Occasionally worrying about your weight is normal, but when this worry becomes compulsive and you develop an unhealthy relationship with your food and the practices that surround it, then it becomes an issue. According the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) “bulimia nervosa is characterized by frequent episodes of binge eating followed by inappropriate behaviors such as self-induced vomiting to avoid weight gain.”
It is worth mentioning, that in this newest edition of the DSM, the frequency of “binge eating and compensatory behaviors” required for this diagnosis has been reduced from two times per week, to one.
Bulimia nervosa can effect anyone, but as Womenshealth.gov reports, a startling 85-90% of those that suffer from it are women. Though scientists continue to research and study bulimia, the site does go on to outline the following factors that may play into a person’s susceptibility of developing this eating disorder:
Keep in mind that if you are suffering from both bulimia and substance abuse, the damage and risk to both your physical and mental health increase. The prevalence of the symptoms of bulimia, can at times, obscure those of concurrent substance abuse. When seeking treatment, it is imperative that you inform your medical team of all other conditions. This includes any drug or alcohol use so that you receive the most thorough and directed care possible.
Research is increasingly illustrating that eating disorders, like drug or alcohol addictions, impact your brain’s chemical makeup. Specifically, they alter the functioning and production of your brain’s neurotransmitters. After a person ceases their bulimic behavior, brain scans show a marked change in neurotransmitter levels, in this case, serotonin.
Psychiatric Times published an article that examined the correlation between addiction and eating disorders and expounded on this theory, stating how the “dopaminergic (DA) reward pathway of the brain” was affected, stating that “in other words, starving, bingeing and exercise all serve as drug delivery devices since they increase circulating levels of -endorphins that are chemically identical to exogenous opiates, and these endorphins are as potentially addictive because of their ability to stimulate DA in the brain’s mesolimbic reward centers.”
Eating disorders and substance abuse often arise in response to stressful situations. Some research suggests that like substance abuse, a person may use bulimia—specifically the binge and purging cycle—as a means to self-medicate comorbid mental health concerns and other issues.
In fact, some people report an alleviation of stress and negative emotions after completing the binge and purge cycle. In addition, some research suggests that those who struggle with bulimia may actually experience a “high” when they purge that could be due to the effect that bulimia has on the serotonin levels within the brain.
Coupled with substance abuse, this fuels and perpetuates a dangerous cycle of self destruction. These are just a few characteristics that lead some scientists to theorize that bulimia may fall under the classification of an addictive behavior.
There are certain factors that stand out as being indicative of a problem with an eating disorder that are also hallmarks of substance abuse or addiction. According to an article written by Carolyn C. Ross M.D., M.P.H. and published by Psychology Today, these include:
It is only by treating all co-occurring conditions that you can truly develop and succeed at a recovery plan and achieve greater health, wellness, and sobriety. Many programs exist to treat bulimia and substance abuse separately, though fewer exist with the training and support necessary to treat both at the same time.
Psychology Today explains the risks of treating them separately, stating “what usually happens is that the individual gets help for either an eating disorder or drug addiction, and when that goes into remission the other condition crops up. The patient goes from one treatment facility to another, thinking they’re making progress but ending up stuck in an endless cycle of remission and relapse.”
Because of this, it is very important that you take the time to research your options, ask questions, and compare treatment programs. Both bulimia and substance abuse stem from a wide and varied history that is unique to each person. Taking the time to perform these duties helps ensure that you can find a program that is the best fit for your situation.
Certain comorbid mental health disorders may also be present with those that suffer from both bulimia and substance abuse, two of the most common being depression and borderline personality disorder. In addition to extensive training within bulimia and substance abuse, any program you enter should also be adept at treating any mental health concerns.
One thing that is different and more difficult about treating an addiction verses an eating disorder is the fact that substance abuse recovery, a person seeks to abstain from drugs or alcohol and remove it from their life. On the other hand, someone with an eating disorder cannot remove food from their life. For this reason, the approach needs to be different. A person needs to learn how to engage food differently by being taught how to change the behaviors, perspectives, and coping mechanisms that surround their mental, emotional, and physical interactions with food.
Both bulimia and addiction should be addressed through therapy, either on an individual basis, or in a group setting; cognitive behavioral therapy has shown success in both disorders. Rehabilitation may occur on either an inpatient or outpatient basis, this will be determined by the severity of your situation.
In order to determine this, the health care practitioner that is working with you will likely administer separate evaluations to determine the extent and presence or your eating and substance abuse disorders, along with your perceptions and behaviors that revolve around each. This will occur in two parts, a screening and an assessment.
During the screening, a questionnaire may be administered, either by means of an interview or through self-reporting. This is followed by the assessment during which the administer will further expound on the information obtained through the screening and direct their inquiry to more fully ascertain the extent of the disorder and the appropriate treatment.
Due to bulimia’s effect on serotonin levels, certain selective serotonin-reuptake inhibitor (SSRIs) antidepressants are used within treatment. Prozac has been shown to markedly alleviate the harmful characteristics of this disorder and achieve success towards helping a person regain control over their eating habits.
Prior to or upon entering into treatment, you need to fully disclose your medical and addiction history. This includes any current medical conditions and any past or current drug use or abuse. Due to the wide and varied side effects and risks associated with each condition, it is crucial that your medical team fully understand any and all health concerns and drug use that you may have.
Remember—there is another similarity between bulimia and addiction—the recovery is a journey and a process, one that takes time and commitment, a recovery that may very well require lifelong maintenance.