Eating disorders are on the rise, according to statistics from eating disorder charities, GPs, and hospital admissions.  One eating disorder charity says that calls to their helpline were likely to reach 17,000 in the financial year ending March 2018 – up from 7,000 the year before.

3ps-consultation Bulimia

Eating disorders, often classified as the “food addictions”, carry the highest morbidity rate of all psychiatric conditions.  Recent research from the NHS information centre showed that up to 6.4% of adults in the UK displayed signs of an eating disorder (Adult Psychiatric Morbidity Study, 2007).  The research shows that 25% of those showing signs of an eating disorder are male.

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The latest version of the DSM (Diagnostic Statistical Manual of Mental Disorders), cites the main eating disorders as anorexia, bulimia, and binge eating disorder (BED).  It estimates that of all patients with eating disorders, 10% are anorexic, 40% are bulimic and rest fall into the “Eating Disorder not otherwise Specified” category.

Bulimia is perhaps the least understood of all the eating disorders.  It was not widely known in medical circles until the British Psychiatrist, Gerald Russell classified it in 1979.  Bulimia Nervosa is a psychological and severe life-threating eating disorder characterized by the ingestion of an abnormally large amount of food in a short time period – often referred to as a “binge” – followed by extreme purging, to avoid gaining weight.

Purging can include forced vomiting, excessive use of laxatives or diuretics and prolonged periods of extreme exercise.  The binge/purge cycle may be repeated several times a day leading to physical symptoms such as:

  • Weight Fluctuation
  • Electrolyte imbalances which can result in cardiac arrhythmia, cardiac arrest and sudden death
  • Broken blood vessels within the eyes
  • Enlarged glands in the neck and jawline
  • Oral trauma such as lacerations in the lining of the mouth and throat from severe vomiting
  • Inflammation of the oesophagus
  • Infertility

Given the extreme symptoms, and now the number of both male and female sufferers, little is known about the causes and treatment for bulimia.  The illness itself is shrouded with such a high degree of secrecy and shame, that it is often hard for sufferers to come forward for treatment in the first place.

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What causes bulimia?

There is no one single cause for bulimia.  Genetic and biological factors are thought to play a part, but most experts believe that childhood trauma or neglect play a large part in the development of bulimia.  Cultural pressures on women and increasingly men, to have the “perfect” body, are also thought to play a part, with certain professions or lifestyles prizing aesthetics more highly.

As with other eating disorders, research suggests that children raised in a family system with criticism, high expectations and a culture of achievement or perfectionism, will be more likely to develop an eating disorder.  Victims of physical or sexual abuse are also highly represented in eating disorder statistics.

More recently, clinicians and psychologists have charted the rise of social media, with its emphasis on digitally altered perfect looks, and sometimes unattainable standards, as being a major factor in the spike in eating disorders.

Treating Bulimia

Sadly, treatment for eating disorders in the UK is becoming harder to gain to access to.  NHS community out-patient services are rare, and many sufferers have to wait until they are ill enough for a hospital admission before they are treated.

Treating a complex condition such as bulimia nervosa requires expert services, but it is perfectly possible to recover.  The best recovery rates are usually achieved with a mixture of psychotherapy, cognitive behavioural therapy and sometimes group support.  In addition, some sufferers may benefit from certain SSRI (“selective serotonin reuptake inhibitors”) antidepressants, which are thought to lessen the urge to binge/purge and to reduce anxiety.

Cognitive Behavioral Therapy (“CBT”) is a useful therapy for eating disorders.  CBT is based on the principle that emotions, thoughts and behaviours are interconnected.  Therefore by identifying and challenged distorted thought patterns, particularly around food and body image, then new thoughts and behaviours can emerge.

Psychotherapy is particularly useful for bulimia nervosa.  Psychotherapy is sometimes called the “talking therapy” and its aim is to help individuals gain a better understanding of what may be underneath maladaptive behaviours, such as binge eating.  Psychotherapy helps individuals understand how some of their thoughts and feelings were formed.  A psychotherapist will usually be interested in a person’s childhood experience of safety, love, relationship and ultimately self-esteem.

Most bulimia sufferers have a distorted sense of self, suffer from feelings of low self-worth, self-hatred and struggle to tolerate and regulate difficult emotions.  A specialist eating disorder psychotherapist will work with a client to improve their poor sense of self, to understand why they think and feel as they do, and to better tolerate difficult feeling states.

Recovery from bulimia can take some time.  An experienced psychotherapist will work with a client in the early phase of their recovery, where the client is attempting to gain some remission from binge eating and purging.  Many eating disorder recovery professionals recommend that eating disorder suffers abstain from sugar and alcohol as they try to stabilize their eating patterns, thus helping to minimize the physiological cravings for sugary or carbohydrate-laden food.

