Bulimia nervosa, often shortened to bulimia, is an eating disorder characterized by bingeing and purging. The National Institute of Mental Health (NIMH) publishes that 0.6 percent of American adults have a lifetime prevalence of bulimia. Women are more likely than men to suffer from bulimia, and the disorder generally appears by around age 20, NIMH further reports. Someone who suffers from bulimia is typically unable to control the amount of food they eat and often has an unhealthy body image and desire to continuously lose weight.
Mayo Clinic reports that there are two main types of bulimia: purging bulimia and non-purging bulimia. With purging bulimia, individuals may consume large amounts of food (often in secret) and then try to purge what they consumed by making themselves vomit or by misusing diuretics, laxatives, or enemas. Someone who suffers from non-purging bulimia may try to get rid of the food and calories with excessive exercise, fasting, or unhealthy dieting.
Bulimia is a serious and potentially life-threatening condition. It may be difficult to recognize, as individuals can maintain a typical body weight, unlike those who suffer from other eating disorders, such as anorexia, for example. Since bulimia does not just involve unhealthy relationships with food, but also negative body image and low self-esteem, treatment should address healthy eating patterns as well as improvement of self-image.
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Rates and Causes of Co-Occurrence of Bulimia and Addiction
According to studies published in the journal Social Work Today, people who suffer from an eating disorder, such as bulimia, abuse alcohol and/or drugs at higher rates than the general population and vice versa. For example, individuals suffering from an eating disorder also abuse alcohol and/or drugs around 50 percent of the time as compared to 9 percent of the general population while those who abuse substances also suffer from an eating disorder 35 percent of the time as opposed to only 3 percent of Americans in general.
The National Survey on Drug Use and Health (NSDUH) estimates that 21.5 million adults in the United States battled addiction to drugs and/or alcohol in 2014 and almost forty percent simultaneously suffered from a form of mental illness as well. The National Eating Disorders Association (NEDA) reports that individuals battling bulimia may abuse alcohol and illicit drugs (like marijuana, cocaine, heroin, methamphetamine, ecstasy and other club drugs, and hallucinogens), as well as both prescription and over-the-counter pharmaceuticals (including steroids, stimulants, tranquilizers, weight loss supplements, laxatives, diet pills, diuretics, ipecac syrup, and more) at relatively high rates.
There are many factors that may contribute to why these disorders often co-occur, which is when they appear in the same person at the same time. Biological or genetic components may be involved as Psychology Today reports that parts of the brain that are related to cravings, both for food and for drugs, may be contributors. It may be more difficult for one person to control cravings and impulses than another, for instance. Levels of dopamine, which is one of the brain’s naturally produced chemical messengers, play a role in impulse control, emotional regulation, and happiness; an imbalance of this neurotransmitter may predispose someone to both addiction as well as an eating disorder. Genetics and family history can also be factors in the onset of either or both disorders.
In addition to biological and genetic factors, both bulimia and addiction may stem from environmental influences and social pressures. Stress and trauma can make it more likely for a person to suffer from low self-esteem and therefore more apt to abuse drugs or alcohol, or to engage in unhealthy eating patterns. Alcohol and drug use, as well as the act of bingeing and purging food, can be a method of trying to control emotions, which Psychiatric Times reports can be the result of childhood trauma or post-traumatic stress disorder (PTSD).
Peer pressure can lead individuals to abuse substances as well as be highly sensitive to their weight and attempt to meet unrealistic body size and shape goals. Media portrayal of body image as well as the glorification of substance abuse can particularly influence young people who have less ability to control their impulses and may therefore be vulnerable to these social pressures. High levels of stress may induce a person to try and regain some semblance of control, which may be temporarily mitigated by substance abuse or by bingeing and purging.
An eating disorder may predate addiction, and individuals may turn to drugs or alcohol as a method of self-medicating difficult emotions or in an attempt to control appetite levels and weight. It can also go the other way, and someone who battles addiction may develop an eating disorder like bulimia due to unhealthy eating patterns formed by drug abuse. Regardless of which disorder comes first, co-occurring bulimia and addiction can lead to a multitude of health, behavioral, and social concerns without proper treatment.
