Bulimia

Bulimia is defined as an eating disorder characterized by recurrent episodes

of binge eating followed by self-induced vomiting, laxative or

diuretic abuse, vigorous exercise, or fasting.

Description

The

(DSM-IV), the reference that doctors use to diagnose mental illness, specifies

that a person must have an eating binge and try to compensate for

it on average twice a week for three months to meet the diagnostic criteria

for bulimia. A binge is an episode in which someone consumes a

larger amount of food within a limited period of time than most people

would eat in similar circumstances. Most bulimics report feelings of loss

of control associated with bingeing. A second criterion of bulimia is

excessive concern with one

There are two subtypes of bulimia, purging and nonpurging,

according to the methods used by the patient to prevent gaining weight

after a binge. People who have the purging subtype use vomiting, laxatives,

enemas, or diuretics to keep from gaining weight; in the nonpurging

subtype, the person fasts or overexercises to prevent weight gain. The

important point is that bulimics do something after a binge to compensate

for their eating. There is another type of eating disorder called

binge eating disorder, in which the person has eating binges but does not

try to vomit, exercise, or do anything else to prevent gaining weight.

Demographics

There is some disagreement about the demographics of bulimia, partly

because the rules for diagnosing it have changed over time. The usual

figure given for bulimia in the United States is 1

school- and college-age women. Many doctors think, however, that

bulimia is underdiagnosed because most people with the disorder are of

average weight or only slightly overweight. In addition, there are large

numbers of teenagers and young adults who have disordered eating patterns

but do not meet the full criteria for bulimia; there may be twice as

many young people in this second group as those who meet the full

DSM-IV definition.

The gender ratio is usually given as ten females to every one male

affected, but some people think that as many as 15 percent of bulimics

are male. Gay men appear to be at greater risk of developing bulimia than

heterosexual men.

At one time bulimia was thought to affect mostly Caucasian women,

but the rates among African American and Hispanic women have risen

faster than the rate of bulimia for the female population as a whole, at least

in the United States. Occupation appears to be a major risk factor for bulimia.

Women whose careers depend on appearance or a certain body build, such as

ballet dancers, models, and professional athletes, are reported to be four times

as likely to develop bulimia as women in the general population.

Causes and Symptoms

The causes of bulimia are not known for certain, but are thought to be a

combination of genetic factors (possibly unusual sensitivity to foods high in

carbohydrates); the emotional climate in the patient

in the wider society to live up to a standardized image of beauty. In terms

of family patterns, people with bulimia often describe their families as conflicted

and their parents as either distant and uncaring or hostile and critical.

Bulimia is associated with a number of physical symptoms. Binge

eating by itself rarely causes serious medical complications, but it is associated

with nausea, abdominal bloating and cramping, slowed digestion,

and weight gain.

Bulimics who force themselves to vomit after a binge may develop

serious medical problems, including:

’s family; and pressures

•

vomited material.

Erosion of the enamel on the teeth, caused by stomach acid in the

•

Enlargement of the salivary glands.

•

teeth.

Scars and calloused areas on the knuckles from contact with the

•

Irritation of the throat and esophagus.•

•

can deplete the body

sodium, and magnesium. The loss of these chemicals in turn can

sometimes affect heart rhythm.

Electrolyte imbalances. The loss of fluids from repeated vomiting’s stores of hydrogen chloride, potassium,

Diagnosis

Bulimia is usually diagnosed during an office visit to the patient

care doctor, although she or he may be sent to a psychiatrist for

an additional evaluation. Primary care doctors are now encouraged to

give a screening test to an adolescent or young adult who seems unusually

concerned about their weight or asks the doctor a lot of questions

about weight loss. These screeners are short sets of five questions about

eating habits that the patient can quickly answer. If the doctor thinks

that the patient may have bulimia, he or she can look for some of the

physical signs that accompany the disorder, such as whether the teeth

and salivary glands are normal. In most cases the doctor will order laboratory

tests of the patient

chemistry is normal. Most doctors will also give the patient an electrocardiogram

(ECG) to check the patient

because some types of chemical imbalances in the blood (from

vomiting or using diuretics) can lead to irregular heart rhythms.

Another important part of evaluating a patient for bulimia is a

mental status examination. The doctor will need to check the patient for

signs of anxiety disorders or depression, because a high proportion of

bulimics have a mood disorder. In addition, people with bulimia are

more likely to be treated successfully for their eating disorder when their

anxiety or depression is also being treated.

’s primary’s blood and urine to make sure that her blood’s heart rhythm. This test is important

Treatment

Treatment for bulimia consists of psychotherapy combined with medications.

The type of psychotherapy most often recommended for bulimics

is cognitive-behavioral therapy (CBT), along with interpersonal therapy.

In CBT, the patient is helped to recognize the distortions in their mental

image of their body and to correct irrational beliefs about food and

eating. Family therapy may be recommended if the patient

appears to be a major cause of his or her emotional distress; as of late

2007, there was some evidence that family therapy is more helpful for

some patients with bulimia than individual therapy. Some bulimics also

benefit from group therapy or support group meetings.

The medications most often prescribed for bulimics are antidepressants,

in particular such drugs as fluoxetine (Prozac) and sertraline

(Zoloft). Scientists do not fully understand how these drugs help in

treating bulimia, but some think that they help to regulate chemical

imbalances in the patient

’s central nervous system.

Prognosis

The prognosis of bulimia depends on several factors, including the

patient

close friendships that she or he has. Patients who are diagnosed early,

have good relationships with their parents, and have several close friends

are more likely to recover. About half of bulimics have good outcomes

after treatment, 18 percent have intermediate outcomes, and 20 percent

have poor outcomes.

’s age at diagnosis, the quality of family life, and the number of

Prevention

While it is difficult to change an entire society and its overly high valuation

of physical attractiveness, parents can certainly lower a child

bulimia in later life by creating a warm and loving home. It is important

to convey to children that they are loved as whole persons with minds

and spirits, not just outwardly pleasing faces and bodies.

’s risk of

The Future

It is not known with certainty whether bulimia is increasing in the

United States, partly because it overlaps with other eating disorders in

some people and partly because doctors are looking more closely at men

who may be bulimic but were not diagnosed with the disorder in the

past. Although doctors are looking for better treatments of bulimia,

including new medications, further research in the chemistry of the brain

is needed.

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