Bipolar

While dealing with Bipolar isn’t always easy, it doesn’t have to run your life. But in order to successfully manage Bipolar, you have to make smart choices. Your lifestyle and daily habits have a significant impact on your moods. Read on for ways to help yourself:

• Seek support. It’s important to have individuals you can turn to for help and encouragement. Try joining a recovery group or talking to a trusted friend.
• Monitor your moods. Keep track of your symptoms and watch for signs that your moods are swinging out of control so you can stop the problem before it starts.
• Make healthy choices. Healthy sleeping, eating, and exercising habits can help stabilize your moods. Keeping a regular sleep schedule is particularly important.
• Keep stress in check. Avoid high-stress situations, maintain a healthy work-life balance, and try relaxation techniques such as meditation, yoga, or deep breathing.
• Get educated. Learn as much as you can about Bipolar. The more you know, the better you’ll be at assisting your own recovery.

What you can do to help yourself—

Living well with Bipolar requires certain adjustments. Like recovering alcoholics who avoid drinking or diabetics who take insulin, if you have Bipolar, it’s important to make healthy choices for yourself. Making these healthy choices will help you keep your symptoms under control, minimize mood episodes, and take control of your life.

Managing Bipolar starts with proper recovery, including drugs and therapy. But there is so much more you can do to help yourself on a day-to-day basis. The daily decisions you make influence the course of your illness: whether your symptoms get better or worse; whether you stay well or experience a relapse; and how quickly you rebound from a mood episode.

Get involved in your recovery—

Be a full and active participant in your own recovery. Learn everything you can about Bipolar. Become an expert on the illness. Study up on the symptoms, so you can recognize them in yourself, and research all your available recovery options. The more informed you are, the better prepared you’ll be to deal with symptoms and make good choices for yourself.

Using what you’ve learned about Bipolar, collaborate with your psychiatrist or therapist in the recovery planning process. Don’t be afraid to voice your opinions or questions. The most beneficial relationships between patient and healthcare provider work as a partnership. You may find it helpful to draw up a recovery contract outlining the goals you and your provider have agreed upon.

Other tips for successful Bipolar recovery:

• Take your prescription as instructed. If you’re taking drugs, follow all instructions and take it faithfully. Don’t skip or change your dose without first talking with your psychiatrist.
• Get therapy. While drugs may be able to manage some of the symptoms of Bipolar, therapy teaches you skills you can use in all areas of your life. Therapy can help you learn how to deal with your disorder, cope with problems, regulate your mood, change the way you think, and improve your relationships.
• Communicate with your treatment provider. Keep the lines of communication open with your psychiatrist or therapist. Your recovery program will change over time, so keep in close contact with your provider. Talk to your provider if your condition or needs change and be honest about your symptoms and any drugs side effects.
• Be patient. Don’t expect an immediate and total cure. Have patience with the recovery process. It can take time to find the right program that works for you.

Monitor your symptoms and moods—

In order to stay well, it’s important to be closely attuned to the way you feel. By the time obvious symptoms of mania or depression appear, it is often too late to intercept the mood swing, so keep a close watch for subtle changes in your mood, sleeping patterns, energy level, and thoughts. If you catch the problem early and act swiftly, you may be able to prevent a minor mood change from turning into a full-blown episode of mania or depression.

Know your triggers and early warning signs – and watch for them—

It’s important to recognize the warning signs of an oncoming manic or depressive episode. Make a list of early symptoms that preceded your previous mood episodes. Also try to identify the triggers, or outside influences, that have led to mania or depression in the past. Common triggers include:

• arguments with your loved ones
• financial difficulties
• lack of sleep
• problems at school or work
• seasonal changes
• stress

Knowing your early warning signs and triggers won’t do you much good if you aren’t keeping close tabs on how you’re feeling. By checking in with yourself through regular mood monitoring, you can be sure that red flags don’t get lost in the shuffle of your busy, daily life.

Keeping a mood chart is one way to monitor your symptoms and moods. A mood chart is a daily log of your emotional state and other symptoms you’re having. It can also include information such as how many hours of sleep you’re getting, your weight, meds you’re taking, and any alcohol or drug use. You can use your mood chart to spot patterns and indicators of trouble ahead.

Develop a wellness toolbox—

If you spot any warning signs of mania or depression, it’s important to act swiftly. In such times, it’s helpful to have a wellness toolbox to draw from. A wellness toolbox consists of coping skills and activities you can do to maintain a stable mood or to get better when you’re feeling “off.”

