1. Bulimia Nervosa Recognising the Warning Signs
Dr Pooky Knightsmith
@PookyH

2. 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

3. 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

4. The Binge Purge Cycle

5. 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)

6. 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.

7. 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.

8. 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.

9. 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

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

11. 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

12. 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.

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

14. 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.

15. 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

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

17. 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

18. 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
Download the student handout version: click here
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