Insightful article on depression and understanding suicidal thoughts and feelings. If you are depressed with thoughts of suicide, here are some possible solutions.

For many years, I had suffered from depression and suicidal urges. I tried to determine why it was happening to me and what I could do to end my pain. The books I found were mostly statistical listings of who took their own life, their income brackets, and vocations. Personal accounts were specific to their situation and recounted little insight into why this was happening to me, or what I could do to end the intense pain.

I am, what some would say, mildly manic depressive and have a family history that would support such a conclusion. But, this is not my story. This is an attempt to help those who are depressed with suicidal thoughts, better understand what they are going through and help them find possible solutions.

Suicidal Thoughts Can Be a Result of the Symptoms of Depression

Most people who are suicidal are also depressed. The two prime reasons that a person becomes depressed, are a loss of control, over their life situation and of their emotions, and secondly a loss of a positive sense of their future (loss of hope). Any therapy which is to be effective in reversing our depressed state, and the resultant suicidal urges, will have to help us regain control, and help us regain hope.

Being depressed causes us to narrow our view of the world around us to such an extent that reality becomes distorted. The negative in our lives is constantly reinforced and the positive around us is discounted as being irrelevant, or even nonexistent. Options to help solve our problems are rejected as having no merit until it seems as if there is no possible solution.

An unrelenting and oppressive sadness comes over us which causes very real pain, as if the pain of the sudden loss of a parent stays with us for weeks, months, and even years. It is as if we are trapped in a dark cave or possibly a tunnel that runs only from our constant pain to somewhere near hell, with no exit to heaven and no exit to joy. We begin to think that there is no relief and that this pain will never end. Tomorrow will be the same, or worse. Death may be the only solution!

Suicide is not a solution, it is an end before a solution can be found. It cannot be considered an option, for an option denotes we have a choice and death robs us of both, option and choice. Death is an irreversible act that does not end the pain, for it remains in those who are left behind. Even people who are totally alone, and take their own lives, transfer their pain to those of us in society who do care, and we do - care!

Many people have suicidal thoughts at some time during their lives. For most the thought is fleeting, happening after a major life loss, or at some point in life where they perceive the future as becoming hopeless. For others, life is not quite so kind, they may have a strong genetic propensity to become depressed, a chemical imbalance or a series of unfortunate life experiences may eventually end in depression. Still others have much to do with causing their own pain by using an unrealistic cognitive thought process and having expectations in life that are not possible to achieve. Whatever the cause, we are all at risk of having strong suicidal urges when it seems as though the future has become hopeless.

There is no class or type of person that is exempt from having suicidal thoughts. Doctors, therapists, and teenagers from all walks of life are all high on the percentage lists of completed suicide, although it seems that those people with strong religious convictions are least likely to attempt.

Depression and Suicidal Triggers

Given a person is depressed and having suicidal thoughts, there are certain triggers which intensify the suicidal urge. Recognizing those triggers of renewed suicidal urges which are present in your life will help you to understand what is happening to you and begin to allow you more control of your emotions.

1. Beginning Therapy and After Therapy.

Suicidal urges are particularly high just after a depressed patient first enters therapy. When beginning therapy the very symptoms give rise to thoughts such as "this will never work", or "why should I put myself through this, when there is no possible hope of success". Combined with these thoughts may be the possibility that the patient and therapist do not connect or bond (as may happen between any two strangers when they first meet). The expectation that therapy will fail, especially if this is not the first attempt, is devastating. We begin to believe that if therapy fails, then we will never be rid of this pain, and what is the use of going on.

THIS IS VERY IMPORTANT! It is particularly tragic when a patient has gone through therapy and the depression has substantially lifted, that they then kill themselves. It happens! Depression is episodic, in that it can come and go, sometimes in an instant. If a person is feeling euphoric and at long last can envision themselves as depression free in the future, any setback will cause a flight back to the conditioned response of suicidal ideation.

The thought of the pain returning is unbearable and the urge to die may become intense. The triggers which cause this renewed depressive and suicidal episode are usually the same things which contributed to the depression in the first place. After therapy a continued exposure to an abusive partner, an oppressive boss, the inability to overcome substance abuse, the inadequate concept of self, financial problems, etc. can trigger renewed suicidal urges.

