Bulimia

I'm 16 and I have been bulimic for four years. I am a gymnast if that has anything to do with it, and I get dizzy a lot during practice. I have told my Dad and asked for help, but he hasn't done anything I would like to know how it's hurting my body and what to do?

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Sue Gilbert

Sue Gilbert works as a consulting nutritionist. For many years she worked with Earth's Best Organic Baby Food, integrating nutrition and... Read more

Recognizing that you have a problem and taking the initiative to seek help is a HUGE first step in the right direction for you. I hope what I have to say to you will help. However, you will have to recognize that you will continue to have to be the one in charge of making corrective changes.

You have asked some important and interesting questions and to start I will just help you to understand a little bit better what bulimia is and why you may be suffering from it.

Bulimia is an eating disorder that is characterized by binging on large amounts of food often followed by guilt and remorse afterwards. This guilt leads the person to purging by either vomiting or the abusive use of laxatives. Bouts of binging are often interspersed with periods of starvation. Excessive exercise is also part of the picture. The bulimic person usually has a distorted body image, perceiving themselves to be fat, when in fact they are not. They are obsessed with food and their weight. Binging and purging are used by the person as a form of weight control to obtain or maintain their ideal body shape or image.

Why does someone become bulimic? There can be a multitude of factors. In general, and maybe not with you, Amy, in particular, but it can be triggered by such things as 1. a predisposition to depression, 2. a conflicting family environment, 3. low self-esteem, and 4. an inability to face conflict or emotions. These factors, coupled with the social pressure to be thin, particularly in a field like gymnastics can also be a cause. Being in 'control' of body shape by eating and purging can be an attempt to gain a measure of control over your emotional confusion, and it provides a distraction from many real problems at hand. The purging can act as a form of relief of built up anxiety and guilt. This may be why you say it is a sort of stress reliever.

I think your involvement in gymnastics is a reason why the problem exists and persists for you. Gymnastics is a sport where leanness is believed to impact performance, and that relationship tends to legitimize the pursuit of thinness. It may be hard to know at what point the quest for thinness changes from a desire to perform well, to one of achieving merely the aesthetics that thinness is believed to bestow on the performer. Your sport may actually be providing a camouflage for your illness, making it acceptable to those who know you. Studies have shown that eating disorders are particularly high in thinness demanding sports where the competition is fierce. You'll be interested to know that in a study at the University of Texas conducted on a group of college gymnasts, only 22% had normal eating habits. 61% had sub-clinical eating disorders, and 16% had bulimia. It seems that you are not alone in your arena.

Physical damage can be serious from bulimia. Some may be irreversible, in particular, the erosion of your teeth. The vomiting can cause enamel erosion of your adult teeth, setting them up for decay and gum disease. Your menstrual cycle may become irregular, caused by a disturbance in your hormone balance. This hormone imbalance if often characterized by a decreased level of estrogen, which will increase your rick for bone fractures, since estrogen is important for the health of your bones. Gastrointestinal problems can occurs from the vomiting or the use of laxatives. These GI problems may include abdominal cramps, constipation or diarrhea, and in extreme or long term cases, there can be ulceration of your windpipe, or even perforation, plus the possibility of stomach rupture. Your purging can cause dehydration and an imbalance in your electrolytes. Electrolytes are important control mechanisms in your heart rhythm and kidney function. It can cause a drop in blood pressure which will make you lightheaded, which may be why you are dizzy during practice. Most of these problems can be corrected once you return to a healthy eating regime.

That's what it may do to your body. What it can do to your performance is also important. You will get tired more quickly, workouts will seem harder, and so you won't be able to take full advantage of your workouts. This will hurt your performance level. Between training sessions, your recovery won't be complete, and so you may become burned out'. Any advantage that your reduced weight has profited you will be outweighed by your decreased energy level, a decreased vo2 max, and a subsequent inability to perform to your potential. What you may have working against you to correct this, is your competitiveness and quest for perfection. Those traits will inspire you to continue training despite the hardships. Someone with out those personality traits would recognize their fatigue, and would quit.

Amy, an eating disorder isn't a problem with a nutritional cause, therefore the solution does not lie with a nutritionist. Of course part of the treatment can be aided by the advise of one, but your main source of support and help will need to come from a trained eating disorders specialist. Eating disorders are so prevalent that finding such a person should not be hard. You may try speaking with your dad again, but perhaps your best bet would be to start with a talk with your school nurse. She should be able to lead you in the right direction. Also, try calling your pediatrician, or ask your dad to call. Let him see this note so that he understands the importance of your problem. A doctor who deals with adolescent girls will undoubtedly know who to refer you to. I suggest that you make these contacts today or tomorrow. Don't give yourself a chance to change your mind about finding help.

The type of treatment you can expect will be both nutritional...that is, breaking the binge, purge cycle, normalizing your weight and eating habits, and, more importantly it will also be psychological, i.e. dealing with the issues that lie beneath your behavior. On average, a bulimic patient requires treatment over the course of 5 months. After that, it may be helpful to join a self-help or support group. Because your problem started at such a young age, it may be that family therapy will be necessary. Perhaps this way your dad can become an ally in your attempts to help yourself.

While you are in the process of getting help and correcting your problem, the following few tips may be helpful. First, learn to like your body. It will have its faults and its good points. That is just who you are and how you are made. Don't set unrealistic, rigid eating rules for yourself. They will only set you up for feelings of failure and guilt should you break them. Remember, eating is good, you have to eat, it is how you survive, it is a life affirming act. Tune into your body and listen to what it is telling you. Your body is what you have to get you trough, learn to be its friend, not its worst competitor. If it is telling you that it is tired, sit down and take a rest. If it is telling you that it is hungry, eat something healthy in a slow and relaxed way. Listen to when it tells you it is full, and then stop eating. If is great to feel comfortably full. That can be a warm, fuzzy feeling that lets you know you are providing for yourself. If you do end up overeating, don't make yourself pay for it later by purging or starving. Try to truly enjoy your sport without worrying about your level of body fat, or how your body looks, rather, focus on the joy of performing well and working hard .

Amy, good luck with this problem. I would enjoy hearing from you again, to hear how you progress. Kudos to you for recognizing your need to get some help and then taking the initiative to do so. That is a great strength that will help to see you to success with this.

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