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Problems

This section includes information and support for:

Eating disorders - Bulimia

What is bulimia nervosa?

If you suffer from bulimia, you will eat large amounts of food, often thousands of calories, in a short space of time. You may begin by eating sensibly but then find you are unable to stop and continue to eat everything available. You may subsequently experience guilt or panic and purge by vomiting, taking laxatives or starving yourself. These binge and purge cycles vary in frequency and degree from person to person.

Exactly why a person binges depends on the individual but it tends to be triggered by situations that she or he finds difficult or distressing. Focusing on food and eating is a way of avoiding other painful issues. Bulimia becomes a way of coping, yet often by the time help is sought, they usually feel that the binge and purge cycle is beyond their control.

What triggers a binge?

Keeping a diary can be very helpful when trying to identify the triggers that cause someone to binge. You could note down your thoughts as well as situations, to help you work out how you can try to bring your bingeing under control.

For instance, you may find that you are more likely to binge…

  • At certain times of the day, maybe when you are at home alone in the evenings
  • At certain times of the month. If a woman has bulimia, there may be certain times during the menstrual cycle when a binge if more likely
  • During a particular season, maybe the winter months
  • Under stress at work, or home, or before exams
  • When snack foods are around, like crisps, biscuits or chocolate
  • When you have skipped lunch or not eaten for a long time
  • In response to something disturbing that you see or read about, such as child abuse

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Ways of coping

It may be difficult to cope with uncomfortable feelings without bingeing. If so, you should seek help and a support group is often beneficial. Here are some ways to help control the urge to binge:

  • If being home alone is a trigger, you should try and leave the house, go for a walk, telephone a friend to at least delay the binge, do something you enjoy that is not associated with bingeing
  • Be kind to yourself with a treat such as massage or a favourite film
  • You should allow yourself to experience these feelings. Writing about your experiences, or drawing them will be helpful to your counsellor in interpreting your expressions
  • Seek inspiration in other peoples writings, paintings and sayings
  • Take up a new interest, enrol in an evening class or become a volunteer.
  • Ensure you get regular exercise, walking once a day is good.
  • Re-educate yourself to eat healthily - low fat products, snack on fruit, vegetables etc. Have treats maybe only at weekends.

Recovery

Recovery from bulimia takes time. It may have taken years to develop the illness and, therefore, it is not easy to break established eating habits, particularly if they have become your way of coping with emotional difficulties. The first step to recovery is to acknowledge that you have bulimia.

You need to re-establish a structured eating pattern and to try and resolve the underlying emotional problem. You are more likely to binge if you deprive yourself entirely of food. The body needs to be reassured that regular meals are available that satisfy physical hunger, as distinct from the emotional hunger that might trigger a binge. Re-educating the body is not easy and if you relapse, it should be regarded as a set back, not a failure.

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Planning meals

Bulimia tends to throw eating patterns into chaos, so planning meals will help. You should:

  • Take it gradually. Begin by planning breakfast each day for a week, then breakfast and lunch, and so on
  • Eat regularly - little and often. Six small meals a day may be suitable. This will help to avoid feeling hungry at a time when you are training yourself in proper eating patterns
  • Try and keep to regular meals, even if you binge and vomit
  • Write out meal plans for the week, it will help to not worry about what to eat and when. You can then allow yourself some flexibility, you must make sure your nutrition is balanced
  • Eat slowly to enjoy the different flavours and textures. Meals should be a pleasure. Relaxation afterwards will allow you to feel satisfied.

Food for health

Food from the following groups will ensure that you are eating a balanced meal and taking in the nourishment the body needs.

  • Bread, cereals, potatoes rice and pasta are carbohydrates; not only are they necessary but they are satisfying and will make you less likely to binge

  • Fruit and vegetables provide many of the vitamins and minerals needed, as well as fibre to combat constipation

  • Meat, fish, eggs, pulses and nuts are proteins essential for renewing the body's cells, including muscle

  • Dairy products - milk, cheese and yoghurt provide calcium for strong bones as well as protein

  • Some fat is essential for the body to function so fat must not be cut out completely

  • Plenty of fluids, especially water, should be drunk although too much at meal times will make you feel bloated. (Drinking to avoid dehydration after purging may appear to increase weight. Do not panic - allow the body to adjust itself).

