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Forum Name: Psychiatric Topics

Question: Depression and Bulimia


 neighbours - Thu Mar 06, 2008 5:48 am

I have recently found myself very depressed after recently being dumped by my long term boyfriend. I am hoping it will of course pass, however what concerns me the most is how obsessed with my weight I have come, (possibly as a result). My appetite is somewhat depressed anyways, but when I do eat I feel very guilty and have found myself vomiting after meals. Can someone give me some advise?
 acidicLOVE - Sun Mar 09, 2008 11:04 am

I'm not a doctor, but I have been bulimic for 3 years and anorexic for 4 years. Don't feel guilty about eating hunny, as hard as it might be. Breakups happen all around all of us, and it sucks, but it's nothing about you. You don't need to feel guilty about the extra weight. Hell, in some countries the bigger you are, the more beautiful you are. Embrace your curves. My motto is no one can make me feel bad about myself without my permission. Eating disorders are deadly, I've seen what it can do to you... hell, I've BEEN what it could do to you. I don't want anybody to ever go through what I put myself through. In the end it really isn't worth it, just talk to your friends, talk to your family, talk to your doctor, you can talk to me if you need a long term insiders opinion of it.
 Dr. K. Eisele - Sun Mar 09, 2008 11:05 pm

User avatar Dear Neighbours:

I'm sorry to hear of your recent difficulties. I understand that a break-up can feel really bad. However, I do know that people get over break-ups. It is very concerning that you have developed symptoms of bulimia, a very serious disease which is difficult to treat.

Maybe it would help for you to know how bad the effects of bulimia can be.

1. Imbalances in the electrolytes--these are sodium, potassium, chloride, etc. Your body needs these substances in order to function correctly, specifically for nerves to communicate with each other and for muscle contraction. When you vomit, you lose electrolytes.
2. Dental problems--your teeth were not meant to be exposed to stomach acid that frequently. Stomach acid erodes the enamel, and gastric contents stain the teeth.
3. Rupture of the esophagus--this is perhaps the most devastating consequence of bulimia. Rupture of the esophagus occurs with repeated vomiting, and can lead to death by hemorrhage (bleeding to death).

Bulimia is a disease that must be stopped as soon as possible! Anorexia is also a potentially lethal disease. You need to consult with a psychiatrist as soon as possible for treatment. Treatment is with medication and psychotherapy.

Please get help soon.
 neighbours - Mon Mar 10, 2008 3:48 pm

What actually constitute's Bulimia? Because maybe I'm just feeling a bit down and it'll all pass, never been bothered about what I eat until recently.
 Dr. E. Seigle - Mon Mar 10, 2008 6:36 pm

Dear Neighbors,

To add to Dr. Eisele's excellent response: worries about your weight and vomiting to attempt to control it are likely your way of trying to cope with your painful feelings that you are having trouble coping with. The solution: to deal with the feelings (and associated thoughts) themselves directly with the help of a trained professional. As Dr. Eisele said, eating disorders can have some very serious medical consequences, so get some help quickly! You can consult with a psychiatrist or a psychologist, but it is important that they both have experience treating bulimia with cognitive-behavioral psychotherapy, which is the talk therapy that has been shown to be effective for bulimia. The use of medication in addition is also often a good option, but should not generally be a treatment by itself (without psychotherapy). If you see a psychologist and not a psychiatrist, you should see your family doctor who can do a physical exam and check your blood chemistries and screen for other medical consequences. A famiily doctor's nutritionist can also be a big help in treating bulimia.

In the meantime, when you have the urge to cause yourself to throw up, use a substitute coping behavior, such as:

1. spending an hour doing something good for your life that you will feel good about later.

2. call someone you trust and talk about the feelings that you are struggling with.

3. work on a hobby
4. do something that might help someone else

5. take a bath
6. spend time with a pet.
7. write a letter, clean a room, write in your journal if you have one.

Also, don't do any purging, excessive exercise, excessive dieting. Again, remember this is about your FEELINGS ABOUT YOURSELF, not really primarily about your weight. The weight issue fools us in a sense.

These are just a few ideas, don't do them if they don't feel "right". You are brave to bring this up- it is an issue that plagues American women, who are assaulted by the media glorifying excessive thinness. Don't let them fool you!

-Dr. Seigle
 neighbours - Wed Mar 19, 2008 7:33 am

I don't really want to talk to anyone. This kind of thing just doesn't happen around here ya know? I am wondering what would cause Bulimia? And I am also wondering what constitutes Bulimia? I know some people don't eat all day then when they do eat an evening meal, they vomit afterwards. However, I am still eating 2-3 meals per day and vomiting after most of them! I don't know whats wrong with me really, just really really really wanna loose weight, and I don't know why because I know I'm not overweight, I'm about 5 ft 4 and 8 and a half stone, but for ages now I've had an desperate need to get down to atleast 8stone, and quickly!!

