Eating binges may occur either spontaneously or as a result of a breakdown in control. Many patients tell me that just tasting a desired food can start an avalanche of eating. One woman said she made a point of memorizing the locations of all the bakeries in her town, so that she could arrange her routes to avoid accidentally smelling fresh-baked doughnuts and pies.
On the other hand, the bulimic may devote a lot of time to planning her binges.
The food consumed during a binge is often high in calories, sweet, and able to be eaten rapidly-even without being chewed!
However, bulimics will eat almost any food-even salad or “health foods”-during a binge. A typical menu for one patient’s binge might be two pounds of peanut M&M’s, a gallon of ice cream, half a chicken, a package of raw Pillsbury chocolate-chip cookie dough, a microwave pizza, a tub of yogurt, and a box of Pop-Tarts. Studies show that the major difference between binge meals and normal meals is often the quantity of food consumed, not the type.
Patients often look on their bulimia as their “dirty little secret.” Most go to great lengths to keep their bingeing and purging hidden. Often this means arranging circumstances so that the patient is alone when she eats.
Other patients know they must conform to their family’s schedules so as not to attract undue attention. They thus eat a normal meal, but may excuse themselves several times during the meal or immediately afterward to go to the bathroom and throw up. If questioned about their behavior, they’ll blame the problem on a “urinary tract infection” or a “stomach virus.” Although I’ve been in practice for a long time, the sheer ingenuity with which bulimics conceal their behavior never ceases to amaze me.
Interestingly, a binge does not necessarily stop when the food disappears-not as long as pizzas or Chinese food can be ordered by phone and grocery stores stay open twenty-four hours a day. Even the feeling of being full won’t do it, a sign some experts believe means that something is wrong with the way the patient’s brain perceives the feeling of fullness. No, the binge might continue to the point of physical pain, when it’s no longer possible to cram in more food. Sometimes the binge stops only when the patient falls asleep. In some cases a family member might enter the room, or a visitor might come to the door, at which point the patient stops eating.
Self-induced vomiting often marks the end of the binge, the return of control. The “punishment” has fit the “crime.” For some bulimics, however, an empty stomach and the relief of abdominal pain mean that they can then turn around and begin all over again.
Surprisingly, vomiting itself can become habitual. Patients believe (wrongly) that because they are throwing up, they aren’t absorbing any calories. Overeating becomes “okay” since it won’t result in weight gain. They also learn the degree to which they can control vomiting. Some patients learn to trigger vomiting simply by applying a little pressure to the abdomen-an act that gets easier over time. For some patients, merely the sensation of having food in their stomachs can trigger intense urges to vomit. Others, however, need a full stomach in order to vomit, and thus need to eat large amounts before they can purge.
In terms of family background, a significant percentage of parents of bulimic children are obese. Obesity in childhood or during the teen years may predispose a girl to develop bulimia. The incidence of depression is also higher among members of families with a bulimic child than in the population as a whole.
An eating binge can be seen as one kind of impulsive behavior. Many bulimics are unable to control other types of impulses as well. A considerable number have a history of stealing. One patient revealed that she sewed pockets inside her coats so she could shoplift food and other items more easily. Sometimes the stealing is motivated by the high cost of eating food in such quantities; sometimes it just reflects the way the patient interacts with her world. Some bulimics engage in promiscuous sexual behavior, having a large number of partners in short-term relationships. The incidence of alcoholism and abuse of illicit drugs is also higher than in non-bulimic populations.
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