The main symptoms of bulimia are:
- bingeing – overeating in a particular pattern
- purging – trying to reduce the effect of binging by attempting to get calories out of your body
- focus on food – thinking about food all the time, even when you don’t want to
- problems with self-esteem and focus on body image when it comes to food and weight
In order for an episode of binge eating to be considered a binge, it should have 2 key features. The first is that the amount of food eaten is far more than normal for the situation – for example, many people eat a lot more on Christmas Day than they would on any other day, but this is normal for the situation, so it wouldn’t qualify as a binge.
The second feature is a feeling that the eating is out of control – feeling as if you can’t stop eating. You might feel disconnected – as if you’re watching the binge happen from outside your body.
There may be times when a person eats a relatively small amount of food, but it still feels like a binge because they feel a loss of control.
Binge eating is usually a very quick process and you may feel physically uncomfortable afterwards. When binge eating is a symptom of bulimia, it happens regularly, not just once or twice.
Binge eating episodes are sometimes spontaneous, where you eat anything you can find. They can also be planned, where you make a shopping trip to buy foods specifically to binge on.
People often find eating comforting. Binges can start as a way to cope with difficult emotions, but become increasingly frequent and out of control.
After bingeing, you might feel guilty, anxious, and angry with yourself. You may also feel uncomfortable physically, for example you might feel sick or bloated from the amount you’ve eaten. Purging is a response to these feelings, as well as an attempt to ‘undo’ any weight gain that could be caused by the binge.
There are a number of ways that people try to purge:
- making yourself vomit
- taking laxatives (medicine that makes you poo)
- taking illegal drugs, such as amphetamines, to try to make your body burn energy faster
In reality, purging has little effect on the calories absorbed from food.
Focus on food
People with bulimia experience ‘intrusive thoughts’ about food. Intrusive thoughts are unwanted thoughts that come into your mind without you wanting to think about them. Because people with bulimia are concerned about gaining weight and body image, but they also consider food something comforting, these thoughts cause distress.
Part of the problem for many people with bulimia is that they’ve learned that eating is comforting. When they feel distress, they want to eat in order to feel better.
People with bulimia also often restrict what they eat, which means that they are feeling hungry often, so they think more about food. When someone is very hungry, intrusive thoughts about food are likely.
After a certain period of time where people with bulimia try to avoid eating, in order to avoid gaining weight, they are likely to lose control and binge.
Problems with self-esteem and focus on body image
People with bulimia often have problems with their self-esteem in general, and as a result can spend a lot of time thinking about their body shape and eating habits. This can lead to setting strict rules about dieting, eating or exercising, which are very hard to maintain.
When people with bulimia are unable to keep to these strict rules, they tend to binge eat. After feeling guilty about binging, they purge to get rid of the calories.
These feelings of guilt then further affect self-esteem, causing what’s often called a ‘cycle of guilt’.