Expert: Joanne - 2/9/2009

Question
QUESTION: Okay, so my family tells me that I am not fat and that I am a great size. I
don't believe them. I want to be skinny like everyone else. This past year I
started to force my self to throw up. I would eat a lot of food in like 30
minutes and then I would go throw it up. Would that be considered an ED?
What kind? I hardly eat breakfast (only on weekends because my parents
expect me to) I eat lunch (not much) and dinner i eat!. The thing is, i hate
what food does so I most of the time go and throw up. I usually throw up
about once a day every other day or everyday depending on what I eat. I am
usually a really good eater. I work out all the time and I have a really low self esteem. Yes, my mom is aware of my eating problems and so is my school
counselor. I just feel I want a different opinion. Do you got any advice on
changing my food habits and as much info as possible on what throwing up
can do to me, how to prevent it and how to work on my self esteem?

Thanks so much, Lea

ANSWER: Lea

It sounds as though you may be developing bulimia nervosa.  In order to get this diagnosed though, you would need to visit your doctor or a specialist eating disorder service.

I think that you really need to sit down with your mum or counsellor and talk this through properly and decide where to go next.  I would recommend trying to get some professional help, preferably with someone who specialises in eating disorders, or at least has experience in treating them.

You need to change your eating habits!  You need to try and eat three balanced meals a day, possibly with snacks between them as well.  There is a chance that you are binging in the evening because you aren't eating enough during the day, however, you also need to look and try and work out exactly why you decided to start purging - if you can think back to why you may be developing an eating disorder, you can then start working on correcting it (this is easier done with professional help!).

Throwing up will ruin your teeth!  No two ways about it - in the long term, you will likely end up with a lot of damage to your teeth.  The most important thing here is if you must make yourself sick, be sure not to brush your teeth afterwards as all you are doing is brushing your stomach acid on your teeth and wearing away the enamel.  Just rinse your mouth with a fluoride mouthwash or toothpaste mixed with water - don't rub!  You risk tearing your oesophagus which can cause quite serious bleeding.  You are putting a huge strain on your heart and may suffer from dehydration and also an electrolyte imbalance which can cause fatal cardiac arrhythmias.

You need to speak to someone about these behaviours properly, soon!  Please try to get some professional help!  In the meantime, eat proper meals regularly and try to busy yourself after meals so that you don't have time to purge!  If you have a dog, immediately go out and walk it, arrange to meet friends, make your family sit longer after meals with you so that you have to sit about and talk rather than head for the bathroom, just do absolutely anything you can to avoid purging!  You need to address this eating disorder properly though!  Eating disorders can be deadly, so if the thought of your teeth rotting away or bad hair and skin aren't enough to stop this, then think about the fact that you could drop dead at any point if your electrolytes get mucked up!

Joanne

---------- FOLLOW-UP ----------

QUESTION: What is purging and binging? I can end up dead? =[. I don't want to end up dead. Today is happened twice, after lunch and after dinner. ='[. I am just feel so fat. Which I am. IDc if people tell me that I am not. I am slowly starting to eat breakfest and lunch (that doesn't stay in). I have great teeth and I for sure don't want them damaged. What is electrolyte imbalance and cardiac arrhythmias. Sorry for all the the questions.

ANSWER: Hey Lea

Binging and purging is the cycle that many people suffering from bulimia will find themselves involved in.  Basically the binging is when someone eats a lot (this normally means a huge amount of food, much more than a person would normally consume at any one time, in fact some can eat more than a whole days worth of calories at once!).  There is then normally a huge sense of guilt and greed and many other emotions which leads to trying to get rid of these calories - 'purging', which is many cases is done via self-induced vomiting, but may also involve laxatives and/or excessive exercise.

I didn't mean to scare you with death, and I apologise for the way that was perhaps put across, but I do feel that it is very important that you are aware that death can be a possible consequence.  Some people don't realise just how serious and dangerous this can become and possibly need a scare like that to try and help get this message through to them.  There is no need for you to end up dead, and there is nothing to say that even if you were to continue with this behaviour that it would definitely happen to you, but it is reckoned that the death rate from eating disorders can be as high as 20% and the long term effects of eating disorders are likely to the cause of many more premature deaths.  Nothing can determine whether you would be in the 80% that will survive it or not, surely it is better not to take the chance and get help now!  As many as 1 in 5 people die from these illnesses, I think that statistic alone should be enough to make you want to get help now before you become much more involved with an eating disorder, as they become harder to treat and much more likely to cause health problems the longer they go on!

Your body has a number of electrolytes, such as potassium, sodium, etc.  They are chemical substances within your body that are responsible for carrying out a number of cellular mechanisms within your body.  For your body to function normally it requires these substances and for some the levels have to be carefully managed by the body.  The body has a number of ways to control the levels of these electrolytes under normal circumstances, but when your body is put under a lot of pressure, it can struggle to do so!  Repeated vomiting can cause a very serious imbalance with regards to your potassium level.  A low potassium level can cause kidney failure in the long run, but much more immediately can have an impact on your heart.  Potassium is required for the heart to work properly, and too little can cause arrhythmias and cardiac arrest, which can cause permanent damage to the heart muscle, or even instant death!

As for you teeth, although to some they may not seem like much to worry about compared to the health of your heart, I know that the state of your teeth can be a huge thing.  Nobody can see the damage to your heart, kidneys or digestive tract if it happens, but your teeth are there for everyone to see and are also there for hopefully your whole life!  If the medical complications aren't enough to convince you to try and change these behaviours, then please do it just for the sake of your teeth!

Joanne

---------- FOLLOW-UP ----------

QUESTION: Alright. WOw i had no idea about all of this stuff. Luckly, since the past wedsnday it has only happened 2 times. =] I now am going to a conselor once a week, i have to. The school is making me. i feel like crying right now. my parenst and r mean. =[

Answer
Lea

I'm glad that it has been more under control for you over the past few days.

Why do you feel like crying?

In what ways are your parents mean?

Why is the school making you see a counsellor?  Are they aware that you have problems with eating, or is there something else going on in your life right now?  Did you tell them about eating problems, or did they figure it out for themselves?

You do know that this counsellor thing can be a good thing, don't you?

Joanne