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A psychotherapist will help a client begin to notice the difficult feeling states which begin to emerge and help each sufferer understand and better tolerate this, without resorting to binge eating or purging behaviour.  This can be a challenging first phase of recovery.  It is vitally important that suffers find a therapist whom they trust and has experience in working with eating disorders.

The good news is that many sufferers with eating disorders do recovery and maintain their recovery.  If you or a friend/family member are struggling with bulimia, anorexia or any form of eating, please contact us on 0203 955 7700

Rebecca Sparkes


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    Detoxification (detox) is the medical intervention required for someone who is physically dependent to drugs or alcohol. If required, medical detoxification would be the first step taken in residential rehab. Detox is used to prevent uncomfortable and dangerous (even fatal) withdrawals symptoms resulting in suddenly becoming abstinent from alcohol/certain drugs.

    The goal of a medical detox is to aid in the physical healing required following long term addiction and rid the body of all together of substance whilst providing a cushion for unpleasant symptoms of withdrawals. Detox is not considered the whole treatment for drug/alcohol addiction and it is always recommended that a comprehensive rehabilitation program is used along side to help maintain long term abstinence.

    Medication is often required for alcohol detox. If you are dependent on alcohol and experiencing withdrawal symptoms it is vitally important to seek medical advice prior to stopping. There is a long list of medications used when treating alcohol addiction and the exact medication given to an individual will depend on their needs/medical history. Some of these include;

    • Chlordiazepoxide (Librium)
    • Lorazepam (Ativan)
    • Diazapam (vailium)

    Librium and Valium are the most commonly used detox medication in the UK. All medication used to help with alcohol detox have been proven to help reduce the effects of withdrawal symptoms.

    There are also a number of drugs recombined by the NHS to help treat alcohol misuse. Some of these include:

    • Naltrexone
    • Disulfiram (Antabuse)
    • Nalmefene
    • Acamprosate (campral)

    Medication is always required for heroin detox. For someone suffering from heroin addiction, the thought of detoxification (detox) can be exceptionally daunting. Withdrawal symptoms from opiates, such as heroin, can be severe and include pain, vomiting, nausea and shaking.

    There are different ways that heroin detox can be carried out, most usually either ‘maintenance therapy’ or ‘full medical detox’.

    Attempting to switch from heroin to a heroin substitute, usually on a controlled prescription, is known as Maintenance therapy. Subsites used are most often methadone or buprenorphine.

    A full medical detox from heroin will always be carried out in a residential rehab setting and will allow the individual to switch form heroin to a substitute and slowly withdraw completing treatment free of all substances. Someone using a heroin substitute can choose to have a full medical detox at any time, however detoxing substances such a methadone can often add to the length of detox required. Drugs most commonly used to fully detox from heroin are, Subutex, Suboxone and Methadone. Much like alcohol, the exact drugs used will be dependent on the individuals needs/medical history.

    Once detoxed from heroin the risk of overdose is much higher following relapse due to tolerance following withdrawal.

    The length of treatment in a residential rehab depends on a number of elements. Some substances require longer periods of detox than others.

    Private paying patients will also often choose a length of stay that suites their therapeutic and financial needs. As a rule, a full treatment program in a rehab is considered to be 28 days (often referred to as a month), however, treatment is offered in several different ways and lengths starting at 7 days.

    Treating alcohol addiction will always require a minimum of 7-10 days, this would be considered the detoxification (detox) faze. The length required for treating drug addiction can vary drastically depending on the substance being used. Detox for Heroin addiction is generally around 14 days minimum, with more time required if substances such a methadone are being used. Treating prescription drug addiction can often take the longest. The time required for treating gambling addiction, eating disorders and sex addiction will be based on the individuals needs.

    Rehab programs can be as long as an individual requires but primary treatment is normally caped at 12 weeks, with the offering for further secondary and tertiary treatment thereafter.

    *based on average rehab stays, everyone will vary dependant on needs and medical requirement/history.

    There is no need for your employer to know that you are seeking help for trauma and addiction unless you choose to involve them with the process. All employers should have a policy that explains what you do if you cannot come to work due to illness – illness to include treating alcohol addiction/treating drug addiction.

    If your work absence extends over 7 days your employer is likely to require an official statement of fitness to work which would be obtained from your GP. This would need to supply evidence of your illness as well as any adjustments required for returning to work, fazed return or reduced hours, but does not need to specify in detail the reason why you have been absent.

    If you are absent from work for 7 days of less, for example entering rehab for a detoxification (detox) on a Saturday for 7-10 days taking a full week away from work, you can self-certify your illness by letting your employer work you will not be attending work for that period of time. Exactly how an individual would do this would be dependent on a specific companies’ policies on taking sick leave.