The coping techniques that work best will be unique to your situation, symptoms, and preferences. It takes experimentation and time to find a winning strategy. However, many individuals with Bipolar have found the following tools to be helpful in reducing symptoms and maintaining wellness:

• ask for extra help from loved ones
• attend a recovery group
• call your psychiatrist or therapist
• cut back on sugar, alcohol, and caffeine
• cut back on your activities
• do something fun or creative
• exercise
• get a full eight hours of sleep
• increase or decrease the stimulation in your environment
• increase your exposure to light
• take time for yourself to relax and unwind
• talk to a supportive person
• write in your journal

Create an emergency action plan –

Despite your best efforts, there may be times when you experience a relapse into full-blown mania or severe depression. In crisis situations where your safety is at stake, your loved ones or psychiatrist may have to take charge of your care. Such times can leave you feeling helpless and out of control, but having a crisis plan in place allows you to maintain some degree of responsibility for your own recovery.

A plan of action typically includes:

• A list of all meds you are taking, including dosage information
• A list of emergency contacts (your psychiatrist, therapist, close family members)
• Information about any other health problems you have
• Symptoms that indicate you need others to take responsibility for your care
• Recovery preferences (who you want to care for you; what treatments and meds do and do not work, who is authorized to make decisions on your behalf)

Reach out to other individuals—

If your loved one has Bipolar, you can be an instrumental support throughout the recovery process.

Having a strong recovery system is vital to staying happy and healthy. Creating a supportive environment includes not just who you surround yourself with, but who you choose to avoid. In order to take care of yourself, it’s necessary to limit your contact with individuals who drain your emotional energy or leave you feeling discouraged, ashamed, or guilty. Instead, spend time with individuals who truly value you and make you feel better.

• Build new relationships – Isolation and loneliness make Bipolar worse. If you don’t have a recovery network you can count on, take steps to develop new relationships. Try taking a class, joining a church or a civic group, volunteering, or attending events in your community.

• Join a Bipolar recovery group – Spending time with individuals who know what you’re going through and can honestly say they’ve “been there” can be very therapeutic. You can also benefit from the shared experiences and advice of the group members. To find a recovery group in your area, use the Depression and Bipolar Support Alliance’s Support Group Locator or contact your local branch of the National Alliance on Mental Illness.

• Turn to friends and family – Recovery for Bipolar starts at home. It’s important to have individuals you can count on to help you through rough times. Isolation and loneliness can cause depression, so regular contact with supportive friends and family members is therapeutic in itself.

Develop a daily routine—

Your lifestyle choices, including your sleeping, eating, and exercise patterns, have a significant impact on your moods. There are many things you can do in your daily life to get your symptoms under control and to keep depression and mania at bay.

• Keep a strict sleep schedule. Getting too little sleep can trigger mania, so it’s important to get plenty of rest. For some individuals, losing even a few hours can cause problems. However, too much sleep can also worsen your mood. The best advice is to maintain a normal sleep schedule, going to bed and waking up at around the same time each day.

• Exercise regularly. Exercise has a beneficial impact on mood and may reduce the number of bipolar episodes you experience. Aerobic exercise is especially effective at recovering from depression. Try to incorporate at least 30 minutes of activity five times a week into your routine. Walking is a good choice for individuals of all fitness levels.

• Build structure into your life. Developing and sticking to a daily schedule can help stabilize the mood swings of Bipolar. Include set times for sleeping, eating, socializing, exercising, working, and relaxing. Try to maintain a regular pattern of activity, even through emotional ups and downs.

Keep stress to a minimum—

Stress can trigger episodes of mania and depression in individuals with Bipolar, so keeping it under control is extremely important. Know your limits, both at home and at work or school. Don’t take on more than you can handle and take time to yourself if you’re feeling overwhelmed.

• Appeal to your senses. Stay calm and energized by appealing to the five senses: sight, sound, touch, smell, and taste. Listen to music that lifts your mood, place flowers where you will see and smell them, massage your hands and feet, or sip a warm drink.

• Learn how to relax. Relaxation techniques such as deep breathing, meditation, yoga, and guided imagery can be very effective at reducing stress and keeping you on an even keel. Studies show that a daily relaxation practice of 30 minutes or more can improve your mood and keep depression at bay.

• Make leisure time a priority. Do things for no other reason than that it feels good to do them. Go to a funny movie, take a walk on the beach, listen to music, read a good book, or talk to a friend. Doing things just because they are fun is no indulgence. Play is an emotional and mental health necessity.

Watch what you put in your body—

From the food you eat to the vitamins and drugs you take, the substances you put in your body have an impact on the symptoms of Bipolar – both for better or worse.