Health Risks of Bulimia and Addiction
Bulimia can lead to many health issues from the cycle of binge eating and then subsequent purging, as published by NIMH. These can include:
- Dehydration from fluid purging
- An imbalance of electrolytes, which can cause stroke or heart attack
- Worn tooth enamel, gum disease, and decaying and sensitive teeth from chronic exposure to stomach acid
- Swelling of salivary glands in throat and neck
- Chronic sore and inflamed throat
- Gastrointestinal issues and acid reflux
- Intestinal irritation and issues related to misuse of laxatives
Irregular bowel movements, constipation, rupture of the esophagus, and staining of the teeth are additional health risks raised by bulimia. Addiction can increase these potential side effects as well as add to them, as individuals battling addiction are often considered to be at high risk for contracting an infectious or sexually transmitted disease; many types of cancer; cardiovascular issues, including irregular heart rate, heart attack, stroke, and high blood pressure; damage to internal organs; gastrointestinal problems; and cognitive concerns. Memory and learning functions can be damaged, and motivation, willpower, and the ability to regulate emotions and feel pleasure are also impacted by addiction.
Individuals who suffer from bulimia and addiction may be likely to have suicidal thoughts or engage in self-harming behaviors. Simultaneous chronic drug use and bulimia can cause massive damage to internal organs and lead to kidney failure, significant gastrointestinal concerns, and severe cardiovascular issues, which can increase all possible health complications and risk for premature death.
Recognizing Bulimia and Addiction
Both addiction and bulimia can be life-threatening and create a vast range of issues and concerns. When these disorders are combined, the risk factors increase.
Both bulimia and addiction can lead to social withdrawal and interpersonal relationship issues, as individuals may become secretive, irritable, and suffer from unpredictable mood swings, emotional highs and lows, and erratic behaviors. Addiction can make people more prone to participate in dangerous behaviors and put themselves at risk without regard to potential consequences. Individuals may change their schedule to accommodate secretive bingeing or purging. This can include ensuring access to a bathroom directly following a meal, for example.
Personality shifts are not uncommon with either disorder, and individuals may no longer participate in activities that they deemed important or a priority before. People who are constantly putting their fingers or hands in their mouths and down their throats to induce vomiting can develop calluses on the backs of their fingers and hands. Exercise may become excessive and ritualistic, and a person suffering from bulimia may continue to exercise despite injury or physical complications.
Individuals who suffer from addiction are unable to control their drug or alcohol use just as someone battling bulimia is unable to control the amount of food they take in during a binge. In both cases, feelings of guilt and shame are likely to follow. Low self-esteem and negative feelings about body image are common. Weight fluctuations and disrupted sleep patterns may also be indicators.
Obsession with drugs and/ or alcohol, where to get the next fix, using the substances, and recovering from their use dominate a person’s life who suffers from addiction. Similarly, someone battling bulimia may be consumed with their weight and dieting. Just as drug and alcohol intoxication can provide a release for someone suffering from addiction, so may bingeing and then purging for a person battling bulimia.
Both addiction and bulimia may lead to withdrawal symptoms when attempts to abstain are made. These can include depression, anxiety, intense cravings, and difficulty sleeping, as well as physical withdrawal symptoms with many types of drugs.
Getting Help for Co-Occurring Addiction and Bulimia
Social isolation, secrecy, and denial are often hallmarks of both bulimia and addiction, and it may be difficult for a person suffering from the disorders to admit when there is a problem and seek help. Families and loved ones can help by staging an intervention. Both bulimia and addiction can be fatal without treatment, and both are treatable with professional help.
An intervention is a structured meeting between an individual battling addiction (and/or other behavioral or mental health issues) and a team of people, including family members, coworkers, clergy members, neighbors, and others invested in getting the person the help they need to recover. The main goal of an intervention is helping the individual to see the benefits of treatment and to willingly enter into a program on their own. In many cases, and especially when co-occurring disorders are present, a professional interventionist can help facilitate the family’s goals. The National Council on Alcoholism and Drug Dependence (NCADD) publishes that when a trained professional is involved, interventions are successful at getting the person to commit to treatment over 90 percent of the time.
An interventionist meets with the family and helps to form an intervention “team,” often without the knowledge of the individual needing help. This team will make note of specific instances in which the disorders affected them personally, often in the form of letters. Consequences are decided upon ahead of time in case the person refuses to enter treatment after the intervention, and loved ones are encouraged to be prepared to follow through with them. In the event that a person refuses to get help, for instance, family members may ask the loved one to move out or refuse to continue to support them financially.