    Any time longer than 7 days it is likely an employer will require a note from the individuals GP certifying their sickness and a fit note on return. Most companies have a clearly outlined policy on sickness and receiving sick pay so the exact requirement can vary. A rehab will always be willing to advise on time off work.

    How much does rehab cost is a very frequently asked question. The cost of treatment can range from £1,000 per week upwards depending on the place, with luxury rehab being the most expensive.

    There are free options available on the NHS but the waitlist of those looking for free treatment is longer than that for privately paying patients. Some private health insurance policies will cover treatment in some rehabs around the country.

    Choosing the right rehab centre will often be based on priced but it is important to follow guidance on the most suitable treatment centre for an individual’s needs which our expert team of advisers are on hand to offer.

    There are certainly pro’s for both treatment near by and traveling for treatment with one of the most asked question being should I get rehab near me? There are rehabs all over the UK and around the world that all offer expert programs, let’s look at how to choose a rehab.

    Local treatment

    Being close to home gives certainly has benefits. Visitors are normally permitted in rehab following the first 7 days stay, therefore if an individual is in treatment for a length of time longer than that being local will make it easier for loved ones to visit.

    Most rehab centres will also provide a full aftercare plan for someone following treatment, this will include ongoing aftercare in the specific treatment centre. Living close by can make it easy to take full advantage of ongoing aftercare. There can also often be the option for ongoing care with an individual therapist, again being close by will allow that treatment to be carried out face to face.

    Some individuals wish to be local but are willing to look broader, for instance the greater city of residence (London, Manchester, Liverpool, etc)

    Treatment Away

    Getting treatment away from home can be very appealing to some. Being out of the local area makes it a lot harder to just walk out of treatment as resources locally are unknown. Some also take comfort in knowing that they are not near home and focus more on treatment.

    As the price for treatment can vary so much from one residential treatment centre to another, private paying patients often would rather travel to keep the cost down. Those using private health insurance may also have to travel to find a treatment centre covered in their policy.

    When opting for treatment away from home this can be anywhere in the UK and also abroad. Aftercare can still be carried out and very successful using tools such as The Online Rehab.

    There is no right or wrong when choosing where to go to residential rehab, but our expert advisors are always on hand to help provide information on all possible options.

    Whilst millions of people in the UK have taken recreational drugs (amphetamine, cannabis, cocaine, crack, crystal meth, GHB, heron, ketamine, methadone, and prescription drugs) and drank alcohol not all become ‘addicted’. Most recent reports show that 279,793 individuals were in contact with drug and alcohol misuse services in the last year with over half of that being from opiate addiction and a quarter for alcohol.

    There are several risk factors invoiced in addiction and those using drugs and alcohol socially, simply take the risk. These risks are as follows;

    Tolerance – basically, if a substance is used repeatedly an individual’s tolerance to it will build. This will result in more of the same substance being required to get the same effect. In the long run this can easily lead to addiction and physical dependencies.

    Environmental risks – these can include influences such a peer pressure and stress as well as physical or mental abuse of an individual (particularly as a child). Overall, those who live with frequent pressures and stress are more likely to reach for a substance to cope and are therefore at higher risk of becoming addicted.

    Drug type – it is very well known that certain drugs are simply more addictive than others. Using substances such as heroin increases the risk of becoming addicted for need to ‘chase’ a high as well as physical dependency.

    Drug administration – how a drug is administered can affect its addictive qualities. A drug injected rather than smoked or snorted will release a quicker and more intense high thus making it psychologically (and in many cases physically) more addictive.

    Biological factors – it is now widely reported that being an addict is not only psychological but also biological. This includes your genetic makeup, mental health, sex and age. It is also reported to be 8 times more likely for the child of an addict to become an addict themselves.

    Its believed that addiction is approximately half genetics and therefore some are 50% more likely to become addicted than others.

    How do you help a loved one trapped in addiction?

    The first step is to help and encourage the individual to become willing to accept help. They do not need to be shouting this off the rooftops, but they do need to be willing to go into treatment. There are ways to help someone become willing to get treatment for alcohol or treatment for drugs.

    Set boundaries – set boundaries and stick to them. Once you have laid them out follow through with whatever consequences you have set however hard it is.

    Stop finances – if you are financially supporting someone stopping these finances can be the quickest way for the addict needing to ask for help. With no money to acquire a substance an addict’s options become very limited.

    Intervention – getting together with other family members/friends/colleagues and staging an intervention is often very successful in the fist stage of acceptance and gaining an admission to residential rehab.

    You can’t make them quit, this can lead to dangerous withdrawal. Boundaries are very important in helping someone become willing to get help. Unfortunately you cannot do someone’s recovery for them and without self-motivation it is very hard to make it work.

    The next step is to call our highly trained advisers 0203 955 7700.

    There is a huge range of rehab options available and where to start can be completely over whelming so let us help.