• Avoid alcohol and drugs. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression. Even moderate social drinking can upset your emotional balance. Substance use also interferes with sleep and may cause dangerous interactions with your meds. Attempts to self-medicate or numb your symptoms with drugs and alcohol only create more problems.

• Be cautious when taking any drugs. Certain prescription and over-the-counter meds can be problematic for individuals with Bipolar. Be especially careful with antidepressant drugs, which can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid drugs.

• Eat a healthy diet. There is an undeniable link between food and mood. For optimal mood, eat plenty of fresh fruits, vegetables, and whole grains and limit your fat and sugar intake. Space your meals out through the day, so your blood sugar never dips too low. High-carbohydrate diets can cause mood crashes, so they should also be avoided. Other mood-busting foods include chocolate, caffeine, and processed foods.

• Get your omega-3s. Omega-3 fatty acids may decrease mood swings in Bipolar. Omega-3 is available as a nutritional supplement. You can also increase your intake of omega-3 by eating cold-water fish such as salmon, halibut, and sardines, soybeans, flaxseeds, canola oil, pumpkin seeds, and walnuts.

Bipolar: Key Recovery Concepts—

• Support. Working toward wellness is up to you. However, support from others is essential to maintaining your stability and enhancing the quality of your life.
• Self Advocacy. Become an effective advocate for yourself so you can get the services and recovery you need, and make the life you want for yourself.
• Perspective. Depression and manic-depression often follow cyclical patterns. Although you may go through some painful times and it may be difficult to believe things will get better, it is important not to give up hope.
• Personal Responsibility. It’s up to you to take action to keep your moods stabilized. This includes asking for help from others when you need it, taking your drugs as prescribed and keeping appointments with your health care providers.
• Hope. With good symptom management, it is possible to experience long periods of wellness. Believing that you can cope with your mood disorder is both accurate and essential to recovery.
• Education. Learn all you can about your illness. This allows you to make informed decisions about all aspects of your life and recovery.

Common Red Flags for Bipolar Relapse—

Warning signs of depression:

• I crave chocolate.
• I don’t care about anybody else.
• I no longer want to be around individuals.
• I quit cooking meals
• I start having headaches.
• Individuals bother me.

Warning signs of mania or hypomania:

• Friends tell me that I’m crabby.
• I can’t concentrate.
• I feel irritable.
• I find myself reading five books at once.
• I find myself talking faster than usual.
• I need to move around because I have more energy than usual.
• I’m hungry all the time.

10 tips for reaching out and building relationships—

1. Accompany someone to the movies, a concert, or a small get-together.
2. Ask a loved one to check in with you regularly.
3. Call or email an old friend.
4. Confide in a counselor, therapist, or clergy member.
5. Go for a walk with a workout buddy.
6. Have lunch or coffee with a friend.
7. Help someone else by volunteering.
8. Meet new individuals by taking a class or joining a club.
9. Schedule a weekly dinner date
10. Talk to one person about your feelings.

Healthy sleep habits for managing Bipolar—

• Avoid exercising or doing other stimulating activities late in the day.
• Avoid or minimize napping, especially if it interferes with your sleep at night.
• Go to bed and wake up at the same time each day.
• No caffeine after lunch or alcohol at night. Both interfere with sleep.

BORDERLINE PERSONALITY DISORDER

While BORDERLINE PERSONALITY DISORDER is a serious condition that requires treatment by qualified mental health professionals, there are also sources of self-help (or self-guided strategies for symptom reduction) for individuals with BORDERLINE PERSONALITY DISORDER. These self-help strategies should be used in conjunction with formal treatments for BORDERLINE PERSONALITY DISORDER (such as psychotherapy and medication).

The symptoms of BORDERLINE PERSONALITY DISORDER, including erratic mood shifts, self-harming behaviors, suicidality, intense emotional experiences, sensitivity to problems in your relationships and problems with impulsive behaviors, may all be related to one core feature: emotion dysregulation, where individuals have very strong emotional responses, difficulty managing those responses and often engage in harmful behaviors in attempts to escape from these emotions. Recovery strategies can help to reduce emotion dysregulation and the other symptoms of BORDERLINE PERSONALITY DISORDER.

What are Recovery strategies?

Since emotion dysregulation is such an important feature of BORDERLINE PERSONALITY DISORDER, many treatments for BORDERLINE PERSONALITY DISORDER emphasize the importance of building recovery strategies to better manage emotions when they arise. What exactly are recovery strategies? They are healthier ways of addressing situations and their resulting emotions.

Why Learn New Recovery strategies?

