Bulimia Nervosa Recognising the Warning Signs Dr Pooky Knightsmith www.InOurHands.com pooky@inourhands.com @PookyH

What is an eating disorder? Food and weight used as a way of coping Serious mental health issue ANYONE can be affected Not all about appearances Low self-esteem

Bulimia Nervosa Roughly normal weight Frequent fluctuation in weight I spent longer throwing up than eating. Every time I’d promise myself I’d stick to my diet this time, but I just couldn’t do it. Roughly normal weight Frequent fluctuation in weight Influence of shape and weight Binge purge cycle Most common forms of purging are laxative abuse and vomiting

The Binge Purge Cycle

Triggers Family relationship difficulties Peer relationship break up Bullying Trauma Exposure via friends, family, media Difficult times of year e.g. anniversaries Exam pressure Times of change (new school, parents split etc)

Bulimia is a secretive disease People with bulimia are often very ashamed of their illness and will work hard to conceal signs and symptoms making it very difficult to spot. An awareness of the warning signs on the next few slides may help you pick up a case early – which will maximise the chances of effective support and complete recovery.

Bulimia Warning Signs Weight Fluctuation Due to the binge purge cycle However, weight change is not always noticeable making this a hard illness to spot.

Due to repeated vomiting. Bulimia Warning Signs Callused Knuckles Due to repeated vomiting. This sign is not always present but is often the most clear indicator of bulimia.

Bulimia Warning Signs Chewing Gum Drinking Water As a food replacement when trying to restrict food intake To mask the smell of vomit after purging

Bulimia Warning Signs Wearing Scarves Scarves will sometimes be warn to hide swollen glands / puffy face caused by vomiting

Could be a sign of purging – either laxative abuse of vomiting Bulimia Warning Signs Toilet after Meals Could be a sign of purging – either laxative abuse of vomiting

Tooth Decay & Sore Throat Bulimia Warning Signs Tooth Decay & Sore Throat Acid in vomit wears away teeth. Dentists often note erosion of enamel on the inside of teeth of someone who vomits regularly.

Can’t focus on School Work Bulimia Warning Signs Can’t focus on School Work Too consumed with eating disordered thoughts

Bulimia Warning Signs Isolation People suffering with eating disorders will often push away their friends and find they have less in common with them than they used to.

Bulimia Warning Signs Summary Weight Fluctuation Chewing Gum/ Drinking Water Toilet after meals Secretive behaviour Puffy Face Calussed Knuckles Sore Throat Tooth Decay Can’t Focus on School Work Isolation / loss of friends

How to be helpful Listen Be honest Persevere & offer support Try to understand Persevere & offer support Voice the difficulties Remember the ‘real’ child

Treatment Options Family Therapy Cognitive Behavioural Therapy (CBT) Family supported in playing an active, positive role Family Therapy Alters behaviour by altering way we think about food / weight Cognitive Behavioural Therapy (CBT) Talking therapy with the aim of developing a healthy diet Dietary Counselling Explores life experiences and their impact on behaviour Psychodynamic Therapy Antidepressants Medication

Need more support? Dr Pooky Knightsmith specialises in mental health and emotional well-being in the school setting. She can provide training sessions or workshops for school staff, parents or students on a variety of topics, including self-harm and eating disorders. For further information and free resources visit www.inourhands.com Email: pooky@inourhands.com Twitter: @PookyH Download the student handout version: click here (free login required)