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There is good news! These suicidal urges do not have to plunge you back into the depths of your depressive hell! This does not signify your therapy has failed or that you must then start again from square one. Recognizing those triggers or releasers of renewed suicidal urges that are present in your life will help you to understand when it happens and, that it can be reversed. The panic which follows renewed suicidal thoughts will be short lived if you do not allow this panic to take control of your mind. See your therapist, a friend, or the local crisis center. Let them help you talk it out, what you need now is - time. The feeling will pass, usually in 2 days or less!

Off in an isolated room playing a game with a young child, or alone in the back yard inspecting whatever, we hide trying to avoid any conversation which might remind us of the pain. Aunt Annabell or even a stranger might ask us if we have a job yet, or if the divorce is final, and we are slammed back into depression and suicidal thoughts. A loving relative might ask us "what's wrong" and try to bring us out of our shell. An inappropriate angry outburst might follow, giving credence to the saying that "you always hurt the ones you love". We are sorry, we depress.

2. The Antagonists.

The antagonists in our lives (the oppressive boss, the abusive spouse or partner, or that jerk who never quits) can easily trigger renewed suicidal urges. Strangers, at first meeting, soon recognize or sense that we are depressed. This may be an unconscious recognition on their part where our general demeanor, body posture, facial expressions, and attitude send signals that may cause them to react with outbursts of anger, which are not warranted, given the circumstances.

This unfair treatment of a depressed person is perplexing and gives rise to thoughts such as "life is so unfair", or "life sucks!". Some others may feel compassion for the depressed person which they are seldom able to adequately express, and they may embarrass or act inappropriately. Still others seek out depressed individuals and take advantage of the situation, all in order to boost an ego that is badly in need of repair. Take heart, as our depression lifts, and we begin to regain control of our lives and of our emotions, this treatment will pass - and it does!

3. Natural Events and Suicidal Thoughts

The effect that natural events have on depression is extremely important, especially when one is beginning to overcome the depressive response. Fast moving weather front lows, the full and new moons, changes of the seasons, and decreased sunlight in winter, will cause an increased state of anxiety when a person is depressed. One is especially at risk when there is a fast-moving weather front approaching the two days before the full moon. This must not be discounted as hearsay or superstition! Hollywood has made a mockery of the effect that the full moon may have on people.

When I mention the effect to people who have not experienced it, the same facial sneer always appears and anything I say after that is discounted as the babblings of an idiot. The fact is, that when depressed we are in a more primal state. Our emotions are raw and we are subject to natural changes in our environment and in our bodies. An increased risk can be anticipated during lows in the cycle of our biological state (such as during a woman's menstrual cycle - men have high and low monthly emotional and physical cycles also).

A statistical correlation has not been identified concerning suicidal attempts and the full moon because the full moon does not cause one to commit the act. The full moon and the other listed natural events cause an increased state of anxiety which exacerbates depression and increases the risk of the suicidal urge becoming strong. Actually, the risk of attempts of suicide is greatest during the week after the full moon, as increased depression and the resultant suicidal urges begin to take their toll.

Strong suicidal urges, mania that approaches panic (and a resultant plunge back to depression), or deepening depression that cannot be explained by a renewed life crisis, can many times be explained by looking at a calender which has the cycle of the moon marked on it! Although knowledge of what is causing this reversal does not keep it from happening, there is comfort in that one now understands what is happening and comfort that it will end in two days or less, and it does!

4. Substance Abuse and Depression

Nicotine, caffeine, alcohol, illegal drugs, obsessive overeating, and some prescription drugs, all have a detrimental effect on depressed persons. Many times the thought is that if the abuse can be overcome then the pain will end. In some cases this may be true, but what if attempts to overcome substance abuse fail? The failure may cause further depression making it difficult to even attempt subsequent withdrawal, let alone be successful. The truth is that it is possible to separate the depression from the substance abuse. Once the depression is overcome the substance abuse can be worked on from a position of strength rather than from a depressed state.

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5. The Death Fantasy

During times of increased stress and trauma some may try to escape the pain of life by fantasizing that they are dead. The fantasy may begin with the thought that one has died, and the family and friends are standing at the graveside, they grieve and are very sorry we are dead. The vast number of people at the funeral attests to how much we were loved and admired. It had taken our death but we were finally able to communicate to them how unfair life had been for us and now they could take us seriously and realize that our pain was real. The "mock" attempts of suicide may be a similar form of fantasy, where the loved ones are envisioned as standing around the hospital bed and they are finally able to realize how unbearable the pain of life was for us.