Why is it important to learn new, healthier ways of coping? By using healthful recovery strategies you may:

• Build confidence in your ability to handle difficult situations
• Improve your ability to be able to continue to function well even when in stressful circumstances
• Reduce the intensity of the emotional distress you feel
• Reduce the likelihood that you will do something harmful (e.g., engage in self- harming behaviors) to attempt to escape from the emotional distress
• Reduce the likelihood that you will engage in behaviors that destroy relationships (e.g., physical aggression) when you are upset
• Ultimately reduce your overall experience of emotion dysregulation

What are Some Different Types of Recovery strategies?

There are literally thousands of different recovery strategies that individuals use to manage stressful situations and the emotions that result. Here are a few types of recovery strategies that work for many individuals:

• Active Problem-Solving. Consider the problem at hand: Is there a way to solve the problem directly?
• Behavioral Activation. Engage in an activity that might take your mind off the stressful situation for a little while.
• Grounding. Practice grounding exercises that are designed to keep you "grounded" in the present moment, rather than caught up in replaying events in your head, worrying about the future or zoning out.
• Mindfulness Meditation. Practice mindfulness meditation, which helps you to observe and describe your experiences without judging or rejecting them.
• Relaxation Exercises. Practice a relaxation exercise, such as deep breathing or progressive muscle relaxation.
• Social Support. Talk to others who may understand what you are going through.

How To Learn Healthier Recovery strategies—

Ready to learn some new, healthier ways of coping? One way to do this is by seeking treatment. Many psychological treatments for BORDERLINE PERSONALITY DISORDER, including cognitive behavioral treatments such as Dialectical Behavior Therapy (DBT), focus on teaching healthier recovery strategies to manage strong emotions. There are online resource pages that can help you find a cognitive behavioral therapist or a DBT provider.

When you are having an intense emotion, it can be hard to know what to do. Unfortunately, many individuals with BORDERLINE PERSONALITY DISORDER turn to unhealthy behaviors in an attempt to cope with emotional pain (e.g., self-harm, substance use, or aggression). Want to replace unhealthy habits with new, healthier skills? Try some of the recovery strategies listed below.

1. Be Mindful— Practice mindfulness of your emotion. Notice the emotion you are having, and let yourself experience it as a wave, without trying to block it, suppress it, or hold on to it. Try to accept the emotion for what it is.
2. Breathe Deeply— Sit or lie somewhere quiet and bring your attention to your breathing. Breathe evenly, slowly, and deeply. Watch your stomach rise and fall with each breath.
3. Call Someone— Reaching out to others can really help when you are struggling with strong emotions. Call a supportive friend or family member. If you don’t have someone in mind that is supportive, call a helpline (for example, in the U.S. you can call the National Suicide Hotline at 1-800-273-TALK).
4. Do Something— Engage in a highly engaging activity. Television or computer activities do not count here -- these are too passive. Instead, take a walk, dance, clean your house, or do some other activity that gets you engaged and distracts you from your current emotions.
5. Ground Yourself— When emotions seem to be taking you out of the current moment (e.g., you are starting to feel “zoned out” or can’t see anything else going on at the moment), do something to ground yourself. Grab an ice cube and hold it in your hand for a few moments, snap a rubber band against your wrist, “snap yourself back” into the moment.
6. Help Someone Else— Do something nice for someone else. It doesn't have to be something big; you can walk to the nearest store, buy a pack of gum, and give the cashier a smile and say "have a great day." It may sound silly, but small gestures like this can really reduce emotional pain.
7. Play Music— Play music that creates an emotion that is the opposite of the one you are struggling with. For example, if you are feeling very sad, play happy, upbeat music. If you are feeling anxious, play slow, relaxing music.
8. Pray— Are you a religious or spiritual person? If you are (or even if you’re not but have considered trying), praying can be tremendously helpful in times of extreme stress.
9. Ride It Out— The peak of most strong emotional reactions (and the urges to engage in harmful activities, like self-harming or drinking, that can go along with these reactions) last for a few minutes and then begin to subside. Grab an egg timer from the kitchen, and set it for 10 minutes. Wait the 10 minutes, and practice riding out the emotion.
10. Take a Warm Bath or Shower— Try to lose yourself in the sensations of the warm water, the smell of the soap, etc. Allow the sensations to distract you from the situation you are upset about.

What is Mindfulness Meditation?

Mindfulness meditation has been defined in many ways, but perhaps one of the most widely-used definitions comes from Jon Kabat-Zinn, Ph.D., (the creator of a treatment for stress and chronic pain called “Mindfulness-Based Stress Reduction”), who defines mindfulness as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.”

