Wednesday 28/9/2022

PHOTO: Katarina Wolnik Vera

Text: Alejandra Misiolek

Bulimia is an Eating Disorder defined (by Oxford dictionary) as an emotional disorder characterized by a distorted body image and an obsessive desire to lose weight, in which bouts of extreme overeating are followed by fasting or self-induced vomiting or purging.

On the other hand, the psychiatric manual of disorders – DSM-5 includes the following diagnostic criteria for bulimia nervosa:

• Recurrent episodes of binge eating, where an episode of binge eating is characterized by both of the following:
• Eating, in a discrete period of time an amount of food that is definitely larger than what most people would eat during a similar period of time and under similar circumstances.
• Lack of control overeating during the episode
• Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
• Self-evaluation is unduly influenced by body shape and weight.
• Binging or purging does not occur exclusively during episodes of behavior that would be common in those with anorexia nervosa.

The psychiatric definition is based more on the behaviors and eating patterns than the emotions. However, in all Eating Disorders, the behavior is only the tip of the iceberg and what is beneath is emotional regulation, self-esteem, difficulties in relating to others, mentalization difficulties and identity confusion.

The part of bulimia where the behavior and emotions seem to converge is the control – the constant feeling of losing control and the obsessive need to regain control. A person with bulimia tends to jump from one extreme to the other and has major difficulties in staying in the space between. How does it start?

As we have already discussed in a previous post, bulimia is very frequently a consequence of restricting or even of previous anorexia: fear of putting on weight leads us to excessive dieting and restriction is a privation that leads us to overeating. Bingeing on food causes anxiety related with putting on weight so purging seems like a solution and the cycle is repeated. This cycle can easily become addictive.

Why?

What is addictive in this mechanism is the fact that you seem be winning. But you actually are cheating on yourself. From the outside it seems that everything is perfect but inside you feel more and more useless, and you feel that you have no control at all.

Losing control causes so much anxiety that finding a “magic solution” seems to be soothing. Vomiting and purging is a fantasy of being able to undo what has happened.

But is it really? You cannot undo the fact that it is harmful to your body, emotionally exhausting and in the long run, prevents you from learning to regulate your emotions in a more healthy way.

The fact that bulimia is addictive and based on vicious cycles means that it gives an illusion of coping, rarely is seen on the outside by others and it is extremely difficult to change it by yourself.