Special Education

Teaching Students with Mental Health Disorders:
Resources for Teachers: Volume 1 - Eating Disorders

Bulimia Nervosa

Often confused with anorexia nervosa, bulimia nervosa is actually a distinct eating disorder. People with bulimia go through behaviour cycles marked by binge eating followed by purging through self-induced vomiting or use of laxatives. Some other behaviours of people with bulimia are excessive exercising or fasting. Like people with anorexia, those with bulimia are obsessed with their weight and body image. They set unreasonably strict diets. When they do not maintain these diets, they fall into episodes of intense eating followed by purging. These episodes typically occur in secret, in order to avoid criticism from family and peers. Unlike students with anorexia, students with bulimia are more likely to acknowledge their behaviour. Despite acknowledging the consequences of the behaviour, they will not use this knowledge to initiate change, but rather use the behaviours to confirm their own negative self-image.

People with bulimia tend to be average weight to overweight, because of their episodes of intense eating. They may, however, go through periods of time when they are underweight. They may also suffer both the physical and mental effects of chronically poor nutrition, including stomach and cardiovascular problems, damage to the immune system, and depression. They are at risk for rupture of the oesophagus, inflamed throat, and other side-effects from self-induced vomiting.

While researchers still do not have a clear understanding of the long-term effects of bulimia, some believe the mortality rate for bulimia is as high as it is for anorexia. They do agree that bulimia is a more widespread eating disorder. It is estimated that as many as three percent of North American females suffer from bulimia nervosa.

Indicators

A student with bulimia nervosa may exhibit some or many of the following indicators.

Behavioral:

  • Eats a large amount of food over a short period of time.
  • Engages in purging or other inappropriate compensatory behaviours after eating, including: self-induced vomiting, fasting, excessive exercise and/or the misuse of laxatives or diuretics.
  • Eats in private or is secretive about eating behaviours.
  • Often eats a restrictive diet.
  • Prefers high-fat, high-carbohydrate and high-sugar “junk” foods during binge episodes.
  • Frequently uses the bathroom for extended periods of time after eating.
  • Engages in “acting out” behaviours, such as shoplifting, binge spending, alcohol or drug use and/or sexual promiscuity.
  • Shows a marked decline in school attendance patterns.
  • Often appears socially outgoing, but on close examination, relationships may tend to be superficial.
  • Sets high goals and constantly strives for perfection.
  • Often appears to be of average weight or overweight.

Cognitive:

  • Is preoccupied with food. Conversations, school projects or artwork may revolve around food themes.
  • Has difficulty concentrating, appears indecisive or, conversely, exhibits rigid “black-and-white” thinking.
  • Makes comments about being overweight or expresses a belief in the importance of self-control when it comes to eating habits.
  • Expresses fears about intimacy in personal relationships.

Affective:

  • Appears anxious, depressed, angry, irritable, defiant or stubborn, or displays intense mood swings.
  • Expresses feelings of inadequacy, worthlessness, anxiety and loneliness.
  • Demonstrates feelings of low self-esteem through appearance, attire, body language or social relations.
  • Expresses a fear of weight gain.
  • Expresses feelings of failure with less than perfect school grades/marks.
  • Associates feelings of shame or guilt with eating disorders when taking part in a class discussion on the topic.
  • Expresses fears about intimacy in personal relationships.
  • Feels dependent on others for approval and appreciation, relying on others to determine self-worth.

Physical:

  • Exhibits broad fluctuations in weight.
  • Has dental problems, broken blood vessels under the eyes, “bags” under the eyes, or throat problems. These are physical conditions that can be caused by self-induced vomiting.
  • Complains of dehydration, fainting spells, dizziness, hand tremors or blurred vision.
  • Suffers from ongoing stomach problems.
  • Engages in binge eating, eating large quantities of food over short periods of time.
  • Experiences loss of, or irregular, menstrual periods.

Distinguishing Characteristics of a Students with Bulimia Nervosa:

  • Experiences recurring episodes of binge eating -- repeatedly eats a greater amount of food than most people would eat during a similar period and under similar circumstances.
  • Feels a lack of control over eating during binge periods. Feels unable to stop eating or control the amount of food being consumed.
  • Engages in repeated purging or other inappropriate compensatory behaviours such as self-induced vomiting, fasting, compulsive exercise or the misuse of diuretics, laxatives, enemas or other medications. Followed by feelings of depression, guilt and fear.
  • Perceives self to be fat, regardless of weight.
  • Has a self-perception and self-esteem which is significantly influenced by body shape and weight.
  • Weight fluctuates frequently.
  • Undertakes rigid and harsh exercise regimes.