When you practice mindfulness meditation, you practice being in the present moment, and noticing all of your experiences. You practice being aware of things happening outside of yourself (e.g., things you see, smell, hear), and things happening internally (e.g., your thoughts, feelings and sensations). Importantly, mindfulness meditation involves being aware without judgment. So, you are paying attention to all of these experiences, without labeling them as good or bad.

Mindfulness is a concept that comes from the Buddhist spiritual tradition. For almost almost 3,000 years, Buddhist monks have practiced mindfulness meditation -- but in recent years mindfulness practice has become increasingly widespread and applied outside of the Buddhism. In fact, most Eastern practitioners who use mindfulness think of it as a skill that can be used separately from any kind of religious or spiritual practice. So, no matter what your religious background, mindfulness meditation may be helpful for you.

What Does Mindfulness Meditation Have to Do With BORDERLINE PERSONALITY DISORDER?

Marsha Linehan, Ph.D., who created Dialectical Behavior Therapy for BORDERLINE PERSONALITY DISORDER was one of the first to apply mindfulness meditation training to the recovery of BORDERLINE PERSONALITY DISORDER. Often, individuals with BORDERLINE PERSONALITY DISORDER not only experience intense emotions, they can become “stuck” in these emotions and judge both the emotions and themselves (e.g., “This is a terrible feeling and I am such a weak person for feeling this way”).

Unfortunately, this can end up making the emotion feel even more intense. And, judgmental thoughts can add other emotions to the mix — if you tell yourself you are weak for feeling sad you may end up feeling both sad and ashamed.

Mindfulness meditation training can help individuals with BORDERLINE PERSONALITY DISORDER to feel less “stuck” in their emotions, and less judgmental of the emotions and themselves. Mindfulness meditation training may also help individuals with BORDERLINE PERSONALITY DISORDER be more effective in applying healthy recovery strategies in the midst of emotional pain, because mindfulness skills allow you to get just a little bit of space to be able to notice the emotion and be more strategic in terms of how you will act in the face of the emotion.

For example, imagine being in a verbal argument with someone you love. During the argument you may feel very intense feelings, such as anger, fear and rage. Without mindfulness skills, you are more likely to act on these feelings without being able to see the consequences -- maybe you yell at your loved one, throw something or storm out. With mindfulness meditation practice, you may be able to notice the emotions you are having (e.g., you may think to yourself “I’m feeling really angry, hurt, and afraid right now”), and you may be able to step back and chose your behavior (e.g., “I am too upset to talk about this and I am may say or do something I’ll regret later. I need to take a time out from this discussion”).

How to Practice Mindfulness Meditation—

There are a variety of ways to begin practicing mindfulness meditation. Usually you can begin practicing mindfulness by trying some exercises that promote mindfulness.

Self-Help Emotional Processing and Expression—

Some individuals find that processing or expressing emotions on their own can be a very useful way to engage in self-help. For example, some individuals write in a journal or blog, others draw or paint -- and some find other creative, healthy ways to express their emotions. There is some research that suggests that expressive writing, for example, can have a variety of positive consequences, including better physical health and reduced psychological symptoms.

It is important to note that for some individuals, engaging in these types of strategies can feel overwhelming or triggering. If you feel you do not have the recovery strategies needed to manage the emotions that come from emotional processing activities, then you probably need to start with some recovery strategies training. However, if you and your therapist think you are ready to try emotional processing exercises, you may find that writing in a journal can be a good place to start.

Bulimia

What is bulimia?

Bulimia (also called bulimia nervosa) is a condition where you think a lot about your body weight and shape. It affects your ability to have a 'normal' eating pattern. Bulimia nervosa is one of the conditions that form the group of eating disorders that includes anorexia nervosa. There are important differences between these two conditions. For example, in anorexia nervosa you are very underweight, whereas in bulimia, you are most likely to be normal weight or even overweight.

How do you know if you have an eating disorder?

If you answer yes to two or more of these questions then you may have an eating disorder:

• Do you believe you're fat when others think you're thin?
• Do you make yourself sick because you are uncomfortably full?
• Do you worry that you've lost control over how much you eat?
• Have you lost more than 13 pounds in the past three months?
• Would you say that food dominates your life?

Who gets bulimia?

Bulimia nervosa mainly affects women aged 16-40. It most commonly starts around the age of 19 years. It affects around 8 in 100 women in the UK. Bulimia nervosa sometimes develops in men and children. Women are 10 times more likely to develop bulimia nervosa than men. However, bulimia nervosa is becoming more common in boys and men. Bulimia nervosa is more common than anorexia nervosa.

