What is bulimia?

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by overeating (bingeing) and then purging to get rid of the calories consumed. A person with bulimia fears gaining weight, yet has an uncontrollable compulsion to binge on foods. After bingeing, the person employs unhealthy methods to rid the body of the calories: vomiting; frequent use of laxatives, water pills, or enemas; fasting; or extreme exercise. Purging after bingeing begins as a means of weight-control, but the bingeing and purging behaviors paradoxically become habitual and out of control.

Signs and symptoms of bulimia?

People who have bulimia are very secretive about their bingeing and purging, so others may not notice the signs and symptoms of the eating disorder. Some symptoms of bulimia are so subtle that only a medical professional would notice them. Surprisingly, being underweight is not a characteristic sign of bulimia, even though people with bulimia are afraid of being too fat. Individuals with bulimia often are of normal weight or overweight because they eat a lot.

The warning signs and symptoms of bulimia include:

• Secrecy surrounding eating and the time period after eating, to allow for bingeing and then purging. Frequent trips to the bathroom after meals, signs and/or smells of vomiting, evidence of laxatives or diuretics. Going to the kitchen after everyone else has gone to bed to binge. Going for unexpected walks or drives at night. Excessive desire for privacy in the bedroom or bathroom.
• Odd eating behaviors, such as avoidance of eating with others; unpredictable and sudden dietary likes and dislikes; skipping of meals; taking very small portions when eating with others; consuming a lot of water or diet soda (to make vomiting easier); cutting food into very small bites; chewing food excessively; separating different types of food on the plate; strange pairings of foods.
• Eating unusually large amounts of food, with no apparent change in weight. The disappearance of large amounts of food, or numerous empty wrappers or containers in the garbage.
• Excessive, rigid exercise regimen – However, it is difficult to distinguish a serious athlete from an athlete with bulimia. Both may train excessively and not eat enough to compensate for the caloric usage
• Complex lifestyle schedules or rituals to make time for binge-and-purge sessions. Typical behaviors are using mints or gum to cover up the smell of vomit, running water in the bathroom to conceal the sound of vomiting, or always going to the bathroom after meals.
• Poor body image; preoccupation with body weight, weight loss, dieting, and control of food – Wearing of baggy clothes to hide the body. A distorted body perception. Avoidance of looking in mirrors.
• Discolored or callused finger joints or backs of the hands – Jamming the fingers down the throat to induce vomiting may damage the outer surfaces of the hands.
• Tooth and mouth problems, such as discolored and decalcified teeth, and sensitive, swollen, and bleeding cheeks and gums. These are caused by vitamin deficiencies and by the stomach acid that comes up with vomit.
• Stomach pain and intestinal irregularities, such as constipation and diarrhea.
• Irregular or nonexistent menstrual periods (in females).

Types of bulimia

There are two types of bulimia, based on how the person with bulimia compensates for the binge eating:

• Purging type of bulimia - The person induces vomiting or uses a diuretic, laxative, or enema to purge food from the body, as a compensation for bingeing.
• Nonpurging type of bulimia - The person with bulimia does not purge food from the body, but instead fasts or engages in excessive exercise to use up calories.

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About Anxiety Disorders

Anxiety Disorders affect about 40 million American adults age 18 years and older (about 18%) in a given year, causing them to be filled with fearfulness and uncertainty. Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders last at least 6 months and can get worse if they are not treated. Anxiety disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder.

Effective therapies for anxiety disorders are available, and research is uncovering new treatments that can help most people with anxiety disorders lead productive, fulfilling lives. If you think you have an anxiety disorder, you should seek information and treatment right away.
This booklet will

• describe the symptoms of anxiety disorders,
• explain the role of research in understanding the causes of these conditions,
• describe effective treatments,
• help you learn how to obtain treatment and work with a doctor or therapist, and
• suggest ways to make treatment more effective.

The following anxiety disorders are discussed in this brochure:

• panic disorder,
• obsessive-compulsive disorder (OCD),
• post-traumatic stress disorder (PTSD),
• social phobia (or social anxiety disorder),
• specific phobias, and
• generalized anxiety disorder (GAD).

Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread.
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Mental ways of beating insomnia

Mental ways of beating insomnia

1. Your body likes routine so aim to go to bed at the same time nightly. Begin winding down about an hour before you go to bed.
2. Avoid caffeine, especially from late afternoon onwards, as it has a stimulating effect for up to 6 hours.
3. Avoid using alcohol to sleep - it produces a shallow, un-restful quality of sleep.
4. Decide bed is for nothing other than sleeping (and making love) - so avoid eating, watching television, telephoning, knitting, having serious discussions, etc.
5. Keep clocks out of sight! Many people create a mini-neurosis through lying awake and checking the clock every few minutes to calculate how much sleep they are missing!
6. Never stay awake in bed for more than about 30 minutes. Have a list of boring/unpleasant tasks beside your bed. Get up and do something from this list if necessary. The idea here is to break the association between being in bed had experiencing insomnia.
7. Avoid rewarding middle-of-the-night waking with food, drink, cigarettes, etc.
8. To get better continuous sleep you may need to temporarily deprive yourself of sleep, at first. Get up a little earlier each day - till you are sleeping as you would like. Then gradually extend the length time you are in bed, once again. (For example, you might begin by getting up 15 minutes earlier every three days - while still going to bed at the same time - until eventually your mind-body "allows you" to get to sleep more quickly at night. Generally this process takes a few weeks to produce results.)
9. Avoid day-time naps. Sleep requirements vary so if you don't need a lot of sleep why not use the time constructively - study, hobby, voluntary work, etc.
10. Use your relaxation skills - before sleep or if you wake.

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Some common causes of insomnia

Cause 1- Ineffective stress management

Insomnia is frequently a symptom of ineffective stress management. The more stressed you become, and the more active your mind becomes in endlessly going over things, the more difficult it is to switch off and get to sleep, to remain asleep, or sleep deeply and restfully.

Cause 2 - Putting things off

Insomnia can be caused by, or exacerbated by, excessive procrastination. We often procrastinate because of the endless succession of unfinished business that runs through our mind as we try to get to sleep. Or because we have let matters get into such a mess that we do not know where to begin to deal with them. This produces mass of un-dealt-with issues in `the back of the mind'.

We may well be able to block these issues out of our minds in the bustle of everyday life - but they continue to affect us emotionally, in the background, producing higher and higher levels of emotional stress. Then, just as we begin to relax fully and drift off to sleep, we suddenly find ourselves coming fully alert and awake - and the misery of insomnia begins once again. (Incidentally, this is also a common reason for early-waking, too.)

Cause 3: poor preparation for sleep

Even if we are not particularly stressed we may also accidentally develop the insomnia habit following one or two occasions when we have difficulty in getting to sleep. This might be caused by result from drinking caffeine in the evening, having too interesting an evening, pleasurably anticipating something, worrying about having to get up early the next day for a special event, and so on. If a bout or two of such quite normal insomnia results in the expectation of insomnia then we can easily develop the habit of expecting to not sleep well which then becomes a self-fulfilling prophecy.

Cause 4 - Worrying about insomnia

Most adults have interrupted sleep; to briefly wake up on occasion during the night is quite normal. But if we then begin worrying that we may have insomnia this creates an alert state of mind and makes it difficult to get back to sleep again. May instances of insomnia are caused by this worrying about insomnia.

Cause 5 - Trying too hard to get to sleep

Sleep comes naturally and effortlessly when we mentally and physically switch off. So it is best approached as a passive process, rather like relaxation. You cannot force things or make yourself go to sleep any more than you can force or make yourself relax. When you re-develop this habit of passively allowing sleep to occur, or not to occur, sleep is likely to occur more easily, because you are not mentally or physically striving

Cause 6 - Unrealistic expectations

As we get older we require more rest and less sleep. The amount of sleep you need depends on a range of factors including your physical health, the amount of mental or physical activity you engage in, you expectations of how much sleep you need, and so on. However it is unlikely that in your 30's or older you will still need the eight or nine hours sleep that you may have needed as a teenager. And you can easily get that extra rest from regular relaxation sessions. via
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Learn to Relax

The ability to relax, or practise simple meditation, is a natural and valuable ability which we all possess, even though we may not have practised it.

Why (re-)learn to relax?

