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==Descriptions, definitions, synonyms, organizer terms, types of==  

Bulimia nervosa, an eating disorder more commonly known as bulimia, is a psychological condition in which the subject engages in recurrent binge eating followed by intentionally doing one or more of the following in order to compensate for the intake of the food and prevent weight gain:

     vomiting 
     inappropriate use of laxatives, enemas, diuretics or other medication 
     excessive exercising 
     fasting 

A person is classified as bulimic when he or she feels incapable of controlling the urge to binge, even during the binge itself, when he or she consumes a larger amount of food than a person would normally consume at one sitting, and when such behavior occurs at least twice per week for three months.

Bulimia is a pathology that involves body image and the desperate desire to appear thin. The majority of bulimic patients are young females from 10 to 25 years old, although the disorder can occur in people of all ages and both sexes.

Bulimia is often less about food, and more to do with deep psychological issues and profound feelings of lack of control. Binge/purge episodes can be severe, sometimes involving rapid and out of control feeding that stops when the sufferers "are interrupted by another person...or [when] their stomach hurts from over extension...This cycle may be repeated several times a week or, in serious cases, several times a day."1 Sufferers can often "see the destructive eating pattern as a way of gaining control over their lives".([http://en.wikipedia.org/wiki/Bulimia_nervosa Wikipedia])

==Application in and effects on classrooms and similar settings==
Nevid and Rathus says, "Adolescent girls may use refusal to eat as weapon against their parents."  In my experience teaching, I have found that most times when students are dealing with an issue of this type, they are feeling the pressure from their peers to try and fit in.  These adolescents see the skinny models in magazines and believe that they need to look like them rather than the way they already look.  This is an unhealthy view of themselves and others and can become obsessive about their looks.  As pointed out in "Psychology and the Challenges of Life, "...young women with anorexia, those with bulimia tend to hld perfectionistic views about body shape and weight, and express unhappiness with their own body shape (Heatherton et al., 1997; Joiner et al., 1997)(Nevid et al., 2005).

[http://72.14.203.104/search?q=cache:eOfosFu6ehcJ:www.girlpower.gov/AdultsWhoCare/resources/Pubs/teachers.pdf+bulimia+in+classroom&hl=en Why should teachers be concerned?]

Disordered eating affects learning outcomes. The irritability, decreased concentration, nausea, headaches,and malaise which often accompany disordered eating have a negative effect on students’ learning. They lose the ability to concentrate in class and complete assignments. As preoccupation with food takes over, a student may retreat from social activities; lose interest in school work, family, and friends; and feel lonely, alienated, and disconnected from society. Younger children are developing eating disorders. Children ages 7 to 13 years are being referred to eating disorder clinics in greater numbers, particularly in the last five years. This increase is due both to the heightened awareness of the signs and symptoms of eating disorders and to their increasing incidence. Students of all ethnic and cultural groups are vulnerable to developing eating disorders. Although rates of anorexia are higher among Caucasian girls, eating disorders occur among girls of all ethnic and cultural groups. In addition, hundreds of thousands of boys and men are also experiencing this problem.

==Evidence of effectiveness==
"Investigators find that many young women with eating disorders have issues of control as well as perfectionism.  These women may feel the only part of their lives in which they can exercise control is their eating" (Shafran & Mansell, 2001). Although some adolescents may feel that they are being effective by following these extremely unhealthy realities, they are truly causing damage to their own bodies.

Consequences of [http://en.wikipedia.org/wiki/Bulimia_nervosa Bulimia Nervosa]
- Electrolyte imbalance, heart arrhythmia, heart failure
- Teeth erosion and cavities 
- Sialadenosis (salivary gland swelling) 
- Potential for gastric rupture during periods of bingeing 
- Irritation, inflammation, and possible rupture of the esophagus 
- Laxative dependence 
- Peptic ulcers and pancreatitis 
- Emetic toxicity due to ipecac abuse 
- Death

Mortality risk:
Eating disorders have one of the highest death rates of all mental illnesses. The Eating Disorders Association (UK) estimates a 10% mortality rate.7 An 18% mortality rate has been suggested for Anorexia Nervosa.8 In addition to the risk of suicide, "death can occur after severe bingeing in bulimia nervosa as well".9 For perspective, these death rates are higher than those of some forms of cancer.