There may be some genetic factor, as the risk of developing bulimia nervosa in close relatives of individuals with bulimia nervosa is four times greater than in the general population.

What are the symptoms of bulimia?

Bingeing and purging are the main symptoms and are usually done in secret.

• Bingeing means that you have repeated episodes of eating large amounts of foods and/or drinks. For example, you may eat a whole large tub of ice cream or two packets of biscuits even if you are not hungry. You feel out of control and unable to stop eating. Binge eating is often done very quickly until you feel physically uncomfortable. This happens not just on one occasion, but regularly. Eating patterns typically become chaotic.

• Purging means that you try and counteract the 'fattening' effects of the food from the bingeing. Self-induced vomiting (making yourself sick) after a bout of bingeing is the most well-known, but not all individuals with bulimia nervosa do this. Other purging methods include taking lots of laxatives, extreme exercise, extreme dieting or even periods of complete starvation, taking diuretics (water tablets) or taking other medicines such as amphetamines.

The reasons why you binge eat and then purge may not be easy to explain. Part of the problem may be due to a fear of getting fat, although it is often not just as simple as that. All sorts of emotions, feelings and attitudes may contribute. The physical act of bingeing and purging may be a way of dealing with your emotions in some way.

What are the physical problems caused by bulimia nervosa?

These are caused by the unusual eating habits and the methods used to purge the body of food (such as vomiting or the excessive use of laxatives). Physical problems do not always develop. They are more likely if you binge and purge often. One or more of the following may develop:

1. Bowel problems— These may occur if you take a lot of laxatives. Laxatives can damage the bowel muscle and nerve endings. This may eventually result in permanent constipation and also sometimes abdominal pains.
2. Chemical imbalances in the body— These are caused by either repeated vomiting or excess use of laxatives. For example, low potassium level which may cause tiredness, weakness, abnormal heart rhythms, kidney damage and convulsions. Low calcium levels can lead to tetany (muscle spasms).
3. Depression— It is fairly common to feel low when you have bulimia nervosa. Some individuals even become depressed, which can respond well to recovery. It is important to talk about any symptoms of depression you may have. Many individuals find they become more moody or irritable.
4. Irregular periods— Many individuals have irregular periods as hormone levels can be affected by poor diet. Periods may even stop all together or you may find that your periods have never started, especially if you started having eating problems when you were younger.
5. Psychological problems— These are very common and include feelings of guilt and disgust after bingeing and purging. Poor self-esteem and mood swings are common.
6. Swelling of hands, feet and face— This is usually due to fluid disturbances in the body. The saliva glands in the face can sometimes swell due to the frequent vomiting.
7. Teeth problems— These can be caused by the acid from the stomach rotting away the enamel as a result of repeated vomiting.

What causes bulimia?

The exact cause is not clear. Some individuals blame the media and the fashion industry which portray the idea that it is fashionable to be slim. This can put pressure on some individuals to try to be slim which can then lead to an eating disorder.

There may be some genetic factor to developing bulimia nervosa, which is triggered by stressful or traumatic life experiences. For example, some individuals with bulimia nervosa have had a childhood where there were frequent family problems with arguments and criticism at home. Some individuals with bulimia nervosa have been abused as a child.

Sometimes bulimia nervosa is also associated with some other psychological problem. (That is, the bulimia nervosa is sometimes just a part of a broader mental health problem.) For example, there is a higher than average rate of bulimia nervosa in individuals with anxiety disorders, obsessive compulsive disorder, depression, post-traumatic stress disorder and some personality disorders.

A chemical called serotonin which is in parts of the brain is thought to have something to do with bulimia nervosa. In some way one or more of the above factors, or even other unknown factors, may lead to a low level of serotonin.

Are there any tests done for bulimia nervosa?

Although there is not an actual test to diagnose bulimia nervosa, your doctor may wish to undertake some blood tests. These are usually done to check your kidney function and potassium levels.

What are the recovery techniques for bulimia?

The aim of recovery is to:

• Encourage healthy eating.
• Help individuals become both physically and mentally stronger.
• Reduce other related symptoms and problems.
• Reduce risk of harm which can be caused by bulimia nervosa.

Many individuals with bulimia nervosa who see their GP will be referred to a specialist mental health team. Members of the team may include psychiatrists, psychologists, nurses, dietitians and other professionals. If you have more severe bulimia nervosa you may be referred to a specialist eating disorder unit.

