Bulimia

An eating disorder in which a person indulges in recurrent episodes of binge eating, followed by purging through self-induced vomiting or by the use of laxatives and/or diuretics in order to prevent weight gain.

The symptoms of bulimia, or bulimia nervosa, include eating uncontrollably (binging) and then purging by dieting, fasting, exercising, vomiting, or abusing laxatives or diuretics. A binge involves a large amount of food, for example, several boxes of cookies, a loaf of bread, a half gallon of ice cream, and a bucket of fried chicken, eaten in a short and well-defined time period. Specific behaviors associated with bulimia include: 1) eating high-calorie "junk food" (candy bars, cookies, ice cream, etc.); 2) eating surreptitiously; 3) eating until stopped by a stomach ache, drowsiness, or external interruption; 4) a tendency to go on "crash diets"; and 5) weight that varies over a 10-pound (4.5 kg) range. Although all of these behaviors are not present in all bulimics, the presence of at least three makes it likely that an individual is suffering from the disorder. In general, binging episodes occur at least twice a week, and may take place two or more times a day.

Unlike anorexics, bulimics may be close to normal weight or overweight (within 15 percent of normal standards) and do not suffer from amenorrhea or lose interest in sex. Bulimics feel out of control, realize that their eating patterns are abnormal, and experience intense feelings of guilt and shame over their binging. Their preoccupation with body weight and secretive eating behaviors may combine with depression or mood swings. Possible warning signals of bulimia may include irregular periods, dental problems, swollen cheeks, heartburn, bloating, and alcohol or drug abuse.

The American Anorexia/Bulimia Association estimates that up to 5 percent of college-age women are bulimic and more than 90 percent of all bulimics are women. The onset of the disorder commonly occurs in the late teens or early twenties and can begin after a period of dieting or weight loss. Risk factors for the disorder involve a pattern of excessive dieting in an attempt to weigh less, a history of depression or alcoholism, low self-esteem, obese parents or siblings, and a history of anorexia nervosa. It has also been suggested that bulimia may have physiological causes, including a defective satiety mechanism.

In order to reduce the risks of developing an eating disorder, cultural attitudes associating thinness and beauty with personal worth and happiness must change to reflect a greater emphasis on developing healthier attitudes and eating behaviors in early childhood. Individuals must learn to value themselves and others for intrinsic rather than extrinsic qualities such as appearance.

Although bulimia is seldom life-threatening, it is a serious illness with severe medical consequences, including abdominal pain, vomiting blood, electrolyte imbalance possibly leading to weakness or cardiac arrest, muscle weakness, and intestinal damage. Bulimics and anorexics rarely cure themselves and the longer the behavior continues, the more difficult it is to help the individual change. The most effective treatment involves a team approach consisting of medical evaluation, individual and/or group psychotherapy, nutritional counseling, anti-depressant medication, and possible hospitalization. Psychotherapy generally consists of investigating the patient's unconscious motivations for binging in combination with behavior modification techniques to help cope with the disease. Commonly recommended medications include diphenylhydantoin (Dilantin), an anticonvulsant, and tricyclic antidepressants. Even with treatment, only about one-third of bulimics appear to recover while another third show some improvement in their eating behavior. The remaining third do not respond to treatment and 10 to 20 percent of these people eventually die of the disease.