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BULIMIA NERVOSA

Bulimia often starts when a young woman hears others at school talking about an "easy" method to control weight: you can eat anything you want, as much as you want, but never gain a pound! It sounds too good to be true … and, unfortunately, it is.

Bulimia Nervosa is a serious, potentially life-threatening eating disorder characterized by unhealthy methods of getting rid of food — vomiting, abusive use of laxatives or water pills, fasting and extreme exercise — to avoid gaining weight. Bulimics usually resort to these methods after compulsively eating large amounts of food in a short period of time, a behavior known as binge eating. The syndrome is called "binging and purging." However, some bulimics will engage in purging simply if they eat more food than they feel they should.

What are the signs and symptoms of bulimia?
Bulimia is usually well concealed from family or friends and can remain undetected for many years. Bulimia is diagnosed when several of the following symptoms exist simultaneously:

Behavioral signs

Eating unusually large amounts of food with no apparent change in weight
Disappearance of large amounts of food in short periods of time
The presence of wrappers and containers indicating the consumption of large amounts of food
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; going for unexpected walks or drives at night (bulimics try to binge when other people are not around)
Excessive, rigid exercise regimen
Creation of complex lifestyle schedules or rituals to make time for binge-and-purge sessions
Physical signs

Unusual swelling of the cheeks or jaw area
Calluses on the back of the hands and knuckles (from self-induced vomiting)
Discoloration, staining, or deterioration of tooth enamel (caused by stomach acid)
Broken blood vessels in the eyes
Brittle hair or nails; dry or sallow skin
Stomach pain
Weakness or fatigue
Loss of menstrual cycle
Swelling of the lower legs and feet, or loss of sensation in the hands or feet (from malnutrition or dehydration)
Emotional signs

Withdrawal from usual friends and activities
Preoccupation with body weight, weight loss, dieting, and control of food
Depression and mood swings
Extreme or impulsive behavior, such as excessive spending sprees or substance abuse
Severe self-criticism
Sense of a loss of control
How is bulimia different from anorexia?
Unlike anorexics, bulimics do not avoid eating. People with bulimia can be hard to pick out because their weight may be average or above average. Bulimics and anorexics do share an obsessive concern with body size, fear of weight gain, guilt, poor self-image and eating in secrecy. Some people can have both anorexia and bulimia. About 50% of anorexics develop bulimia.

Who is likely to suffer from bulimia?
Like anorexia, bulimia is most often found in young women ages 11- 17, but has been seen in women even into their 60s. Although once considered a disorder suffered strictly by Caucasian, affluent women, bulimia has become common among all races and income levels. Although not as common, males can also become bulimic.

What are the effects of bulimia?
Bulimia has serious medical and psychological implications. Some of the major damage that results from bulimia includes:

Physical effects

Electrolyte imbalance caused by dehydration (can lead to irregular heartbeats, heart problems, and even death)
Inflammation of the esophagus from frequent vomiting
Tooth and gum problems
Chronic irregular bowel movements and constipation from laxative abuse
Vitamin and mineral deficiencies
Chronic kidney problems or failure
Emotional effects (some of which may also be causes)

Shame and guilt
Depression
Low self-esteem
Impaired family and social relationships
Perfectionism
"All or nothing" thinking
What causes bulimia?
Bulimia often begins as what seems to be a good idea: a way to manage weight without dieting. It continues as a means of self-control, which paradoxically becomes habitual and out of control. Some of the precursors to bulimia include:

Feeling out of control because of difficulties at home
Suppressed anger
Unmet needs
Feeling undeserving
Major life changes, such as divorce, family problems, loss of a relationship, a move
Because bulimia sometimes occurs in more than one family member, there is also research being conducted to determine whether this is a genetic or learned behavior.

A cultural or social environment that values thinness as the key element in attractiveness may also cause or reinforce a propensity toward bulimia.

What should you do if you suspect bulimia in a family member or friend?
Confronting a bulimic may encourage her to seek help and begin the process to recovery. Before confronting the person, have a plan. Decide:

why you are concerned
who will be involved
where to confront
how to talk, and
when is a convenient time.
What is the treatment for bulimia?
Like all bad habits, the longer someone takes part in them, the harder they are to break. Recognizing and addressing the problem as soon as possible is most important. Because bulimia involves both the mind and body, medical doctors, mental health professionals, and dietitians often are involved in the patient's treatment.

Goals of treatment for bulimia are likely to include:

Psychoeducation about the medical implications of bulimia
Identification of triggers for binging and purging behavior
Interrupting the "rituals" of bulimic episodes
Challenging weight and body image beliefs
Improving self-esteem and ability to communicate needs and feelings
Treatment provides a support system and ends the isolation and shame commonly felt by bulimics. Some bulimia treatment programs include an OA (Overeaters Anonymous) 12-Step Program, self-help groups conducted by the Eating Disorders Association, or self-help groups run by hospital outpatient units. Some programs also use antidepressant medications to treat bulimia.