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Bulimia Nervosa

An eating disorder marked by episodes of binge eating followed by one or more behaviors to control weight, most commonly self-induced vomiting, laxative abuse, fasting, or excessive exercise.

Bulimia tends to appear in late adolescence or early adulthood, and most cases occur among middle- and upper-class females. The binge-purge episodes are almost always kept secret, and they tend to follow a recurrent pattern with at least two episodes per week. Like anorexia nervosa, bulimia has its roots in complex social and emotional issues. The family histories of bulimic youth often include emotional chaos, excessive anger, depression, substance abuse, and physical or sexual abuse.

Physical effects

Although bulimia is not associated with the severe weight loss of anorexia nervosa, it does cause a number of serious health risks, the most significant of which are gastrointestinal. Consequences of frequent vomiting include damage to the esophagus, stomach, pancreas, and small intestine. Eventually, a bulimic patient may have trouble keeping down any food for more than a few minutes, and laxative abuse can lead to chronic abdominal pain and constipation. Dehydration, kidney stones, hypoglycemia, and irregularities in heart rhythm are some of the effects of bulimia. A dentist may notice gum disease, numerous cavities, and damaged tooth enamel caused by the acid content of vomitus.

Psychological effects

Bulimia, like anorexia nervosa, is related to anxiety or conflict. However, while the anorectic individual denies she has an eating disorder, the bulimic individual is aware that she has a problem. She feels controlled by food and views her eating habits (and therefore her self) as repulsive to others. She finds comfort in the act of eating, even while dreading the inevitable purge that is to follow.

A bulimic adolescent may experience mood swings, anxiety, or irritability. Normal sleep patterns are often disrupted by amphetamine-induced insomnia, middle-of-the-night eating binges, or bouts of laxative-induced diarrhea. Bulimia is usually marked by secretive behaviors, and bulimic adolescents will often steal food or money to buy food.

Treatment and prognosis

Because a bulimic individual's overall body weight remains normal, it is sometimes years before her family or friends realize that she is struggling with the illness. If an adolescent girl exhibits any signs of an eating disorder, a doctor should be alerted immediately. Effective treatment for bulimia incorporates psychotherapy, nutritional counseling, and medical care if physical problems are present. Antidepressant medication is sometimes prescribed to regulate mood, and support groups are often sources of information and encouragement.

Reliable information is not available on the long-term prognosis for adolescents with bulimia. Studies seem to indicate that relapses are fairly common later in life, especially during periods of stress.

See also Anorexia Nervosa; Eating Disorders.

For Further Study

Books

Jablow, Martha M. A Parent's Guide to Eating Disorders and Obesity. New York: Delta Publishing, 1992.

Maloney, Michael, and Rachel Kranz. Straight Talk about Eating Disorders. New York: Facts on File, 1991.

Organizations

National Eating Disorders Organization
Address: 6655 Yale Avenue
Tulsa, OK 74136
Telephone: (918) 481-4044

National Association of Anorexia Nervosa and Associated
Disorders (ANAD)
Address: P.O. Box 7
Highland Park, IL 60035
Telephone: (847) 831 -3438

—Gail B. Slap, M.D.
University of Pennsylvania School of Medicine