Purging vs. Non-Purging Bulimia
All people with bulimia are overly concerned with weight and body shape. Obsessions like this are a core part of the bulimia diagnosis. (1)
While people who purge and don’t purge share many attributes, how they manage their condition is very different.
All people with bulimia binge. Episodes involve the following:
- Secrecy: Few people want others to watch them bingeing, so they eat privately. Binge sessions often take place late at night when everyone is asleep.
- Volume: A binge is characterized by an abnormally large meal. Some people focus on snacks, like cakes and cookies. Others eat anything they can find in the kitchen or refrigerator. It’s not unusual for someone to be in pain after a binge session due to the sheer amount of food they consumed.
- Disassociation: Some people with bulimia experience an out-of-body sensation while they’re eating. They don’t notice feeling full, as they may not be paying attention to the body at all. Once they are done with the binge, they realize how much they ate and how uncomfortable they are.
- Disgust: When the episode is through and the people look at the food wrappers, dishes, and other binge leftovers, they feel horrified. Many people feel guilt, shame, anger, and repulsion after bingeing.
An obsession with body image paired with a huge meal is a recipe for disaster. People with bulimia want to be thin, but their eating habits can cause tremendous weight gain.
People with purging bulimia use vomiting, laxatives, and other severe methods to remove food from binges from their bodies. People with non-purging variants of bulimia are different.
What Methods Do Non-Purging Bulimics Try?
People with non-purging bulimia either can’t or won’t use vomiting, diuretics, or laxatives to lose weight. They use one of three methods instead.
Caffeine-based diet pills, prescription drugs (like Ritalin), and illicit drugs (like cocaine) all work directly on the brain and alter appetite signals. For some people with non-purging bulimia, these solutions seem ideal.
Many people with this form of bulimia already have a history of substance abuse, so they may be comfortable taking illicit drugs. Once they start using drugs for this purpose, their use can quickly escalate until a full-blown addiction has developed. (2)
Skipping meals, reducing portion sizes, or focusing on “safe” foods are all common dieting habits. For almost 90% of people with non-purging bulimia, diets and weight loss come before binges. (3)
Eating patterns like this aren’t satisfying, and they can leave people feeling hungry and deprived. Bingeing soon follows, as people develop an obsession with the foods they’ve been denied. Any weight loss they accomplished through their diets disappears due to the bingeing patterns.
Some people with bulimia develop an unhealthy relationship with running, weightlifting, and other forms of physical activity. They believe that moving their bodies can keep them from gaining weight.
In time, exercise can grow compulsive. Symptoms include the following:
- Exercising while ill or injured
- Feeling anxiety or stress if unable to exercise
- Hiding evidence of exercise
- Spending a significant amount of time exercising (4)
The Dangers of Non-Purging Bulimia
While people with non-purging bulimia don’t want to gain weight, they will do so. Bingeing adds thousands of calories to any meal plan, and the methods non-purgers use to remove those calories just don’t work to remove those calories from the body.
Of those who diet, 95% regain the weight in five years. And for every 100 calories we hope to burn through exercise, most people blast away only 72. (5,6)
Drugs are also ineffective as weight loss aids, as most people regain the weight when they get sober. At best, it results in weight fluctuations.
95% of those who diet regain the weight they lost in 5 years.
Experts say meaningful diet changes that persist throughout the life span can inspire weight loss, and exercise can help people keep that weight off. The best way for non-purging bulimics to lose weight is to enter treatment and stop binge eating. If they build a healthy lifestyle with a focus on a balanced diet and regular exercise, they can best manage their weight for the long term. (7)
Severe obesity associated with non-purging bulimia can lead to premature death from heart disease, stroke, respiratory illness, or cancer. The longer the issue persists, the greater the long-term damage. (8)
How to Talk With Someone About Non-Purging Bulimia
People with non-purging bulimia may feel like they don’t need significant help, as they’re not running to the bathroom to vomit or starving themselves thin. But bulimia of any type causes intense mental suffering. The person you love may be happy someone cares enough to speak up.
Make a place before you approach your loved one. By taking the time to prepare a bit, you’ll set the best foundation for a good talk. Consider the following:
Where to Start
Find a quiet place to talk where you won’t be disturbed. Kick off the conversation by discussing the bulimia signs you’ve seen.
Maybe you’ve watched the person spend three hours at the gym, or you noticed stacks of cookie wrappers in the trash. Be specific about what you’ve noticed and what you think it means.
Avoid a judgmental tone. Try to present what you’ve observed in a matter-of-fact manner. Keep in mind that they are already judging themselves and need your kindness.
Express Your Support
Then, tell the person how much you care. Remember that bulimia can be incredibly isolating, and people with this eating disorder often feel very misunderstood. Talk about how you want to help.
Now isn’t the time to convince them that they don’t need to lose weight. In fact, you won’t be able to. They need professional help, and they need to know they have your support.
Listen Carefully
Some people will open up willingly and tell you about their eating habits. Others won’t.
Be ready to accept any feedback you’re given, knowing that the person may be processing many feelings all at once. Let them talk if they seem willing.
Conversations like this aren’t easy. But for many people with bulimia, they are the first step in a journey that leads to getting better.
How Is Non-Purging Bulimia Treated?
Non-purging bulimia is treated much in the same way as standard bulimia and other eating disorders.
Assessment
First, a doctor will make an assessment, determining overall health status and identifying any physical issues that need to be addressed. Some individuals may need to be initially hospitalized to address electrolyte imbalances or severe nutritional deficiencies.
Medications
Medications like antidepressants are sometimes used to balance moods and address depression, which often co-occurs with bulimia. Both prescription and over-the-counter medications may be recommended to address specific symptoms such as anxiety or muscle aches.
Therapy
Therapy is the backbone of treatment for non-purging bulimia and other eating disorders. Cognitive behavioral therapy (CBT) is often recommended to identify negative thought patterns and replace them with more positive behaviors. In fact, CBT is cited as the treatment of choice for bulimia. (9)
Other
Other therapeutic modalities and supports will round out a comprehensive treatment plan for non-purging bulimia. This may include nutritional planning, refeeding, yoga and meditation, and other forms of bodywork. Physical movement is often part of the recovery process as patients learn to appreciate what their body can do instead of just focusing on how it looks.
A Better Future
With a tailored treatment approach, you can learn to manage non-purging bulimia. It doesn’t have to control your life. You can get on the path to a better, healthier tomorrow.
Resources
- Bulimia Nervosa. National Alliance on Mental Illness Michigan.
- Nonpurging Bulimia: A Distinct Subtype of Bulimia Nervosa. (1991). International Journal of Eating Disorders.
- Differences Between Binge Eating Disorder and Nonpurging Bulimia Nervosa. (March 1999). The International Journal of Eating Disorders.
- Compulsive Exercise. National Eating Disorders Association.
- The Dangers of Dieting and Clean Eating. National Eating Disorders Association.
- Exercise Won’t Help You Lose Weight. Here’s the Disappointing Reason Why. (October 2021). The Jerusalem Post.
- Physical Activity for a Healthy Weight. (June 2022). Centers for Disease Control and Prevention.
- Obesity Linked to Premature Death with Greatest Effect in Men. (July 2016). University of Cambridge.
- Cognitive Behavioral Therapy for Eating Disorders. (September 2010). The Psychiatric Clinics of North America.