The sorts of recovery techniques that may be offered include the following:

1. Psychological ('talking') recovery techniques— Cognitive behavioral therapy (CBT) is the most commonly used psychological treatment for bulimia nervosa. It helps you to look at the reasons why you developed bulimia nervosa, aims to change any false beliefs that you have about your weight and body, and it helps to show you how to deal with emotional issues. Talking recovery techniques take time and usually require regular sessions over several months. Recovery may also involve other members of your family going to meetings to discuss any family issues. However, CBT does not suit everyone. About a third of individuals drop out before finishing the course. Other forms of psychological recovery techniques may also be used. For example, cognitive analytic therapy (CAT), interpersonal psychotherapy (IPT) and focal psychodynamic therapy.

2. Medication— A medicine may be advised by your doctor. The most commonly used medicines are selective serotonin reuptake inhibitor (SSRI) antidepressants. These are used to treat depression but, in higher doses, one called fluoxetine can reduce the urge for bingeing or purging. These are not usually recommended if you are younger than 18 years old. Treatment of any physical or teeth problems that may occur. This may include taking potassium supplements, dental care and not using laxatives.

3. Help with eating— It is best if you have regular meals; even if you only eat small meals. It is beneficial to the body to eat at least three times a day. You should try to be honest (with yourself and other individuals) about the amount of food you are actually eating. You should reduce the number of times you weigh yourself; try only to weigh yourself once a week. It may be useful to keep an eating diary in order to write down all the food that you eat.

Self-help measures—

Self-help methods for the recovery of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Self-help support groups are an especially powerful and effective means of ensuring long-term treatment compliance and decrease the relapse rate. Individuals find they can bounce ideas off of one another, get objective feedback about body image, and just gain increased social support. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings.

There are a number of self-help books and manuals available. These provide strategies in how to cope with, and overcome, bulimia nervosa. Some individuals find these very helpful and prefer them to 'formal' treatment. It is certainly worth trying a self-help manual if there is a waiting list or difficulty in getting psychological treatment.

Anorexia and bulimia aren’t about food. They’re about using food to cope with painful emotions such as anger, self-loathing, vulnerability, and fear. Disordered eating is a coping mechanism–whether you refuse food to feel in control, binge for comfort, or purge to punish yourself. But you can learn healthier ways to cope with negative emotions.

The first step is figuring out what’s really eating you up inside. Remember, “fat” is not a feeling, so if you feel overweight and unattractive, stop and ask yourself what’s really going on. Are you upset about something? Depressed? Stressed out? Lonely? Once you identify the emotion you’re experiencing, you can choose a positive alternative to starving or stuffing yourself.

Here are a few suggestions to get you started:

• Call a friend
• Listen to music
• Play with a pet
• Read a good book
• Take a walk
• Write in a journal
• Go to the movies
• Get out into nature
• Play a favorite game
• Do something nice for someone else

Emotional Do and Don't Lists—

Do…

• use individuals to comfort you when you feel bad, instead of focusing on food
• let your emotions come and go as they please without fear
• fully experience every emotion
• be open and accepting of all your emotions
• allow yourself to be vulnerable with individuals you trust

Don’t…

• avoid feelings because they make you uncomfortable
• focus on food when you’re experiencing a painful emotion
• let individuals shame or humiliate you for having or expressing feelings
• pretend you don’t feel anything when you do
• worry about your feelings making you fall apart

Improving your self-image—

You are more than what you weigh, a fact you lose sight of when you have an eating disorder. When you base your self-worth on physical appearance alone, you’re ignoring all the other qualities, accomplishments, and abilities that make you beautiful. Think about your friends and family members. Do they love you for the way you look or who you are? Chances are, your appearance ranks low on the list of what they love about you–and you probably feel the same about them. So why does it top your own list?

Placing too much importance on how you look leads to low self-esteem and insecurity. But you can learn to see yourself in a positive, balanced way:

• Challenge negative self-talk. When you catch yourself being self-critical or pessimistic, stop and challenge the negative thought. Ask yourself what evidence you have to support the idea. What is the evidence against it? Just because you believe something, doesn’t mean it’s true. Answering these questions will help you see things in a more realistic light.

• Focus on what you like about your body. Instead of searching for flaws when you look in the mirror, appreciate the things you like about your appearance. If you’re distracted by “imperfections,” remind yourself that nobody’s perfect. Even supermodels get airbrushed.

• Make a list of your positive qualities. Think of all the things you like about yourself. Are you smart? Kind? Creative? Loyal? Funny? What would others say are your good qualities? Include your talents, skills, and achievements. Also think about bad qualities you don’t have.

Learning healthy eating habits—

If you’ve been struggling with an eating disorder, chances are you’ve forgotten what healthy eating looks like. But learning and establishing healthy eating habits is an essential step in recovery from anorexia and bulimia.

