with your thoughts.

Find out what you need

A constant flow of information and images of bodies can cause us to lose confidence in our own judgment, and the contact with our own bodies. When am I really hungry? May I be hungry? What does it mean to me to feel good? Can I be happy without being seen as successful? The answers to these questions can give you insights on what you need to feel good.

You may need to learn more about healthy eating, exercise and sleep, and what your body needs to feel good. You can learn to trust your body and distinguish between hunger and sweetness. Sometimes relaxation and exercises in mindfulness can help.

What can I get for the treatment of bulimia?

The treatment of bulimia you receive is primarily psychotherapy, either individually or in groups. The therapy is about changing your way of eating and processing difficult emotions. Sometimes medicines can also be included in the treatment.

Investigation consisting of interviews

In order to plan the right treatment of bulimia, a thorough investigation is first done. You get to answer questions about your eating behavior and how you feel about life in general. This is done in a series of interviews conducted by a psychologist or curator. Sometimes you have to fill in different questionnaires to map the problems.

You can also go through a general body examination, weigh yourself and submit different samples. If you are under 18, parents are also usually interviewed.

Common therapy forms

The methods of therapy that have been found to be particularly effective against bulimia are cognitive behavioral therapy, KBT, interpersonal psychotherapy, and family therapy.

Cognitive-behavioral therapy, KBT, means you get help with eating regular meals. This way you can break what creates the craving for heat. As a support, you have a food diary where you write down everything you eat and the thoughts and feelings that come up when you eat and between meals. You and the therapist use the food diary to see how the eating pattern is changing and to investigate important thoughts, feelings and situations that trigger heat-related attacks. KBT is also available as an Internet treatment.

Interpersonal psychotherapy focuses primarily on how to deal with conflicting relationships. The therapy method helps you mature in the way you manage your emotions and relate to other people, although it may take longer before it changes your eating behavior.

If you still live at home, family therapy may be an option. Then parents and also possible siblings participate.

At least six months of treatment

How long the treatment of bulimia lasts and how it is designed varies, but often it is a weekly therapy session for six to nine months.

Depending on how you are feeling and what other problems and difficulties that have emerged during the treatment period, you may need to have continued therapeutic contact that can deal with other things than the eating disorder itself.

Information and group meetings

Many specialist clinics arrange group meetings for both those with bulimia and those close to them. There you and your relatives can get information about bulimia, food and how to eat better.

At some receptions, there are daycare activities where you cook and eat food together, and discuss various problems related to eating.

Self-help literature can be a support

You may also benefit from reading books about how others have recovered from eating disorders, so-called self-help literature. Self-help books cannot replace qualified treatment, but it can be extra help to manage your problems, for example by increasing your self-esteem or managing stress or difficult feelings with the help of mindfulness.

Sometimes you can get medicines

Bulimia can also be treated with antidepressants. They may to some extent stop the impulse to heat up. But treatment with medication alone does not work as well as psychotherapy.

Therefore, treatment with antidepressants should always be in combination with psychotherapy and not as a single treatment.

Unusual with hospital care

It is unusual for you to need care in hospitals.

Financial support for dental care

You may have the right to receive financial support for the dental care you may need if you have had bulimia and suffered burns due to vomiting. You may also be entitled to a subsidy for preventive dental care, so-called special dental care allowance. On the one hand, you may have the right to receive dental care at the same cost as other medical services for a limited time, if it can be seen as part of rehabilitation after bulimia.

You can ask your doctor or dentist for more information. 

Pregnancy and breastfeeding

Even if you have been free of bulimia for several years, eating disordered thoughts about food and your own body can come back during pregnancy or after you have had a baby. It is not uncommon for you to feel fear of the weight gain that is necessary when you are pregnant, or that you are worried about what will happen to your body after you have given birth.

Important to tell about the eating disorder

If you have bulimia and become pregnant, it is important that you tell about the eating disorder for the midwife at the maternity care center so that the pregnancy can be followed in the best possible way. The body has a natural tendency to protect the fetus by, for example, ensuring that the fetus receives nutrition in the first place.

There is some increased risk of miscarriage if you have bulimia. Therefore, it is very important that you get professional help early. Even during the time after you give birth to a child, there is an increased risk that you who have previously had an eating disorder will have problems again. Read more about eating disorders in connection with pregnancy and breastfeeding.

Most will be fine again

When you are sickest, it may feel like you will never be well or will never feel happy again, but it is not at all. You can get rid of bulimia. It may take time, but it will lead to a healthier and happier life.

It is part of the eating disorder that it may take time before you realize that you have problems with eating. Feelings of shame may make it difficult for you to talk about how you feel even if you understand it.

Realizing the problem makes it possible to get rid of it

It is quite common to think that you are alone in having these problems. But you are not alone, and you do not need to continue to have eating disorders. It is a problem that you have, and that you can get rid of.

Get help from others

The road back can be long and difficult, but it is never late to be free from the disease. Even if you have lived with bulimia for many years, you can be better or completely healthy. If you seek help, through health care or in a support group, you increase your chances of being healthy.

Ehtisham Nadeem

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