If one becomes preoccupied with the death fantasy or uses it to excess in escaping from the pain of life, the fantasy will become a conditioned response in reaction to added stress or crises. Death can become a friendly thought and one may begin to fear the pain of life more than they fear death.

6. Bipolar Disorder: A Manic Crash and Burn

The bipolar, manic depressive person (one who alternates between periods of manic euphoria and a depressed state) should be extra careful to identify those triggers which may cause a reversal of mood. Some people seem to be able to control their manic periods, others cannot. Even those who outwardly seem to be in control are at risk if they have a reversal of fortune, and their sometimes unrealistic endeavors turn sour. The mood swing can be swift, unexpected, and dangerous. In an instant we can be slammed back into a depressed state with strong suicidal urges.

Our View of the Future

The human conscious mind is the only entity on the face of this planet which is able to conceptualize and abstract the future. The need for a positive sense of the future is one of the prime motivators of human life. This need transcends even the event of our ultimate demise and is the motivation to envision a continuation of life after death. We do not want to think that death is the end. Heaven, and life after death with God fulfills this need for the religious person, others have envisioned reincarnation, or that we enter (body whole) into another dimension without the need to believe in God. For others, the legacy of their works or the continuation of their genes through their offspring is enough to give them a positive sense that death is not a complete end.

In the short-term, and for those who do not concern themselves with what happens after we die, there is still the need for a positive sense of our future. It is what makes us get up in the morning and face the coming day. Even in the face of adversity or drudgery, we are motivated to endure, because we envision an end to these conditions and a better future at some later date. The anticipation of future events is what makes our body ready itself for the sex act, it is what motivates us to amass wealth and power, to buy a lotto ticket, to set goals and have aspirations.

Even the diehard sofa potato looks to the future as told to him by the upcoming programs in the television listings, and of course there is that next thirst quenching beer and resultant belch, to look forward to. We all have a need for something to look forward to, if we lose all hope that the future holds anything positive or that our present pain will ever end, most of us will depress.

Conclusion

Knowing what is happening to us goes a long way in being able to regain control over our lives and our emotions. But real healing will not be possible until the depression is lifted. I recommend that anyone who is depressed and having suicidal thoughts seek help. There are drugs which may help to maintain a depression-free life, and therapy is needed to help us better understand why we became depressed and what we need to do in order to live our life in control of our emotions.

This manuscript was conceived while I sat on a ledge overlooking the abyss of hell. I would contemplate if I should follow the intense urge to jump and end it all, or if I could muster the strength to take control of my emotions and of my life. I tried so very hard to picture the future - with me in it. I hope that relating the knowledge I have gained from my experience and my pain might somehow help ease your pain. Knowing what is happening to you and some of the reasons why it is happening might help you regain a positive view of your future, a view that includes both, you and me.

Research shows that best predictor of suicide is a previous suicide attempt.

People who have attempted suicide once remain at risk of another try for the rest of their life, a comprehensive new British study indicates.

The study, which covered 23 years, has implications for relatives and friends as well as psychotherapists of those who have tried to take their own lives.

"Basically, we are talking about the rest of their lives," says lead author Dr. Gary R. Jenkins, a consulting psychiatrist at East Ham Memorial Hospital in London. The report appears in the new issue of the British Medical Journal.

Jenkins and his colleagues studied the records of 140 people who attempted suicide between May 1977 and March 1980, looking specifically at the cause of death for the 25 who had died by July 2000.

"Examination of death certificates revealed three suicides and nine probable suicides (four were recorded as open verdict and five as accidental death)," they report.

Using these findings as a guideline, the researchers extrapolated the risk of additional suicide attempts for the next 23 years.

Their conclusion: the suicide rate for those who had attempted it once was 5.9 attempts per 1,000 people per year for the five years after the first try; 5.0 attempts per 1,000 people per year 15 to 20 years after the first try; and 6.8 attempts per 1,000 people for the final three years.

"The rate did not decline with time," the researchers report.

The overall suicide rate for the general population is about two attempts per 1,000 people per year.

"This confirms something we know about suicide, that the best predictor is a previous attempt," Jenkins says. "But there haven't been any studies of this length. This paper proves what we have thought clinically -- a previous attempt is a predictive factor even if it is more than two decades after the first act."

The findings demonstrate that "if a patient shows up in an emergency room and has made a suicide attempt, the clinician needs to be aware that the risk of doing so again is very high, and the patient should not be let go without a psychiatric assessment or follow-up," Jenkins says.