I'm just not liking anything to do with my life at the moment really. I've taken the advise of doing activities I like, daily. And have started going swimming, which is fun and I enjoy it, but when I get home I just feel real sad again. Do you think I am depressed? And if so, what can I do about all of this. I am crying daily and moping around the house. Please advice me!!!!
 Dr. E. Seigle - Wed Mar 19, 2008 6:51 pm

Dear neighbours,

Bulimia is a disorder caused by a mix of psychological issues, social factors, life experiences, and even biological factors. Bulimia is marked by an individual's marked preoccupation with thinness; they often "feel" fat even though they know intellectually that they are not. People with bulimia usually have periods of dieting alternating with some episodes of over-eating. Bulimia also causes people to "purge", by causing themselves to vomit food they have recently eaten or to defecate the food by using laxatives. Excessive exercise can also be a problem. Socially, bulimia is associated with the excessive value that our society puts on thinness, transmitted through the media and advertising. Women and even men learn to "place" too much of their self-esteem in their body appearance, rather than in a fuller and deeper appreciation of their entire self. Other psychiatric disorders often go along with bulimia, particularly depression and anxiety disorders, as well as substance abuse. People with bulimia often have childhood backgrounds marked by unhappiness and dysfunctional family relationships. Another core feature of bulimia is that people have difficulty experiencing, tolerating, and expressing their feelings, and it seems that their obsessive regulation of their weight and body appearance takes the place of, or is a proxy for, "dealing with" their feelings in a healthy manner. It's a kind of substitute for emotional literacy, as it were.

My guess from your description is that you do have some components of depression, or that you may tend to feel depressed when alone. These are just informed speculations, and I cannot be sure. But you can be sure that bulimia exists everywhere, it is just well hidden due to unfortunate shame about it. There is no substitute for going to see a mental health professional who has special expertise in eating disorders, and your treatment should likely include psychotherapy, and consideration of medication (both for the possible depression and the bulimia. The help of a nutritionist, often associated with your family doctor's office, can also often very important.

You showed courage in raising this issue, so please know that there need be no shame in acknlowledging the bulimia, which is an enemy that you did not choose, but which our society has largely caused an epidemic of; would you be ashamed to get treatment for asthma or high blood pressure? Keep up the good work- this is very treatable and you can feel much better! Also know that bulimia can have dangerous, even fatal, medical consequences.

-Dr. Seigle
 neighbours - Thu Jul 24, 2008 4:10 pm

I havent written for a while because life was looking up for me for a short time. However, recently I have started to feel some what depressed and upset again. I'm starting to become very emotional, crying almost on a daily basis and I'm not sure why. My life is pretty perfect at the moment, I've just graduated and have got a brilliant job lined up. Though my parents are moving abroad next week, and I'm quite concerned I'm going to be very very lonely. Well I know I will be.

I've become very obssessed with my weight again, similarly to how I was feeling when I last posted. All I want to do is drop to below 8 stone, I think I'll feel much thinner and therefore much happier if I'm between 7 and a half and 8 stone as opposed to being between 8 and a half and 9. Could you tell me how I can acieve this? Because at the moment I am seriously concerned that I am going to go down the bulimia path again, similar too a few months back where I would often find myself overeating and vomiting. Please help me. Any advice would be great.
 Dr. E. Seigle - Sat Jul 26, 2008 9:05 am

Dear neighbours,

It is a well-hidden secret that "bulimia doesn't happen" around here- that being because of the shame that people feel about it. I'll bet it is well represented in your area.

It is very difficult to defeat bulimia on your own, without any help, because of the compelling nature of what are called the "cognitive distortions" of bulimia, such as "I'm fat", or "I'll be happy if I reach "x" weight", or "I'm worthwhile and attractive at "x" weight....etc. People need help with these distoritions, as well, as being educated about the serious body damage that comes with repeated vomiting, such as esophageal inflammation and bleeding, abnormalities of blood sodium and potassium which can cause abnormal heart rhythms and even cardiac arrest, malnutrition, osteoporosis, irregular periods, overgrowth of the salivary glands, and others. The vomiting tends to be an addictive activity, which needs to be stopped with the help of a therapist, otherwise it often gains in strength.

Bottom line, the bulimia is probably a way that you have of regulating negative feelings and low self-esteem, only it doesn't really work over the long run, it's like a drug.

A combo of psychotherapy and SSRI medication such as fluoxetine as well as nutriotional and illness education can be very helpful. Please consider it, you'll likely be glad later. don't relegate yourself to this serious and dangerous disease.

Good luck, E. Seigle MD

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