Treatment can help. [http://www.anred.com/ ANRED's web site] states that, although without treatment 20% of people with eating disorders will die from the disease, with treatment that can be reduced to 2-3%.  With treatment, 60% can recover from eating disorders.  [http://www.anad.org ANAD’s] figures are conflicting, but hopeful as well.  They report that 6% will die and 50% will recover.  Recovery, however, is not quick or easy.  It may take 7 to 10 years or more to recover as psychological as well as physical issues must be addressed and resolved.  Recovery is not just a return to "normal" eating.  Among many things, it means maintaining a normal weight, eating normal foods, getting rid of an irrational fear of food, maintaining healthy family relationships, having mutually satisfying friendships, learning to be kind to oneself, giving up perfectionism, developing problem solving skills and being able to simply "have fun".

==Critics and their rationale==
Social-cognitive theorists suggest young women with anorexia set unreasonable demands on themselves in the pursuir of perfection, including what in their minds is the "perfect body" (Cockell et at., 2002; Halmi et al., 2000).  Keeping this in mind as students progress through the schools everybody has to be aware of the consequences of these illnesses.  Many times students believe that they can achieve what they set their minds to, but it cases like this, the goal is unattainable. "Yet, 'perfection' is an impossible goal, even for fashion models who are themselves prone to develop eating disorders because of presures to match an idealized image" (Rathus et al., 2005)

==''Signed'' "life experiences", testimonies and stories==

Testimonial by Valerie Munds...

Bulimia was something I struggled with from the time I was 16 years old until I was 26 years old. It was and still is a big part of my life. Most people think it is somethings girls/boys may only do for a short time to lose weight, but my episodes lasted ten years. I was lucky enough to have a supportive family and great counselor to help me end the vicious cycle. Still a day does not go by that I don't think of the damage I did to my body and the things I lost a long the way. Bulimia is a vicious cycle that consumes your life at times. It may come and go like a cold. It may stick around and destroy you. Now I reach out to young girls and boys who may be caught up in this vicious cycle. I have been actively involved in support groups for people with eating disorders for fifteen years now. If you think you may know someone who is suffering from bulimia, reach out to them and show you care, you may make a huge difference in the life of another person. You may even save their life.

I have seen many cases of this in the last ten years in our school disrict.  All of the cases I know of have been girls who believed they were to fat.  I believe this comes from the commercials, magazine adds, and the general pressure that is put on girls to have the perfect body.  Many of these girls were not heavy to start with they just did not have muscle tone yet.  Once the process started for these girls it was hard to stop and actually hard to look at.  They thought they looked good, but most people thought they looked terrible.  Of the cases I am talking about these girls did go and get help.  Of course they did not do this without a fight, but to the girls credit they did go.  Hopefully they will stay fully recovered.  Bret Helms


I am a third grade teacher in the Champaign school district.  I happen to work at one the more desirable schools in which many professors and affluent families enroll.  I have noticed in my short time there, that some of my students have already begun worrying about their weight.  How disheartening it was to hear one of my third graders (barely 60 or 70 pounds wet) told one of her friends that she was not going to eat lunch anymore because she is getting too fat.  Furthermore, she explained that she was going to start the diet that her mom was on to help her lose weight.  In addition, at the beginning of school year, I asked my students to write an All About Me book in which they filled in answered to leading questions.  One question asked, "If my friends were to describe me, they would say..."  To this, two girls who did not work together on the assignment, responded, "that I am pretty because I am skinny."  If these children do not have positive figures in their lives who can help them understand that they should love themselves no matter what, they will continue on a road of self destruction and poor self esteem.  ~S. Ward