John L. McIntosh, professor of psychiatry at Indiana University and a past president of the American Association of Suicidology, says the study also indicates that "people in this person's life should react and respond more quickly when there are difficulties."

"Friends and particularly family members will want to seek help for this person and make sure he or she gets to a mental health professional quickly," McIntosh says.

The British study is valuable because "it reinforces long-standing results from other studies that are not nearly as lengthy as this one," McIntosh says. "We didn't know that this risk continued with them this long. We are basically talking about the rest of their lives."

"Many would assume that the heightened risk will be gone after two or three years. This suggests that is not accurate," he adds.

Source: Healthscout News, Nov. 14, 2002

(Editor's note: This author shares her bulimia story, but wishes to remain anonymous.)

I am here to tell you that you can overcome your eating disorder. I did it, and I did it alone. Here is my story.

It all started the summer after my freshman year when I decided I would lose weight. I am 5'4" and weighed about 135. I was not fat, but I wanted to be thinner. I started the sugar busters diet, and I worked out 4 days a week doing kickboxing or sculpting classes at a local gym. I was so proud when I got down to 122 pounds, but I was afraid I wouldn't be able to maintain it.

After going out to eat one day, I felt extremely guilty for not following my diet. I ate pasta...a big carbohydrate no-no. I can remember going to the toilet, sticking my fingers down my throat and thinking, "I shouldn't be doing this, Why am I doing this?" I don't exactly remember the order of events after that, but I know in no time I was throwing up every meal.

I can remember at first, when I would eat and not be able to throw on after going to the grocery store with my mom. She would always ask me how I could eat so much and not gain weight, and I would play dumb and be like I really don't know...and she would be like I guess you really boosted your metabolism when you were on that diet. What really surprises me though, is that my father (a doctor) never noticed.

Vacations were always difficult because in a hotel room I wouldn't be able to throw up because my parents could hear me, unless I took a bath and could run the water. The disorder consumed my whole life. Before I could ever commit to anything, I always had to decide when and where I would be able to throw up.

I was obsessed with food. Anything fried, anything sweet, or anything in large portions I loved. I stretched my stomach so much, it took so much to fill me up, and I would eat until I couldn't possibly eat anymore. It was ridiculous.

I knew this was odd. I researched on the internet and found out that the constant churning up of the acid from my stomach caused these cavities. I knew I had to stop. It was like a huge flashing light saying "YOU ARE HURTING YOURSELF!" (read about eating disorder health problems)

I decided I would eat right and exercise, and that way I would still maintain my weight. WRONG! I gained weight, and just went back to my old ways.

Then one day, April 7th, my parents and I went to this brunch. When my mom got out of the car she began walking and passed out, falling on her shoulder and face. It was the scariest thing I had ever witnessed. My father was so angry. He knew something was up. My mom later explained that she had gone to the doctor and found out she had gained 7 pounds. Being the health-conscious person she is, she had over exercised and took laxatives and diet pills to drop those 7 pounds. My parents fought for days. My dad was so angered by how I would read on the scale each morning. I just kept putting on the pounds because I had messed my metabolism up so badly.

I couldn't fit into my size 0 clothes as well and actually had to start buying size 2s and 4s. I fell into a little bit of a depression now that I look back on it. Finally, one day, I decided I had to get off that scale. I couldn't let a number on a scale determine how I felt about myself for that day. I NEVER get on the scale anymore. I have gained weight, but I have accepted it. I exercise regularly and eat healthy, but I don't have any forbidden foods, because that could always send me back into a binge causing me to purge.

Yesterday was 4 months recovered (bulimia recovery). I have not had a single relapse, and I never feel like, "I wish I could throw up." I feel like I'm a stronger person now for fighting this. . and fighting this alone. I have learned what's really important, it truly is what's on the inside.

--Anonymous

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(Editor's note: This author wishes to remain anonymous. Learn how bulimia stories like this can save a life.)

I have never talked about stuff like this before to people I dont know. But after a year of throwing up everyday and experiencing other symptoms of bulimia, I have decided to try lots of different things to get better. To be happier. To remember what is was like to be excited about life. What triggered this bulimia recovery!? or why now!?

