The Urge to Purge

Have you ever eaten so much you thought you would explode?  In college, I was introduced to the term "Happy Nausea" - a feeling of happiness from eating some really yummy food combined with feeling nauseated from eating so much of the yummy food.  Think about the diagnosis of Bulimia Nervosa.  The definition according to the Diagnostic and Statistical Manual, 4th Edition (DSM-IV) is listed below.  The bulleted parts are from the DSM-IV, the paragraphs are my own commentary on these criteria.

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
• Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
• A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

What's the definition of binge eating?  There is an effort to quantify the caloric intake of a binge episode, but it really needs to be looked at within the context of other behaviors.  That's why there's the other element of losing control.  This is often connected with intense emotions, feeling overwhelmed, or having difficulty coping.  

• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications; fasting, or excessive exercise.

Then there's the purging - an effort to undo the binge episodes, to compensate for the excessive caloric intake.  The stereotypical purge is inducing vomiting.  I'm reminded of the line from Heathers where Heather Chandler says to Heather McNamara "Grow up, Heather.  Bulimia is so '87."  If it's not coming up before digestion, then there's the effort to move it along more quickly with laxatives and diuretics or to "cleanse" the system with enemas or colonics.

• The binge eating and inappropriate compensatory behaviors occur, on average, at least twice a week for three months.

So a one-time incident isn't sufficient for a diagnosis, but rather an established pattern of behaviors.

• Self-evaluation is unduly influenced by body shape and weight.

This ties into the motivation for engaging in the behaviors.  If identity is strongly related to  physical appearance, then controlling body shape and weight may function as a way of trying to control other aspects of the self.  It's not uncommon for body shape and weight to have some influence on a person's self-evaluation, but the distinction here is "undue" influence.

• The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

This is more a distinguishing between which label to put on the behaviors.  Anorexia trumps Bulimia because there are more extensive behaviors that are also present.  These include weighing 85% of expected weight and not having menstrual cycles.

• Specifying Type: Purging Type vs. Non-purging Type (exercise & fasting to compensate).

The specifiers are helpful in defining the type of control that is used to compensate for the binge eating behaviors.

Looking at these criteria, one might argue that anyone on a diet has an eating disorder.  After all, the whole premise of weight loss efforts is the intentional restriction of food intake and the increase of physical activity to "balance out" caloric intake.  And what about the motivation for someone choosing to go on a diet?  It's often related to dissatisfaction with physical appearance.  While there are elements of the disorder in "typical" life and not uncommon for a "normal" person to experience, there is a threshold at which these behaviors cross the line to become a disorder.

I have never made myself vomit after eating, but I will admit that I've had the passing thought about it.  Sometimes the discomfort from an overly full stomach has been so powerful that I want nothing more than for finding some way to relieve that pressure.  I've joked with my husband about installing a valve in place of my belly button, so you can imagine my surprise when I saw this poster in the mall: 

I have no idea what it was advertising, but it was exactly what I envisioned having installed!  Each time I over-eat, I really can't be surprised when I experience the after-effect.  So why do I keep doing it?  Often it's because I'm giving myself permission to over-eat.  My eating is so strict most of the time that I want to take advantage of my "binge" opportunities.  I am trying to be more aware of these situations, so I can plan for quality cheats over quantity cheats (with my father-in-law's birthday dinner as a prime example). 

As with any tendency to diagnose someone's behaviors, I remind people that it's important to look at the larger context and to see if it truly meets the criteria of a disorder - causing distress and/or impairment to functioning.  I'm not anorexic.  I'm not bulimic.  I don't have an eating disorder.  These are real disorders that can have a tremendous impact on the individuals suffering from them and on their loved ones.  These diagnoses are not to be taken lightly and are important to address.  It's important to keep an eye out for when someone may be dealing with an eating disorder, but it's equally important to not assume that because someone is eating in a strict or regimented manner that they have an eating disorder. 

Food Log:

• Meal 1  
• 2 egg whites and 2 eggs with salsa (28g)
• Meal 2 
• Green beans 
• Meal 3 
• 2oz chicken (12g)
• Meal 4
• 4oz chicken (24g)
• Green beans
• Meal 5
• Generous tablespoon of peanut butter (5g)

Protein:  69g

 

Exercise:

• Time:  Zumba for 30 minutes, Stairmill for 45 minutes
• Level:  Level 6
• Calories: 600

Today's Weigh-In:  143.3