Bulimia is a form of anorexia nervosa (eating disorder in which the patient eats too little in order to lose weight). Persons with this condition eat, but then purge through self-induced vomiting or misuse of laxatives or enemas. About half the people who have anorexia are bulimic.
Causes and Risk Factors
A variety of factors are involved in developing bulimia. Some are hereditary. Others are social, such as the pressure to be thin. Psychological factors can also increase risk.
About 95% of cases involve girls or women. Mostly, people in middle and upper economic classes are affected. College-aged women are most at risk. An estimated 2% develop the condition.
Bulimia can be short term or ongoing. It can be severe and even life-threatening. Many who develop the condition are intelligent and have high standards for success and achievement. They tend to be overly neat, do things repeatedly and become unreasonably preoccupied. At the start, the problem may be subtle.
People with bulimia follow a pattern. They repeatedly eat large amounts of food over a short period of time (usually within two hours). Then they use different ways to stop the effect of eating too much. These include forcing themselves to vomit, taking laxatives and diuretics, severe dieting or exercising too heavily.
The cycle is often set off by emotional stress. Psychologically, the binging is associated with feeling out of control. Purging is an attempt to regain control. Eating and purging are usually done in secret.
There are differences between people who have bulimia and those who have anorexia. People with bulimia tend to:
- Have a body weight that stays close to normal
- Be more aware that there is a problem with their behavior and feel guilt or remorse
- Be more likely to admit their concerns to a doctor or another person
- Be more outgoing
- Be impulsive, abuse drugs or alcohol and feel depressed.
Other symptoms of bulimia may include:
- Erosion of tooth enamel from self-induced vomiting
- Enlarged salivary glands in the cheeks
- Inflamed esophagus (pathway between the throat and the stomach)
- Reduced potassium levels in the blood. This may cause irregular heart rhythms.
- Sudden death as a result of abnormal heart rhythms
- In rare cases, a person may eat so much during a binge that the stomach bursts or the esophagus tears. This can be life-threatening.
A doctor should look for the following signs if there is concern that a patient may have bulimia:
- An out of proportion concern about weight gain
- Wide changes in weight
- Signs of excessive laxative use
- Swollen salivary glands in the cheeks
- Scars on the knuckles from using fingers to force vomiting
- Erosion of tooth enamel from stomach acid
- Low potassium levels as shown in a blood test
To confirm a diagnosis, it is necessary for the person to describe binge-purge behavior. This behavior should consist of two or more episodes a week for at least three months.
The two most effective approaches to treatment are:
- Cognitive-behavior (thinking and reasoning) therapy. This can lower the number of binging episodes in about two-thirds of cases. It can stop the behavior entirely in one-third of cases.
- Therapy with certain antidepressants such as Prozac. However, binging tends to come back when drug therapy is stopped.