About 3 weeks ago, I got into a car accident. I rolled my van over down the street on its side, into a pole through a brick fence and then it tipped back over. This is only one in a string of events of a horrible year. This particular one just tipped me over. I was done. I was tired of the next thing and the next thing. I just wanted to be left alone to die. I was sitting in the hospital hoping something was wrong with me, hoping I had some type of internal bleeding or something was messed up enough to end everything. I was just so tired of all the ****. All the everyday struggles that I go through that no one knew about on top of the everyday life struggles that occur.

I am a single mother and had my son very young. So that in itself is a struggle. I work 60 + hours a week (this is me cutting back ). We just moved to a new country where my mother lives to try and make a fresh start 6 months ago after a bad string of events. ( my son was already with my mother)

When My Bulimia Started

I can't remember the exact day it happened. I was always very confident with my body. I was always healthy. You could say I was 5'3 and about 145-155. I always had moved up and down but I thought I carried it well and my outgoing personality and ability to fit into any situation ( we moved a lot) never left me wanting things like boyfriends. I used to watch those shows on Montell and Jenny Jones lol about girls with eating disorders and I never understood it. Why did girls care so much. It's not all about looks. I am not the most attractive but I was happy with myself.

Then, last year, I got 2 full time waitressing jobs and was working 90+ hours a week. I starting taking these energy pills to keep me awake and all of a sudden without me realizing it, the weight was falling of me. Before I knew it, the 8 I once wore was getting loose, then became too big, then I was in a 6! I had never been in a 6 my whole life.... then I became obsessed. Then my boyfriend started saying how much better he liked it. Said I wasn't fat anymore. I couldn't believe it. I didn't realize I was fat. I couldn't think of anything else but losing weight. I hardly ate and when I did I was throwing up everything. The weight fell off me. I went from a 6 to a 4 and then to a 2. At my thinnest, I was 113 lbs.

I Felt I Lost Control of My Life

My boyfriend was a gangster type ( we won't go into that ) but the life he led and forced me to lead made me stressed. My life was in chaos. I was robbed at gunpoint, got kidney stones, was so broke I couldn't afford to pay anything, was constantly arguing with him. My life was a mess. My weight was the one thing I could control. Nothing else around me was okay. I was at the lowest I had ever been. He controlled every aspect of my life: what we ate for dinner, what I bought, how clean the house was, when the laundry was done, where I went, how long I was gone for, who I talked to. Everything! I couldn't get out. I was so deep in. It got worse and worse. When we would fight, he would call me fat. He would put me down. It just made me feel worse.

My son was with my mom who was out of the country, so I could try and get my life together. I was running out of time and was trying to sort things out. Then, the worst possible thing happened. I found out I was pregnant. I didn't know what to do. I couldn't have another baby. I was in no mental state or financial state to look after another kid. I couldn't look after the one I had. And especially not with him. But when he found out, if I had tried to have an abortion, he would have killed me.

I did the only thing I thought I could do at the time. I made arrangements and ran away in the middle of the night. I moved my stuff out while he was at work. I had an emotional breakdown in the middle of my living room. I couldn't believe my life had come to this. Luckily, my friend was there to help me and drove me away to stay with him for a week. I was going to move overseas with my mom. Make a fresh start or so I thought.

Running Away From Your Problems Doesn't Solve Anything

Once I got there, I thought after I had sorted everything that I would stop worrying about my weight. I knew I was going to put some weight on and I thought I was okay with it. But then I realized I like being skinny. I like that guys looked at me wherever I went. I liked that, for the first time ever, I was referred to as skinny or little. I was the girl that when I told other girls I felt fat, they would just roll their eyes. I liked it and I was used to not eating, so keeping off the weight along with throwing up wasn't hard.

But then I met someone.... and when I was happy, I started eating more. I was struggling with putting on weight as fast as I lost it. Which caused me to eat more. I was spiraling out of control. It's all I could think about. Every time he and his family ate and gave me something, I literally felt like a fat failure.