• Challenge your strict eating rules. Strict rules about food and eating fuel anorexia and bulimia, so it’s important to replace them with healthier ones. For example, if you have a rule forbidding all desserts, change it into a less rigid guideline such as, “I won’t eat dessert every day.” You won’t gain weight by enjoying an occasional ice cream or cookie.

• Don’t diet. Healthy eating–not dieting–is the key to avoiding weight gain. Instead of focusing on what you shouldn’t eat, focus on nutritious foods that will energize you and make your body strong. Think of food as fuel for your body. Your body knows when the tank is low, so listen to it. Eat when you’re truly hungry, then stop when you’re full. If you follow these simple guidelines -- your body will look and feel its best.

• Stick to a regular eating schedule. You may be used to skipping meals or fasting for long stretches. But when you starve yourself, food becomes all you think about. To avoid this preoccupation, make sure to eat every three hours. Plan ahead for meals and snacks, and don’t skip!

Find a specialist—

The first step in eating disorder recovery is finding a doctor or therapist who specializes in anorexia and bulimia. As you search, focus on finding the right fit. Your relationship with your doctor or therapist is important to the recovery process. Look for someone who makes you feel comfortable, accepted, and safe.

To find an eating disorder recovery specialist in your area:

• Ask your primary care doctor for a referral
• Ask your school counselor or nurse
• Call the National Eating Disorders Association’s toll-free hotline at 1-800-931-2237 (Mon–Fri, 8:30 a.m. to 4:30 p.m. PST)
• Check with local hospitals or medical centers
• Search online at the eating disorder websites listed to the right

Address health problems—

Anorexia and bulimia can be deadly–and not just if you’re drastically underweight. Your health may be in danger, even if you only occasionally fast, binge, or purge, so it’s important to get a full medical evaluation. If the evaluation reveals health problems, they should take top recovery priority. Nothing is more important than your physical well-being. If you’re suffering from any other life-threatening problem, you may need to be hospitalized. While the thought of hospitalization may be scary, try to remember that its sole purpose is to keep you safe!

Make a long-term recovery plan—

Once your health problems are under control, you and your doctor or therapist can work on a long-term recovery plan. First, you’ll need to assemble a complete eating disorder recovery team. Your team might include a family doctor, a psychologist, a nutritionist, a social worker, and a psychiatrist. Then you and your team will develop a recovery plan that’s individualized to meet your needs.

Relapse prevention—

The work of eating disorder recovery doesn’t end once you’ve adopted healthy habits. It’s important to take steps to maintain your progress and prevent relapse.

• Avoid pro-ana and pro-mia websites. Don’t visit websites that promote or glorify anorexia and bulimia. These sites are run by individuals who want excuses to continue down their destructive path. The “support” they offer is dangerous and will only get in the way of your recovery.
• Develop a solid support system. Surround yourself with individuals who support you and want to see you healthy and happy. Avoid individuals that drain your energy, encourage your disordered eating behaviors, or make you feel bad about yourself.
• Fill your life with positive activities. Make time for activities that bring you joy and fulfillment. Try something you’ve always wanted to do, develop a new skill, pick up a fun hobby, or volunteer in your community. The more rewarding your life, the less desire you’ll have to focus on food and weight.
• Identify your “triggers”. Are you more likely to revert to your old, destructive behaviors during the holidays, exam week, or swimsuit season? Know what your triggers are, and have a plan for dealing with them, such as going to therapy more often or asking for extra support from family and friends.
• Keep a journal. Writing in a daily journal can help you keep tabs on your thoughts, emotions, and behaviors. If you notice that you’re slipping back into negative patterns, take action immediately.
• Stick with your eating disorder recovery plan. Don’t neglect therapy or other components of your recovery, even if you’re doing better. Listen to the advice of your recovery team and continue to follow their recommendations.

What is the prognosis?

Bulimia nervosa is the sort of condition that is difficult to cure fully 'once and for all'. Many individuals improve with treatment, but bad spells (relapses) may recur from time-to-time in some cases. Many individuals find they still have issues with food, even after recovery, but they are more in control and can lead happier, more fulfilled lives.

Studies suggest that 10 years after a diagnosis of bulimia nervosa about 5 in 10 individuals are well, about 2 in 10 individuals still have bulimia nervosa, and about 3 in 10 individuals are somewhere in the middle. However, the recent study about CBT treatment (cited at the end) suggests that with good quality CBT, the outlook is probably even better than these 'overall' figures. It is very unusual to die from bulimia nervosa.