• Relaxation enables you to take an break and switch off from the stresses of life whenever you wish.
• It provides a few precious moments in which to re-charge your mental and physical batteries.
• Relaxation is the bed-rock of effective stress management.
• It enables you to stand back and switch off from problems - so that, often, when you return to them you can perceive solutions that had previously escaped you.
• If you have intense fears or phobias you will find your relaxation skills essential for using methods such as systematic desensitisation to dissolve your fears.
• Relaxation has been scientifically proven to be health enhancing (See Beyond the Relaxation Response, by Herbert Benson & William Proctor).

How to relax - with a relaxation tape

Get a good relaxation tape and spend a few weeks becoming skilled at switching off and deeply relaxing whenever you wish.

at first it may be helpful to use a tape with a spoken commentary since this will take you through a series of steps to help you become deeply relaxed. However once you have learned, in this way, the physical routine for switching off and relaxing you may find it best to use a music-only tape and to use your own imagination to relax deeply and to actively utilise imagery during the session.

How to relax - without a relaxation tape

The following is a simple method of relaxing which you can develop by using mental imagery aided, perhaps, by soft relaxing music:

1. Make yourself physically comfortable. Initially shrug, stretch, and then sit comfortably upright with hands resting on your thighs or lap. Use a few long exhales to help you settle. Keep your eyes open for now.
2. Pay attention to what you can see, hear, and feel.
3. Close your eyes. This gives your brain a break by reducing the amount of incoming data it has to process.
4. Now pay attention to what you can see, hear and feel with your eyes closed.
5. Do five long exhales (see next section below). With each exhale relax, in turn, a different part of your body as follows (1) Your feet and legs, (2) Your hands and arms, (3) Your torso, (4) Your head and neck, (5) Your entire body. Pay attention to the relaxing effect of each of these out-breaths.
6. Now continue to allow yourself to switch off - breathing normally - paying attention to how your body can relax a little more each time you exhale.

The breathing method when relaxing

• Breathe in through your nose fully but not deeply
• Hold the air for no more than one or two seconds
• Allow the air out through your nose - prolong the out of breath so that it is long and slow
• Pause... while you wait for your body to naturally and easily inhale once more (again through the nose).

This method of breathing is key to enjoying a wonderful relaxation session. It is meant to be quite slow and completely effortless. No breath holding, no straining, no counting - just discovering the rhythm that is right for you, personally.

In particular pay attention to the pauses -- the brief pause at the end of your in-breath and the longer pause at the end of the out-breath.

Why relax in a sitting position?

Because, initially, many people find relaxing to be quite soporific. Having been deprived for so long deprived of the quality of the deep rest which relaxation evokes, your mind-body can relax so deeply that you slip into natural sleep.

There is nothing wrong with this. In fact it’s a great way of getting to sleep at night.

However it is a good idea, in the beginning, to train yourself to relax in a sitting position so that you will be able to relax at will just about anywhere and for just a few minutes e.g. in the dentist chair, while waiting for a train or plane, before an important interview or presentation, etc.

Tips for your Relax Session

1. Years of `normal' stressful living undermine our natural ability to switch off and relax anywhere, anytime. You are now simply re-learning this natural ability.
2. Relaxation is something you allow to happen. You cannot force the issue. It is a gradual process of discovering your personal forms of emotional and physical tension and then discovering the ways of releasing these which work best for you.
3. At first most people find it much easier to relax the body rather than the mind. This is normal. You can certainly learn to allow your mind to become quieter - it simply takes a little longer.
4. For the first few weeks relax in a sitting position. It is easier to relax lying down but if you make yourself too comfortable you risk falling asleep or becoming too drowsy and this negates some of the benefits. (See previous section, too).
5. There is no right way to relax! So rather than attempting to `get it right' experiment to discover what works best for you.
6. The quality of your relaxation will vary considerably during any session. One moment you may think you are losing the experience and the next you may be even more relaxed than before. So if you think it is not working decide to calmly stay at ease for another minute or so. Then, if necessary, give up and have another session 30-60 minutes later.
7. There is no `right' time to relax. Take a break any time you like - especially when you notice tension or a negative mood beginning to build up. For the first few weeks you may find it more beneficial to take lots of short 3-5 minute breaks. Most people find it useful to have a relaxing session at the beginning of the day.
8. Initially your tension level may rise again soon after a session and you may wonder what is the point in relaxing. Here remind yourself that had you not taken a break the tension would now be much higher - and that these breaks are conditioning your body/mind to react differently to pressures.

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