How Do I Know If I Have Bulimia?

According to the National Institutes of Health, your eating disorder qualifies as bulimia if you experience these binge-purge symptoms at least twice a week for three months:

• You eat much more food than usual, in just a short time -- especially snacks or other foods high in calories. This episode is called a binge, and while it lasts, you feel like your eating is out of control.

• After a binge, you use aggressive purging tactics to try to prevent gaining weight from all the food you just ate. You might make yourself vomit or take laxatives, diuretics, enemas, or other medications. You also might use fasting or excessive exercise as part of this harmful strategy.

• Your thoughts about your bodyweight and shape dominates how you feel about yourself overall.

If you have bulimia, you probably share some common feelings that people with anorexia may have. For example, you may fear gaining weight, and you always want to lose weight.

But unlike anorexia, which is a different eating disorder, you might be able to keep your body weight in the normal range, which helps to keep your bingeing and purging a secret. But to you, binging can make you feel ashamed, while purging brings a sense of relief.

What Are the Treatments?

The primary bulimia treatment often combines psychotherapy, antidepressants, and nutritional counseling. It is helpful to find a psychologist or psychiatrist experienced in dealing with eating disorders. The same is true for nutritional counseling, whether the patient sees the family doctor or another health professional. Clinics that specialize in eating disorders can often provide psychiatrists, psychotherapists, and nutritionists. All therapists involved should work in close cooperation with one another.

Psychological treatments for bulimia may involve individual, family, or group psychotherapy. Behavior or cognitive therapies often are prescribed as well. Behavior therapy focuses on altering habits (like bingeing and purging). Sessions are usually devoted to analyzing the behavior and devising ways to change it, and the patient follows specific instructions between sessions.

Cognitive therapy focuses on habitual behavior; it aims at exploring and countering the negative thoughts that underlie destructive habits. Individual or group psychotherapy focuses on the underlying emotional experiences and relationships that have caused the bulimia.

Antidepressants, such as selective serotonin reuptake inhibitors -- SSRIs including Prozac (Fluoxetine) and Zoloft (Sertraline) -- used with psychological therapies, are now a mainstay in bulimia therapy.

Alternative Choices

Most alternative therapies for bulimia do not address the root causes of the disorder, but they can be helpful in relieving some of the physical distress resulting from it. If you want to include this type of treatment in your recovery, it is important to consult practitioners who are experienced in dealing with eating disorders. And be sure to tell your doctors and therapists about any complementary therapy you receive.

Mind/Body Medicine

Body exercises such as yoga, tai chi, qigong, and dance can help bulimics with their problems of body image. Reprogramming mental processes to gain control over the binge-and-purge cycles is another approach. Either hypnotherapy or EEG biofeedback may help. If you seek help here, be sure to ask hypnotherapists or biofeedback practitioners about their experience in treating eating disorders. And again, tell your doctor and other therapists about the care you get.

Nutrition and Diet

A nutrient-dense, sugar-free diet may help reduce binge eating. Also, eliminate alcohol, caffeine, flavor enhancers, most salt, and cigarettes. Eat a balanced diet, supplemented daily with vitamin C (1,000 mg), vitamin B complex (50 mg), and a multivitamin/multimineral supplement.

Remember that your treatment probably will include some retraining on how you think about food, your eating, and your body. Treatment may be needed over a long period to try to win control over the binge-purge habits.

next: Eating Disorders: When Outpatient Treatment Is Not Enough