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Agencies which offer support and information for eating disorders

  • SupportLine Telephone Helpline: 01708 765200, email info@supportline.org.uk - Confidential emotional support to children, young people and adults. Also keeps details of agencies, counsellors and support groups throughout UK.

  • www.aba12steps.org
    Anorexics & Bulimics Anonymous (ABA) uses the 12 step programme adapted from Alcoholics Anonymous to address the mental, emotional and spiritual components of the disorders of anorexia and bulimia.  UK meetings in London, Newcastle and Southampton.

  • Anorexia & Bulimia Care (ABC)
    www.anorexiabulimiacare.org.uk
    03000 11 12 13
    (Option 1 SupportLine, Option 2 family and friends)
    ABC is a national UK eating disorders organisation with over 25 years experience. Ongoing care emotional support and practical guidance to anyone affected by eating disorders.
  • beat - beat eating disorders (formerly the Eating Disorders Association)
    Adult - 0808 801 0677
    Youth - 0808 801 0711

    www.b-eat.co.uk

  • British Nutrition Foundation
    020 7557 7930
    www.nutrition.org.uk
    Provides information and advice on nutrition and related health matters. Produce a wide range of leaflets and books.

  • Caraline: 01582 457474, www.caraline.com - Helpline providing counselling and support for people experiencing anorexia, bulimia, compulsive overeaters. Monthly self help group and individual counselling, specialised programmes. Helpline covers UK, local services to Bedfordshire.

  • Clinical Excellence to Care Excellence:
    0300 323 0140
    www.nice.org.uk

    Publish guidelines relating to Treatment of Anorexia

  • DABS Mail Order Book Catalogue
    07854 653118
    24hr Answer Phone
    www.dabs.uk.com
    Books relating to Eating Disorders, Child Abuse, Self Esteem, Assertiveness, Self Harm etc.

  • Eating Disorders Research Unit, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.

  • Independence
    01223 550801

    www.independence.co.uk
    Publishes book Coping with Eating Disorders price approx. £5.95.

  • Office of Health Economics:
    www.ohe.org
    Publishes a useful book called Eating Disorders: Anorexia Nervosa and Bulimia Nervosa 1994 by Richard West. Cost £5.00
  • Overeaters Anonymous: 07000 784985 - 24hr information line on a/machine. Works to relieve our compulsion to overeat/undereat or an obsession of food and dieting by living by spiritual principles based on the 12 steps of Alcoholics Anonymous.

  • Young Minds: 0808 802 5544 - email enquiries@youngminds.org.uk, www.youngminds.org.uk - Helpline and other support services for parents concerned about the mental health of a baby, child or young person. Produces a range of leaflets, reports etc.

Useful websites

  • www.mengetedstoo.co.uk - Men Get Eating Disorders Too. Supporting the needs of men with eating disorders includes information, support and online forum.

  • Mind - Food and Mood:
    www.mind.org.uk

    Site which explores the relationship of what you eat and how you feel
  • www.rcpsych.ac.uk - Information on eating disorders

  • www.nutrition.org.uk - Information about healthy eating

  • www.surgerydoor.co.uk - Click on 'medical conditions' then click on 'mental health' for information relating to bulimia

  • www.swedauk.org - Somerset and Wessex Eating Disorders Association. Website includes information and support in relation to eating disorders.

Resources: EDA, SupportLine, Independence

Useful book

Bulimia Nervosa & Binge Eating: A Guide to Recovery by Peter Cooper, Christopher Fairburn - Publishers Constable & Robinson: ISBN 1854871714
Click here to read more or buy this book

Information for Carers

This information is for parents, brothers, sisters, friends, and anyone else who may be caring for someone who has an eating disorder.

An eating disorder is a complex disorder and not always about weight and wanting to be thin, it can often develop when a person finds it difficult to cope with feelings, which could be anger, trauma, hurt, resentment, and a sufferer is invariably experiencing deep emotional pain.  This could be as a result of prolonged stress, breakdown of personal or family relationships, bullying, abuse, school/college difficulties, feeling isolated, bereavement, traumatic event etc.  The sufferer feels under tremendous pressure and as if she or he is not in control of their own life. They see food as one way of exerting that control and also a way of taking the focus of the painful feelings they are trying to avoid.  However sadly sooner or later the eating disorder becomes another thing in the person’s life over which they have no control.

