1. BULIMIA NERVOSA Stay Active, Stay Healthy, Stay Beautiful

2. WHAT IS BULIMIA NERVOSA? The National Eating Disorder Association defines Bulimia Nervosa as, “a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge-eating.” 1 The National Eating Disorder Association defines Bulimia Nervosa as, “a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge-eating.” 1

3. SYMPTOMS AND WARNING SIGNS Symptoms Symptoms  Frequent episodes of consuming very large amounts of food followed by behaviors to prevent weight gain, such as self-induced vomiting  A feeling of being out of control during the binge-eating episodes  Self-esteem overly related to body image 1 Warning Signs  Evidence of purging behaviors such as frequent trips to the bathroom, signs and/or smells of vomiting, presence of wrappers or packages, of laxatives or diuretics  Excessive, rigorous exercise regimen- despite weather, fatigue, illness or injury, the compulsive need to “burn off” calories  Withdrawal from usual friends or activities 1

4. THESE ATHLETES ARE REALLY SKINNY… Many athletes actually suffer from Bulimia, without vomiting episodes. Many athletes actually suffer from Bulimia, without vomiting episodes. Some people are actually known as “obligatory exercisers.” 2 Some people are actually known as “obligatory exercisers.” 2 What is an obligatory exerciser? A person who will not interrupt their exercise schedule, even when they are injured or when they know exercise could harm their lives. 2

5. IS THAT REALLY CONSIDERED A PART OF AN EATING DISORDER? Other names for “obligatory exercisers” Other names for “obligatory exercisers” Activity disorder Activity disorder Compulsive athleticism Compulsive athleticism Exercise addiction Exercise addiction Exercise dependence Exercise dependence Excessive exercise 2 Excessive exercise 2 Symptoms: Focuses on reducing body weight and changing body shape Maintains a rigid diet Structure social activities around the exercise routine Keeps extensive logs and records 2

6. TREATMENT FOR OBLIGATORY EXERCISE Periodization- cycles of training with set recovery periods Periodization- cycles of training with set recovery periods Cognitive-behaviorial therapy Cognitive-behaviorial therapy Group therapy Group therapy Family therapy Family therapy Medicine 2 Medicine 2 Do these symptoms and treatments sound familiar? Do these symptoms and treatments sound familiar?

7. WHY WOULD I HAVE THIS? Biological Factors Behavioral Factorrs Social Factors Psychological Factors Genetics Eating Disorders A combination of many different parts of your life can come together to affect your chance of an eating disorder. 9

8. DOES IT REALLY AFFECT ME? Bulimia affects 1-2% of adolescent and young adult women. 1 Q: I have lots of friends and I don't know anyone with bulimia. How come I don't know anyone with bulimia if it's so prevalent? A: People struggling with bulimia usually appear to be normal body weight. 1

9. BUT AT LEAST I'LL BE SKINNY... Does weight really matter when your health is involved?? Health Risks of Bulimia Electrolyte imbalances that can lead to irregular heartbeats or heart failure, even death Tooth decay or staining of teeth from frequent vomiting.  Unfortunately, once tooth enamel is eroded, it will not regenerate, and restorative dental procedures may be necessary Chronic or irregular bowel movements from the use of laxatives 8

10. I PLAY SPORTS, MY FRIENDS STAY HEALTHY... Athletes are just as at-risk of bulimia. Athletes are just as at-risk of bulimia. According to a study, one- fourth of both male and female athletes had episodes of overeating on a daily basis (bingeing). According to a study, one- fourth of both male and female athletes had episodes of overeating on a daily basis (bingeing). The study also showed that more athletes admitted to Bulimia, rather than Anorexia, another common eating disorder. 3 The study also showed that more athletes admitted to Bulimia, rather than Anorexia, another common eating disorder. 3 Female athletes also reported lower self-esteem than male athletes. Their goal was to achieve a body fat content that was very unhealthy and would result in amenorrhea. 3

11. WHY WOULD I CARE ABOUT AMENORRHEA? Ammenorrhea is when your menstrual cycle (your period) comes infrequently. (Ex.- once every 6 months) Ammenorrhea is when your menstrual cycle (your period) comes infrequently. (Ex.- once every 6 months) Most women have to maintain approximately 17% body fat to menstruate. Most women have to maintain approximately 17% body fat to menstruate. Osteoporosis may occur within 1 year. Osteoporosis may occur within 1 year. Often increases food occupation and increases the likelihood that overeating will occur. 3 Often increases food occupation and increases the likelihood that overeating will occur. 3

12. WHY DO ATHLETES CARE ABOUT GETTING SKINNY AND NOT JUST ABOUT THE SPORT? Some athletes actually work for types of thinness. Some athletes actually work for types of thinness. Performance Thinness- belief that a lower weight and body fat percentage will enhance their performance Performance Thinness- belief that a lower weight and body fat percentage will enhance their performance Common types- endurance sports (running, cycling) Common types- endurance sports (running, cycling) Appearance Thinness- belief that thinner athletes will be rewarded Appearance Thinness- belief that thinner athletes will be rewarded Common types- figure skaters, gymnastics 3 Common types- figure skaters, gymnastics 3

