Bulimia Nervosa

1. Stay Active, Stay Healthy, Stay Beautiful Bulimia Nervosa

2. What is Bulimia Nervosa? • The National Eating Disorder Association defines Bulimia Nervosa as, “a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge-eating.”1

3. Symptoms and Warning Signs • Symptoms • Frequent episodes of consuming very large amounts of food followed by behaviors to prevent weight gain, such as self-induced vomiting • A feeling of being out of control during the binge-eating episodes • Self-esteem overly related to body image1 • Warning Signs • Evidence of purging behaviors such as frequent trips to the bathroom, signs and/or smells of vomiting, presence of wrappers or packages, of laxatives or diuretics • Excessive, rigorous exercise regimen- despite weather, fatigue, illness or injury, the compulsive need to “burn off” calories • Withdrawal from usual friends or activities 1

4. These athletes are really skinny… • Many athletes actually suffer from Bulimia, without vomiting episodes. • Some people are actually known as “obligatory exercisers.”2 • What is an obligatory exerciser? • A person who will not interrupt their exercise schedule, even when they are injured or when they know exercise could harm their lives.2

5. Is that really considered a part of an eating disorder? • Other names for “obligatory exercisers” • Activity disorder • Compulsive athleticism • Exercise addiction • Exercise dependence • Excessive exercise2 • Symptoms: • Focuses on reducing body weight and changing body shape • Maintains a rigid diet • Structure social activities around the exercise routine • Keeps extensive logs and records2

6. Treatment for Obligatory Exercise • Periodization- cycles of training with set recovery periods • Cognitive-behaviorial therapy • Group therapy • Family therapy • Medicine2 • Do these symptoms and treatments sound familiar?

7. Why would I have this? A combination of many different parts of your life can come together to affect your chance of an eating disorder. 9

8. Does it really affect me? Q: I have lots of friends and I don't know anyone with bulimia. How come I don't know anyone with bulimia if it's so prevalent? A: People struggling with bulimia usually appear to be normal body weight.1 Bulimia affects 1-2% of adolescent and young adult women.1

9. But at least I'll be skinny... Does weight really matter when your health is involved?? Health Risks of Bulimia • Electrolyte imbalances that can lead to irregular heartbeats or heart failure, even death • Tooth decay or staining of teeth from frequent vomiting. • Unfortunately, once tooth enamel is eroded, it will not regenerate, and restorative dental procedures may be necessary • Chronic or irregular bowel movements from the use of laxatives8

10. I play sports, my friends stay healthy... • Athletes are just as at-risk of bulimia. • According to a study, one-fourth of both male and female athletes had episodes of overeating on a daily basis (bingeing). • The study also showed that more athletes admitted to Bulimia, rather than Anorexia, another common eating disorder.3 • Female athletes also reported lower self-esteem than male athletes. • Their goal was to achieve a body fat content that was very unhealthy and would result in amenorrhea.3

11. Why would I care about amenorrhea? • Ammenorrhea is when your menstrual cycle (your period) comes infrequently. (Ex.- once every 6 months) • Most women have to maintain approximately 17% body fat to menstruate. • Osteoporosis may occur within 1 year. • Often increases food occupation and increases the likelihood that overeating will occur.3

12. Why do athletes care about getting skinny and not just about the sport? • Some athletes actually work for types of thinness. • Performance Thinness- belief that a lower weight and body fat percentage will enhance their performance • Common types- endurance sports (running, cycling) • Appearance Thinness- belief that thinner athletes will be rewarded • Common types- figure skaters, gymnastics3

13. Treatment Options • Nutritional Counseling- learn to structure & pace meals, adjust calories to maintain weight • Cognitive Behavioral Therapy (CBT)- identify & change disordered thoughts that bring on the compulsive behavior, find better ways to cope with life’s stresses • Interpersonal Therapy- tries to improve relationships that may be framing the problem4

14. Treatment Options (cont.) • These treatment options are usually more effective when implemented with other strategies • Self-help- internet-based modes & support groups • Medicine- SSRIs (selective serotonin reuptake inhibitors)4

15. Will this little pill help me feel better? • One of the treatment options for Bulimia is medication. The most common medications fall in the category SSRis. • SSRis (Selective Serotonin Reuptake Inhibitors)- changes the balance of serotonin in the brain, which helps the brain cells send and receive messages, which boosts moods • Some ones I might hear- Celexa, Lexapro, Prozac, Zoloft, Paxil5

16. Take some time to yourself! • Some studies have been done to see if mindful meditation can work to stop the urge to binge, which is caused by your anxiety. • These meditation interventions have been used for other addictive characteristics. • One study found that the meditation can have marked immediate impact on decreasing the episode. 6

17. How do I meditate mindfully? • This is something you can do even without money! • Sometimes called “present-focused awareness” • What do I do? • Sit comfortably. • Focus on your breathing. • Bring your mind’s attention to the present without drifting to concerns for the past or future.6

18. What can my parents do to help me? • Coaches, athletic directors, teammates and parents should be aware of a pursuit of low percentage body fat. 3 • Greater percentage of full remission with parents involved in the treatment process, ex. Family therapy.7

19. Where can I go in Ohio? • Professionals • Cincinnati- Anne Kearney-Cooke 513-588-9431 • West Chester- Teri Role-Warren 513-779-920910 • Centers • Cleveland Center for Eating Disorders 216-765-0500 • Lindner Center of Hope 513-536-4673 • The Center for Balanced Living 614-293-9550

20. Works Cited • 1 National Eating Disorder Association (2014). Bulimia Nervosa. • 2 Physician Sports Med (2005). The Obligatory Exerciser Assessing an Overcommitment to Exercise. • 3 International Journal of Eating Disorders (1999). Athletes and Eating Disorders: The National Collegiate Athletic Association Study. • 4 The Harvard Medical School Family Health Guide (2006). Treating Bulimia Nervosa. • 5 Mayo Clinic (2014). Selective Serotonin Reuptake Inhibitors. • 6 The Harvard Health Publications (2014). Mindful Meditation May Ease Anxiety, Mental Stress. • 7 National Institute of Mental Health (2012). Spotlight on Eating Disorders. • 8 Journal of Women’s Health (2004). Bulimia: Medical Complications • 9 National Institute of Mental Health (2014). What are Eating Disorders? • 10 National Association of Anoxeria Nervosa and Associated Disorders (2014). Eating Disorder Professionals: Ohio.