I have an eating disorder and I've vomited blood, what should I do?

Some people with an eating disorder (ED) induce vomiting as a way to compensate for overeating or as a way to expel emotions they otherwise don't know how to express, such as anger or pain. It's a way of channeling negative emotions, albeit turning them against themselves. This behavior doesn't solve the problem; on the contrary, it shifts the focus and makes it worse. Furthermore, it interferes with both physical and mental health, as well as the quality of life of those who resort to it.

Vomiting can create a vicious cycle, in which a prior trigger (an emotion, feeling, situation, etc.) leads to, for example, compulsive binge eating, which provides temporary relief from discomfort. This momentary relief is followed by a feeling of guilt that precedes self-induced vomiting. Thus, inducing vomiting can become addictive, operating through the same mechanism as self-harm.

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When this behavior is recurrent, the person may even vomit blood . With repeated vomiting, stomach acid erodes the lining of the esophagus. The pressure exerted can swell the blood vessels in the esophagus, which can then rupture. The lining of the esophagus is thin and does not withstand the gastric acid that rises with vomiting. Eventually, the lining tears, which is why blood can be vomited.

Even if the bleeding is minor, once it has occurred it can recur. In fact, it can even lead to esophageal rupture, resulting in severe bleeding. Bleeding is a warning sign and should not be ignored.

Consequences of persistent vomiting:

• Erosion of the teeth, eventually destroying the tooth enamel.
• Swelling of the salivary glands.
• Superficial injuries to the upper part of the throat caused by the force of vomiting.
• Ulcers or bleeding in the walls of the esophagus due to the presence of acid in the stomach.
• Stomach hernia, reflux and heartburn.
• Potassium imbalance or dehydration can result from the loss of gastric juices, water, and minerals during vomiting. Thirst, dizziness, weakness, or muscle spasms may occur. The risk is increased if laxatives are also used.

What to do if you have vomited blood?

If you notice you are vomiting blood, you should tell your doctor or go to the emergency room as soon as possible , as this is a serious complication and could recur. It is also recommended that you tell people you trust so they can help you. It is especially serious when there is repeated self-induced vomiting that dilates the esophagus and causes reflux and heartburn.

Basic advice if you vomit blood:

• Rest in a seated position, without fully stretching out. Stretching out could increase bleeding.
• In the following days, avoid spicy, heavy, or hard-to-digest foods. Avoid coffee, alcohol, and stimulants to prevent irritating your esophagus and stomach.
• If the bleeding recurs, go to the emergency room.
• If you experience dizziness, cold sensations, rapid heartbeat, or faintness, you may have internal bleeding. In this case, it is also recommended to go to the emergency room immediately.
• Do not eat or take any medication to try to stop or neutralize the bleeding.

It's important to remember that bleeding can endanger our health. The bleeding may appear slight or have stopped externally, while it continues internally.

The medical team will perform a physical examination, check the patient's overall health, and monitor for bleeding. Medication is sometimes necessary, but generally, it is sufficient to allow the body to recover and give the esophageal lining time to heal. This recovery process takes a few days, provided vomiting does not continue.

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Strategies to help stop the thought of inducing vomiting:

• Engage in an activity that distracts your attention: listen to music, read a book…
• Don't stay in the kitchen or bathroom for too long. You could even go outside for a walk.
• Try to connect with other people. Don't isolate yourself.
• Avoid being alone at home. Especially after a disappointment or frustration.
• Try not to restrict your food intake or fast regularly. Not eating or eating very little can cause anxiety, which can lead to binge eating and vomiting.
• Talk to people you trust about emotional distress, even if you don't know how to identify or describe your emotions.
• Write a short diary about what happens to you and how you feel.
• Work with the therapeutic team to find other ways to channel your distress. They exist; it's just a matter of discovering them, and this team will help you achieve that.
• Let yourself be helped. Get treatment.