13. TREATMENT OPTIONS Nutritional Counseling- learn to structure & pace meals, adjust calories to maintain weight Nutritional Counseling- learn to structure & pace meals, adjust calories to maintain weight Cognitive Behavioral Therapy (CBT)- identify & change disordered thoughts that bring on the compulsive behavior, find better ways to cope with life’s stresses Cognitive Behavioral Therapy (CBT)- identify & change disordered thoughts that bring on the compulsive behavior, find better ways to cope with life’s stresses Interpersonal Therapy- tries to improve relationships that may be framing the problem 4 Interpersonal Therapy- tries to improve relationships that may be framing the problem 4

14. TREATMENT OPTIONS (CONT.) These treatment options are usually more effective when implemented with other strategies These treatment options are usually more effective when implemented with other strategies Self-help- internet-based modes & support groups Self-help- internet-based modes & support groups Medicine- SSRIs (selective serotonin reuptake inhibitors) 4 Medicine- SSRIs (selective serotonin reuptake inhibitors) 4

15. WILL THIS LITTLE PILL HELP ME FEEL BETTER? One of the treatment options for Bulimia is medication. The most common medications fall in the category SSRis. One of the treatment options for Bulimia is medication. The most common medications fall in the category SSRis. SSRis (Selective Serotonin Reuptake Inhibitors)- changes the balance of serotonin in the brain, which helps the brain cells send and receive messages, which boosts moods SSRis (Selective Serotonin Reuptake Inhibitors)- changes the balance of serotonin in the brain, which helps the brain cells send and receive messages, which boosts moods Some ones I might hear- Celexa, Lexapro, Prozac, Zoloft, Paxil 5 Some ones I might hear- Celexa, Lexapro, Prozac, Zoloft, Paxil 5

16. TAKE SOME TIME TO YOURSELF! Some studies have been done to see if mindful meditation can work to stop the urge to binge, which is caused by your anxiety. Some studies have been done to see if mindful meditation can work to stop the urge to binge, which is caused by your anxiety. These meditation interventions have been used for other addictive characteristics. These meditation interventions have been used for other addictive characteristics. One study found that the meditation can have marked immediate impact on decreasing the episode. 6 One study found that the meditation can have marked immediate impact on decreasing the episode. 6

17. HOW DO I MEDITATE MINDFULLY? This is something you can do even without money! This is something you can do even without money! Sometimes called “present-focused awareness” Sometimes called “present-focused awareness” What do I do? What do I do? Sit comfortably. Sit comfortably. Focus on your breathing. Focus on your breathing. Bring your mind’s attention to the present without drifting to concerns for the past or future. 6 Bring your mind’s attention to the present without drifting to concerns for the past or future. 6

18. WHAT CAN MY PARENTS DO TO HELP ME? Coaches, athletic directors, teammates and parents should be aware of a pursuit of low percentage body fat. 3 Coaches, athletic directors, teammates and parents should be aware of a pursuit of low percentage body fat. 3 Greater percentage of full remission with parents involved in the treatment process, ex. Family therapy. 7 Greater percentage of full remission with parents involved in the treatment process, ex. Family therapy. 7

19. WHERE CAN I GO IN OHIO? Professionals Professionals Cincinnati- Anne Kearney-Cooke 513-588-9431 Cincinnati- Anne Kearney-Cooke 513-588-9431 West Chester- Teri Role-Warren 513- 779-9209 10 West Chester- Teri Role-Warren 513- 779-9209 10 Centers Centers Cleveland Center for Eating Disorders 216-765-0500 Cleveland Center for Eating Disorders 216-765-0500 Lindner Center of Hope 513-536- 4673 Lindner Center of Hope 513-536- 4673 The Center for Balanced Living 614- 293-9550 The Center for Balanced Living 614- 293-9550

20. WORKS CITED 1 National Eating Disorder Association (2014). Bulimia Nervosa. 1 National Eating Disorder Association (2014). Bulimia Nervosa. 2 Physician Sports Med (2005). The Obligatory Exerciser Assessing an Overcommitment to Exercise. 2 Physician Sports Med (2005). The Obligatory Exerciser Assessing an Overcommitment to Exercise. 3 International Journal of Eating Disorders (1999). Athletes and Eating Disorders: The National Collegiate Athletic Association Study. 3 International Journal of Eating Disorders (1999). Athletes and Eating Disorders: The National Collegiate Athletic Association Study. 4 The Harvard Medical School Family Health Guide (2006). Treating Bulimia Nervosa. 4 The Harvard Medical School Family Health Guide (2006). Treating Bulimia Nervosa. 5 Mayo Clinic (2014). Selective Serotonin Reuptake Inhibitors. 5 Mayo Clinic (2014). Selective Serotonin Reuptake Inhibitors. 6 The Harvard Health Publications (2014). Mindful Meditation May Ease Anxiety, Mental Stress. 6 The Harvard Health Publications (2014). Mindful Meditation May Ease Anxiety, Mental Stress. 7 National Institute of Mental Health (2012). Spotlight on Eating Disorders. 7 National Institute of Mental Health (2012). Spotlight on Eating Disorders. 8 Journal of Women’s Health (2004). Bulimia: Medical Complications 8 Journal of Women’s Health (2004). Bulimia: Medical Complications 9 National Institute of Mental Health (2014). What are Eating Disorders? 9 National Institute of Mental Health (2014). What are Eating Disorders? 10 National Association of Anoxeria Nervosa and Associated Disorders (2014). Eating Disorder Professionals: Ohio. 10 National Association of Anoxeria Nervosa and Associated Disorders (2014). Eating Disorder Professionals: Ohio.