Anyway, long story short, it actually got better for a while. Then he left. He had gotten in trouble before I met him and his court case was up after we met and he had to go away for a year. The depression took over me again and I couldn't control my binge eating. My comfort eating. The more I ate, the more I was never full. I could eat and eat. But it is getting harder and harder to throw up. It's like your body becomes resistant. Sometimes, I sit in the bathroom with my stupid toothbrush down my throat for at least an hour. So angry at myself and wanting to punch the wall or scream or worse cause I am so mad at myself for not being able to make myself throw up all the ****. I just ate.... cookies, cakes anything that gave me that instant gratification. Not only do I make myself throw up constantly, but I exercise obsessively. I park my car 45 minutes out of town. It's winter over here, so I walk 45 minutes to work and 45 minutes back in the cold and wind and rain. I can't stop cause if I miss even one walk, I feel TERRIBLE. It's not even worth it. I look in the mirror now and I see someone fat, someone who is disgusting, who has nothing to offer anyone. (read how bulimia support groups can help)

I am exhausted. I am tired of feeling like this. I either want to die or fix this cause I just can't live like this anymore. I told my mom about it finally after a year, cause I realised I couldn't do this alone. She is a psychologist and told me the reason I am not losing any weight; all the exercising and purging I am doing messes your metabolism up. So no matter what I do, I won't lose weight staying where I am .... continuing the way I am.

I want the old me back I want to be better again. I want to look in the mirror and see that same person that I once saw.

That is why I am writing this story. The more open I am about it the easier it seems to get. When I kept it to myself, I couldn't stop. Who could stop me if no one knew?

Three weeks ago, I did good for a week but then relapsed and made myself sick every day last week. I have started this week really trying. I have joined a gym, am trying to change my diet, and am hoping this is it. It's only been two days but I am hoping I am getting that girl back.

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I guess I was always a binge eater; I don't remember when I became bulimic. I remember doing it occasionally in university, and after I graduated when I was alone all the time. It seemed like I had no friends at all to lean on, except myself.

It got really bad when I moved across the country to try to start a new life. My first job was really stressful- everyone there seemed to hate me. I still had no friends. Bulimia became a daily way of existing. Even when I got a better job where I made some friends, it didn't get any better. (what causes bulimia?) I finally sought help about a year and a half ago. Therapy was helpful to the extent that someone finally was listening to me.

But giving up bulimia meant giving up my way of dealing with stress. I was numb as long as I was worried about lunch and calories and shopping. When I started to recover from bulimia, a lot of feelings were released. I experienced a euphoria and energy that i hadn't felt in...forever. I started writing and learning guitar and singing. But it also threw me into a pit of despair so deep and dark that I had several times when I was actively imagining my death or planning it. Silverchair's 'suicidal dream' and 'never too late' became my theme songs.

I'm Trying But Bulimia is Stubborn

But things are okay right now. My arts are saving me. I expect the suicidal feelings now, so I can get through them. Sometimes I relapse. That's to be expected too. I just put it behind me and move on. I will be bulimic for the rest of my life. I am sure.

I relapse all the time. But there's nothing else to do except keep moving on. I read that the only way to stop the binging is to stop the purging, so it's a battle to just let myself overeat sometimes and then just 'let it go'. But it's really, really, REALLY hard to do. After I overeat, I get so scared and upset, like 'I'm going to be fat and then I'll be single forever'. I just can't risk that happening.

(Editor's note: This author wishes to remain anonymous. You can find more bulimia stories here.)

article references

The pro bulimia movement, which is often known as pro-mia or just mia, is part of a movement that claims bulimia is a lifestyle choice and not a mental illness. Pro bulimia proponents seek to promote acceptance of bulimia and they often offer encouragement to bulimics. These pro bulimia or pro-mia individuals deny the horrifying physical consequences of the disease and its ability to kill if left untreated.

Who Would Want To Be Pro Mia?

The movement likely stems from our human nature to form social groups. We all want to feel accepted and part of the norm of a group of people. This might result in social cliques, like in high school, clubs, interest groups or support groups. While many of these groups have a positive impact on their members, the pro bulimia movement mostly skews reality so that members feel better about not seeking recovery from bulimia.

Unbeknownst to many parents, the movement has grown in popularity in recent years due to the unrealistic images of women found in Western society. These images suggest that being thin is beautiful and desirable, while being fat is not. Our culture and media are telling women to be thin and pro-mia advocates take this message to mean that bulimia can be a normal lifestyle choice and this will lead to becoming desirable.

Pro Bulimia Individuals Misguided

Pro bulimia groups often join with pro-anorexia (or pro anna, or simply referred to as Anna) groups. While some pro bulimia organizations claim to support bulimics both through the eating disorder and recovery, many simply want others to accept bulimia as a lifestyle choice. These groups often want doctors and others to respect their decision to be bulimic.

Those who are pro-mia feel that the eating disorder is a positive part of their identity and an accomplishment of self-control.