For those caring for someone who has an eating disorder it can be very frustrating because often the sufferer will not admit to having a problem and therefore will refuse to get any kind of help or even discuss the issue.

It is important to remember you cannot help someone unless they are ready to admit there is a problem and be prepared to do something about it.

Sufferers of eating disorders often have very low self esteem and often seem to strive for perfection.  When they see themselves falling short of perfection that affects their self esteem making the person feel not good enough. A person who has an eating disorder often finds it hard to verbalise how they actually feel. 

A carer may often feel helpless and not know what to do and it is helpful to try and gain as much information as you can about the disorder so that you know what to expect.  There are many resources on the internet and some agencies also publish booklets for carers.  Try and keep positive and leave around for the sufferer some information which may be helpful like supportive websites, leaflets, booklets, and information on local counselling services, telephone helplines etc.  When they feel ready to address the problem they will then have some information to hand which they can access.

Find a time to talk to the sufferer when you feel calm, relaxed, and there is nothing else going on to distract. Try to avoid judging or accusing, blaming, and you can explain you have noticed a change in their eating habits and in their personality and you are concerned and you are there if they feel they want to talk about this at any time, and encourage them to seek help from helplines and counselling services.  Explain that you accept the person unconditionally whatever issues there are going on for them and love them – this can mean a tremendous amount to the sufferer who often has a fear of opening up as they don’t want to be blamed or judged.

Try and get across that you want to help them to overcome this and ask them in what ways they feel you could help.

If a person refuses to eat, try and work with them to let them have some control over what they feel they may eat, if a person is bulimic and makes herself/himself sick, explain it is the responsibility of the sufferer to clear it up, so that they are taking responsibility for their own condition.

By and large it is best to avoid getting into indepth discussions about food, weight, and a persons personal appearance, instead focus on the persons skills, accomplishments, qualities, etc.  Try and boost the persons self esteem in whatever way you can.

It is important to recognize that somehow day to day life has to carry on, try to avoid making this issue take over your life, try and encourage the sufferer to carry on with normal activities, socializing with friends, and family members.  Try to avoid focusing all attention on the sufferer which means other family members may be neglected which could cause anger and resentment.

Meals times can cause enormous pressure for everyone, so sometimes it can help to play games or have music on as a way of relieving the tension which may be around.  It can also be a good idea to have something planned to do after mealtimes, like a walk, game, some activity which may help distract someone who is bulimic from making themselves sick.

Try and work with the person as much as possible letting them remain in control.  If they agree to go to counselling you could offer to go with them the first time and wait in the waiting room, but leave the decision up to them as far as possible.

It is important that whatever treatment they have that the reasons behind the eating disorder are addressed, not just the eating disorder itself, otherwise, it is highly likely that the eating disorder will return.  A person who has an eating disorder has to try and find alternative ways which are healthy and positive of coping with stress, problems, traumas, and very often counselling can give the sufferer an outlet for their feelings which can be of enormous help to them.  

Some sufferers, particularly those of a very low weight may need day or residential care from a specialized unit and it is important to talk to those helping the sufferer to ensure that talking therapies are also given and if they are not to ensure that is arranged.  All too often we are told by sufferers who have been hospitalized that the focus is solely on getting them to a healthy weight and then they are discharged without any talking therapies being provided, sadly in those cases the eating disorder invariably returns.  

Ensure that you yourself get help and support, recovery may be a slow process and there will be many changing emotions for you to deal with yourself, it is not something to carry alone.
  
The following agencies can also provide help and support to Carers.

B-eat (formerly the Eating Disorders Association)
Helpline 0345 634 1414
Youth Helpline 0345 634 7650

www.b-eat.co.uk
See Help and Support Section – Carers on their website.

Anorexia and Bulimia Care  Parents
Helpline 03000 11 12 13
Option 1 Supportline Option 2 family and friends


National Christian organization run by Christians for sufferers, families and carers. Can put parents of sufferers in contact with other parents of sufferers. www.anorexiabulimiacare.org.uk

Young Minds:
0808 802 5544 
www.youngminds.org.uk

Helpline and support services for parents concerned about the mental health of a child or young person. Publications.

www.mind.org.uk – publish booklets in relation to eating disorders including information for Carers.

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