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Bulimia & Binge Eating: Eating Disorders Carry Serious Health Risks

Bulimia & Binge Eating: Eating Disorders Carry Serious Health Risks

The country was transfixed by the Terri Schiavo tragedy that unfolded in our own backyard. Most of the coverage of the Schiavo case focused, understandably, on the pressing life-or-death legal battle and related social issues.

But underlying the tragedy of this case, indeed, perhaps the root cause of it all, was an eating disorder. In 1992, a jury found that doctors failed to recognize, diagnose and treat Schiavo's bulimia, which led to the heart failure and oxygen deprivation that left her in a persistent vegetative state.

This is a major danger of bulimia, which is characterized by the patient's binging on food followed by purging by inducing vomiting or using laxatives. Unlike anorexics, whose dysfunction is often first recognized by others because of their severe underweight condition, most bulimics do not meet that same skinny, emaciated description. Statistically, most patients with bulimia are normal weight or slightly overweight, and the disorder and purging behavior can go on for years undetected by others.

And as we've seen once again, the risks are very serious. The greatest danger is the severe electrolyte disturbance and potassium shortages that can lead to arrythmias and heart failure. People die of this disorder. But along the way, there are plenty of other problems. Gastric disorders are common, damage to the esophagus from regurgitated stomach acid, teeth that rapidly begin rotting out from the stomach acid.

And while the purging behavior may begin as a sincere, if misguided, attempt to control or reduce weight, studies have shown that in true bulimics, it quickly becomes a cathartic behavior more closely tied to the patient's stress level than to their weight level. It's not a matter of calories in/calories out. It becomes a compulsive way to respond to stress, almost like alcoholic drinking.

And much like alcoholism, an identifying characteristic of true bulimia is the patient's feeling of being out of control of the behavior, of feeling compelled, beyond their own choice. There are actually some people who employ the binge-and-purge behavior without being pathological. They may overeat at a celebration and simply want some relief from that overstuffed feeling. It's not a healthy practice in any case, and the occasional purger would be wiser to choose prior restraint over purging afterwards, but they're not necessarily bulimic.

True bulimia is characterized by the patient engaging in the binge-and-purge behavior several times a week. They often do not want to do the behavior, but they can no longer simply stop themselves. And it's a behavior of tremendous shame, because, unlike alcoholism, which can be denied or disguised in various social guises, there's just no rationalizing vomiting.

And for those who continue to rationalize their bulimia as a weight-control mechanism, it's often a shock to learn that research has shown that the body quickly adjusts to the behavior, becoming efficient at more rapidly extracting calories from food swallowed. Even if the food is only down for five to 7 minutes, they've shown that the body will learn how to absorb what it needs. This may account for a bulimic's more normal weight as opposed to an anorexic's emaciation.

Yet even upon learning the pointlessness of the rationalized behavior, many can't stop. Faced with the prospect of giving the behavior up, many bulimics feel panicked, at a loss, wondering how ever they will manage their stress without it. This is the same with patients who have the binge eating disorder without the purging component. There is a feeling of a total lack over control of the behavior. They eat because they must eat, pleasure in the food is irrelevant.

An extraordinarily high proportion of women with binge eating disorder have a history of sexual or physical abuse. Over and over therapists hear patients describe the behavior as their way to quiet or bury and internal pain by cramming food in on top of it, more and more, until the emotional or psychological pain is actually replaced by the physical pain of having gorged themselves.

They are hurting themselves. The lay media often portray people with binge eating disorder as eating to reward themselves, as practicing an avoidance behavior. Again, there are people who misuse food, who engage in 'emotional eating" to cheer or comfort themselves, perhaps inappropriately. But people with a true disorder are using these binging episodes not as reward, but punishment. They'll do this to the point that it hurts and they feel awful.

The food becomes as a weapon against themselves, as a way to respond to their feelings of guilt or low self-esteem, by punishing their bodies with the pain of overeating. While it may appear to be, it's seldom an act of luxuriantly over-indulging in something so yummy it's just irresistible.

For serious treatment, most eating disorders are best treated in some kind of controlled residential program where the sneaking and hiding of behaviors is more difficult, and there's a structures program that must be adhered to, including oversight to reinforce correct behaviors. Sometimes, even if a binger has just had a tremendous binge and is feeling miserable, when the time comes for the appropriate, planned meal, they'll be required to eat it anyway to reinforce that food is for meal times, not for stress.

Yet of all the eating disorders, binge eating has the best likelihood of cure and can often be managed through cognitive behavioral therapy and recreating the patient's relationship with food and eating, shifting it back to the nutritive act it's supposed to be. It often takes deconstructing the behavior, to help patients see how they got to the point they are, and helping them stop them stop.

As with most bulimics, by the time they've sought treatment, binge eaters know their behavior is destructive. They've hurt themselves long enough that they're run out of rationalizations for it, and they reach a point where their desire to be well is simply bigger than their fear of changing.

The bottom line is that food is supposed to sustain us. It's not supposed to be used as a brutal, potentially lethal, weapon against ourselves.

While both bulimia and binge eating are hard to identify because these are hidden behaviors, those close to people with these eating disorders may recognize that something is amiss, even if they can't put their finger on it, or catch the person in the act. You can often tell if someone has a healthy relationship with food or not. You might not always be able to do something about it, but bulimics and bingers can respond well to intervention and therapy, and like anyone, they can always benefit from compassion and support.

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