I had always had issues with my weight.  Throughout high school I tried so hard to control my weight.  My senior year was most disappointing.  I took two aerobics classes.  I ate the "right" foods.  I had a job that involved physical labor (UPS).  With all of this effort and no results I became frustrated.  I ended up going through cycles where I would not eat for days.  After periods of starvation, I would binge and purge.  Once this unhealthy cycle began, I dropped weight so fast.  I lost 80 pounds in three months.  Family and friends complemented me on my success.  This positive attention just encouraged the behavior.  I became obsessive.  I would work out two or three times a day.  I would weigh myself multiple times a day.  I had a journal that I marked my body measurements in every week.  I would stare in a mirror and pick myself apart.  This unhealthy lifestyle lasted approximately 5 years.  I never got professional help.  I never shared my troubles with my family.  It took a while to stop because my body became accustomed to getting rid of food any time I ate.  Eating made me physically ill.  My digestive system was getting torn apart and I was getting a lot of cavities.  I was ashamed of my behavior.  I got into a very meaningful relationship and gradually was able to stop.  I didn’t want my boyfriend (now husband) to know what I was doing.  I am still surprised that none of my family or friends inquired about my odd behavior.  My advice is this:  If you notice a friend, family member or student that is losing a drastic amount of weight in a very short period of time, talk to them.  There may be something behind the loss.  There may be a person that is screaming on the inside for someone to notice...for someone to tell them everything is going to be okay. ~V. Amen

I have a very dear friend who has suffered from Bulimia since she was in sixth grade.  She is now 36. She started binging and purging after a difficult year where she was bullied by her entire class.  They called her "Big Birtha," spread rumors about her, and isolated her socially.  She hid the disorder from her family all through her teens.  It wasn't until she was going through a divorce in her mid twenties that her family found out.  Like others have said, the excessive binging and purging came and went depending on what stressors she had in her life. What she has told me is that it started out as a way to control her weight, but ended up being an addiction which soon controlled her life.  Last year, her mother and sisters talked her into going into a treatment program.  To this day she is struggling with the disease. As teachers we see all kinds of teasing and bullying in the classroom.  I think it's important to raise our awareness of the long-term damaging effects that this type of emotional and physical abuse can have on young people.  M. Torrise

Bulimia is a disease, a mental illness. Food is just a symptom of this eating disorder.  Treating the food intake aspect of bulimia does not effectively change the behavior or thought process.  Intensive personal counseling is a good avenue to take with this disorder as it identifies deeper issues in which bulimia helps (ineffectively) temporarily alleviate.  There is a reason for people to binge and puke, it is stuffing down unwanted emotions( fear, anxiety, self-hate) and vomiting the unwanted food out is temporary relief, only to occur again, as this disease is a vicious cycle.  I believe food disorders is as harmful as any other drug disorder.  Emily Kaffel

==References and other links of interest==
Rathus, S.A. and Nevid, J. S. (2005) Psychology and the Challenges of Life: Adujustment to the New Millenium. Danvers, MA: John Wiley and Sons, Inc.

Heatherton, T.F., Mahamedi, F., Striepe, M., Field, A.E., & Keel, P. (1997).  A 10-year longitudinal study of body weight, dieting, and eating disorder symptoms.  ''Journal of Abormal Psychology, 106,'' 117-125.

Joiner, T.E., Heatheron, T.F., Rudd, M.D., & Schmidt, N.B. (1997).  Perfectionism, perceied weight status, and bulimic symptoms.  ''Journal of Abnormal Psychoogy,'' 106, 145-153.

Cockell, S.J.,Hewitt, P.L., Seal, B., Sherry, S., Goldner, E.M., Flett, G.L., et al. (2002).  Trait and self-presentational dimensions of perfectionism among women with anorexia nervosa.  ''Cognitive Therapy and Research, 26,'' 745-758.


Shafran, R., & Manselli, W. (2001).  Perfectionism and psychopathology: A review of research and treatment.  ''Clinical Psychology Review, 21,'' 879-906.

[http://en.wikipedia.org/wiki/Bulimia_nervosa Wikipedia-Bulimia_Nervosa]

[http://www.nimh.nih.gov/publicat/eatingdisorders.cfm/ National Institute of Mental Health]

[http://www.healthyplace.com/Communities/Eating_Disorders/beat_bulimia/bulimia_4.html/ Bulimia:Getting Help]

[http://www.mentalhealth.com/dis/p20-et02.html This site offers links to descriptions, diagnosis of bulimia, treatment, and research.]

[http://www.anred.com ANRED, Anorexia Nervosa and Related Eating Disorders]