Pro bulimia groups also tend to:¹

• Share pro-mia tips and techniques on crash dieting
• Help each other find socially-acceptable ways to decline food
• Compete with each other in weight loss or fasting
• Commiserate with each other after binge eating
• Give pro bulimia tips on how to vomit, use enemas and laxatives
• Give pro-mia tips on hiding weight loss
• Post their weight, body measurements, details of their dietary regime and pictures of themselves to gain pro-mia acceptance
• Be hostile towards the non-eating disordered community

Pro bulimia and pro anorexia web sites are on the rise with a 470% increase found from 2006 to 2007. A similar increase was found in 2008. Pro mia blogs continue to be created and their traffic is increasing.

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Thinspiration

Thinspiration is used in both pro anorexia and pro bulimia movements and is a blanket term for images and quotes designed to inspire those with an eating disorder to gain or maintain their thin figure. The images depict thin people, often models and actresses, who fit within the super-thin category. A thinspiration quote may be as follows²:

"One day I will be thin enough. Just the bones, no disfiguring flesh. Just the pure clear shape of me, bones. That is what we all are, what we're made up of and everything else is just storage, deposit, waste. Strip it away, use it up."

There is also a pro bulimia tip known as reverse thinspiration where images of obese women and fatty foods are used to induce disgust and further motivate weight loss.

Potential Impact of Pro Bulimia

The pro bulimia movement could negatively affect those vulnerable to developing an eating disorder or those who are already bulimic. The pro bulimia tips offered by pro-mia individuals make it easier and seem more acceptable to be bulimic and not seek bulimia treatment or recovery.

While being part of a social group is normal, the pro-mia groups can potentially be harmful for everyone. Seriously ill bulimics can die, due to their illness being driven by a distorted image of their body and the world around them. On the other hand, as everyone has a right to self-expression and a feeling of belonging, how can the pro-mia movement be stopped without impacting these basic human rights?

Are Pro Mia Tips and Websites Hurting Our Youth?

The simple existence of pro bulimia sites isn't harming by itself, but unrestricted access to them without the counterbalance of medical information is dangerous. What's more, these websites are very efficient at delivering pro-mia tips and tricks as illustrated by a Stanford Medical School study showing:

• 96.0% learned new weight loss or purging methods while visiting pro-ana or pro-mia sites
• 46.4% of viewers of pro-recovery sites learned new techniques

In the best case scenario, pro-mia websites are browsed simply out of curiosity and are not visited again. In the worst case scenario, they can spark an interest in developing or continuing with bulimic eating patterns. Research bears out the idea that those who view a pro-eating disorder website only once experience lower self-esteem and are more likely to become preoccupied with exercise and weight loss.

Fighting the Pro Bulimia Impact on Our Youth

The number one weapon against the pro bulimia movement is education. It is important for parents to educate their children on eating disorders, their effects, proper nutrition, and health. Parents should acknowledge that pro-mia and pro bulimia tips and tricks exist, but that these are from people in the throes of mental illness and should be considered products of their eating disorder and not reasonable advice. Taking responsibility for a teen's education about, and access to, the internet is another way to help them deal with pro bulimia information when they find it online.

article references

Background:

The word rumination is derived from the Latin word ruminare, which means to chew the cud. Rumination is the voluntary or involuntary regurgitation and rechewing of partially digested food that is either reswallowed or expelled. This regurgitation appears effortless, may be preceded by a belching sensation, and typically does not involve retching or nausea.

In rumination, the regurgitant does not taste sour or bitter. The behavior must exist for at least 1 month, with evidence of normal functioning prior to onset. Rumination occurs within a few minutes postprandial and may last 1-2 hours. Though frequency may vary, rumination typically occurs daily and may persist for many months or years.

Pathophysiology:

While the pathophysiology of rumination remains unclear, a proposed mechanism suggests that gastric distention with food is followed by abdominal compression and relaxation of the lower esophageal sphincter; these actions allow stomach contents to be regurgitated and rechewed and then swallowed or expelled.