The intervention team also should research and set up a treatment plan prior to the final meeting with the loved one so if they are ready to seek treatment, they can head there immediately. The final intervention meeting should take place when the person is most at ease. The approach should be nonjudgmental and full of love and support.
Treatment Options and Recovery
As disorders impacting emotional regulation, willpower, motivation, and behaviors, both addiction and bulimia require specialized care to foster recovery. Brain chemistry is literally rewired by chronic drug and alcohol use, and this can take time to reverse.
Some similar regions of the brain are thought to be involved in both bulimia and addiction, and behavioral therapies are useful in helping to improve behaviors by focusing on thoughts. One such form of behavioral therapy, Cognitive Behavioral Therapy (CBT), has actually been shown through neuroimaging to physically rewire the brain and repair dysfunctions of the central nervous system, as published in The Journal of Neuropsychiatry and Clinical Neurosciences. CBT can highlight harmful thoughts, explore how these thoughts can lead to self-destructive and negative behaviors, and then work to positively modify them. By learning tools and techniques to manage cravings and handle potential triggers for these cravings, individuals can regain a healthy life and brain balance.
Co-occurring disorders, such as bulimia and addiction, are generally optimally treated in an integrated fashion since the disorders are so often complexly intertwined. By treating both disorders at the same time, via a team of medical, substance abuse, and mental health professionals all working together, relapse may be minimized and recovery enhanced.
Co-occurring bulimia and addiction can be treated in either an outpatient or a residential manner. Generally speaking, a residential treatment program can provide the highest and most comprehensive form of care with the widest range of beneficial amenities and programs. As a result, inpatient treatment is most often recommended for cases of co-occurring disorders and particularly for eating disorders. A residential program can offer nutritional training and planning, fitness and exercise programs, and additional holistic measures to restore physical health. Residential programs are highly structured and can provide continuous care and supervision around the clock for the duration of the program.
Detox is often the initial stage in a treatment program, and medical detox can offer a safe environment for toxins to be processed out of the body while helping to manage cravings and potential withdrawal symptoms. Medications may be helpful both during detox and ongoing treatment for bulimia and addiction. Antidepressants, mood-stabilizing, and antipsychotic medications are often considered to be beneficial in treating both bulimia and side effects of drug withdrawal.
Supportive care is necessary during treatment and recovery. Peer support and 12-Step programs are extremely useful, in addition to relapse prevention, life skills training, and educational programs. Support groups that cater to individuals battling both an eating disorder and addiction can provide people with the knowledge that they are not alone and help to foster positive connections with other individuals who are striving for the same thing: abstinence and sustained recovery.
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Living with Bulimia and Addiction
Bulimia is a potentially life-threatening disorder that often co-occurs with drug and alcohol abuse and addiction. Genetic, biological, and environmental factors all play a role in the onset of both disorders, as overlapping contributors may be involved. Similar brain regions and family history, as well as social pressures, stress, and exposure to trauma (especially at a young age) all may contribute to the onset of bulimia and also to substance abuse and subsequent addiction.
Bulimia and addiction co-occur at very high rates as addictive behaviors and actions, a loss of control, withdrawal symptoms, and relapse are indicators of both disorders, the journal Neuropsychiatrie publishes. Bulimia is even sometimes referred to as an “addiction” in and of itself. People suffering from bulimia have no control over the amount of food they eat during a binge, and their preoccupation with body image and weight causes them to feel the need to purge after consumption. In similar fashion, addiction is signified by an inability to control drug use and leads to changes in behaviors as a result.
Bulimia may be a side effect of unhealthy eating habits and emotional deregulation resulting from addiction, or addiction can be the result of attempting to control cravings and appetite levels as well as attempting to self-medicate emotional disturbances related to bulimia. Both disorders serve to exacerbate side effects and symptoms of the other in the long run.
Bulimia and addiction are both highly treatable, as brain chemistry can be reregulated with behavioral therapies and medications. A sustained recovery is enhanced when individuals participate in an integrated and comprehensive treatment program that teaches tools to minimize relapse and control cravings as well as to maintain healthy physical and emotional balance by restoring self-confidence levels and positive self-image. Support group engagement, alumni programs, and aftercare services can foster a long-term recovery after the initial treatment program is concluded as well. Both addiction and bulimia can be managed for a long and healthy recovery with ongoing dedication and commitment.