Several mechanisms for the relaxation of the lower esophageal sphincter have been offered, including (1) learned voluntary relaxation, (2) simultaneous relaxation with increased intra-abdominal pressure, and (3) an adaptation of the belch reflex (eg, swallowing air produces gastric distention that activates a vagal reflex to relax the lower esophageal sphincter transiently during belching). Rumination may cause the following:

• Halitosis
• Malnutrition
• Weight loss
• Growth failure
• Electrolyte imbalance
• Dehydration
• Gastric disorders
• Upper respiratory distress
• Dental problems
• Aspiration
• Choking
• Pneumonia
• Death

Frequency:

• In the US: No systematic studies have reported the prevalence of rumination; most of the information about this disorder is derived from small case series or single case reports. Rumination disorder has been reported in children and adults with mental retardation as well as in infants, children, and adults of normal intelligence. Among those with otherwise normal intelligence and development, rumination is most common in infants. The prevalence in adults of normal intellectual functioning is unknown because of the secretive nature of the condition and because physicians lack awareness of rumination among this population.
  Rumination is more common in individuals with severe and profound mental retardation than in those with mild or moderate mental retardation. Prevalence rates of 6-10% have been reported among the institutionalized population of individuals with mental retardation.
• Internationally: Rumination has been reported and researched in other countries (eg, Italy, Netherlands); however, frequency of occurrences in other countries is unclear.

Mortality/Morbidity:

Rumination is estimated to be the primary cause of death in 5-10% of individuals who ruminate. Mortality rates of 12-50% have been reported for institutionalized infants and older individuals.

Sex:

Rumination occurs in both males and females. A male predominance has been reported by 1 case series, although this finding may not be definitive.

Age:

Rumination onset in otherwise normally developing infants typically occurs during the first year of life; onset usually manifests at age 3-6 months. Rumination often remits spontaneously.

• For individuals with severe and profound mental retardation, onset of rumination may occur at any age; average age of onset is age 6 years.
• Rumination among adolescents and adults of normal intelligence is gaining increased recognition.

History:

• Symptoms may include the following:
  • Weight loss
  • Halitosis
  • Indigestion
  • Chronically raw and chapped lips
• Vomitus may be noted on the individual's chin, neck, and upper garments.
• Regurgitation typically begins within minutes of a meal and may last for several hours.
• Regurgitation occurs almost every day following most meals. Regurgitation generally is described as effortless and rarely is associated with forceful abdominal contractions or retching.

Physical:

• Regurgitation
• Vomiting not visible to others
• Unexplained weight loss, growth failure
• Symptoms of malnutrition
• Antecedent behaviors
  • Postural changes
  • Putting hands into mouth
  • Gentle gagging motion of the neck region
• May appear to derive satisfaction and sensory pleasure from mouthing the vomit rather than considering vomitus in the mouth disgusting
• Tooth decay and erosion
• Aspiration that may cause recurrent bronchitis or pneumonia, reflex laryngospasm, bronchospasm, and/or asthma
• Premalignant changes of the esophageal epithelium (ie, Barrett epithelium) that may occur with chronic rumination

Causes:

Although the etiology of rumination is unknown, multiple theories have been advanced to explain the disorder. These theories range from psychosocial factors to organic origins. Cultural, socioeconomic, organic, and psychodynamic factors have been implicated. The following causes have been postulated over the years:

• Adverse psychosocial environment
  • The most commonly cited environmental factor is an abnormal mother-infant relationship in which the infant seeks internal gratification in an understimulating environment or as a means to escape an overstimulating environment.
  • Onset and maintenance of rumination also has been associated with boredom, lack of occupation, chronic familial disharmony, and maternal psychopathology.
• Learning-based theories
  • Learning-based theories propose that rumination behaviors increase following positive reinforcement, such as pleasurable sensations produced by the rumination (eg, self-stimulation) or increased attention from others after rumination.
  • Rumination also may be maintained by negative reinforcement when an undesirable event (eg, anxiety) is removed.
• Organic factors: The role of medical/physical factors in rumination is unclear. Although an association between gastroesophageal reflux (GER) and the onset of rumination may exist, some researchers have proposed that a variety of esophageal or gastric disorders may cause rumination.
• Psychiatric disorders: Rumination in adults of average intelligence has been associated with psychiatric disorders (eg, depression, anxiety).
• Heredity: Although occurrences in families have been reported, no genetic association has been established.
• Other proposed physical causes include the following:
  • Dilatation of the lower end of the esophagus or of the stomach
  • Overaction of the sphincter muscles in the upper portions of the alimentary canal
  • Cardiospasm
  • Pylorospasm
  • Gastric hyperacidity
  • Achlorhydria
  • Movements of the tongue
  • Insufficient mastication
  • Pathologic conditioned reflex
  • Aerophagy (ie, air swallowing)
  • Finger or hand sucking