Bulimia

Episodes of binge-eating followed by strategies to avoid weight gain

  • Usually develops in early adulthood
  • More common in females
  • Episodes can be brought on by stress
  • Genetics is not a significant factor

People with bulimia (known medically as bulimia nervosa) worry excessively about their weight, body shape, and self-image. They typically binge on high-calorie food items, such as ice cream or chocolate, and then report a loss of control over their eating. After binge-eating, they use a number of methods to avoid weight gain, such as self-induced vomiting, using laxatives, and excessive exercising.

A person affected by bulimia is usually of average weight, and binge-eating and purging by vomiting and using laxatives are carried out secretly. He or she may have had anorexia nervosa in the past or may alternate between the two conditions. The disorder is more common in women and usually develops between the ages of 18 and 30. The person may have poor self-control and low self-esteem and may also indulge in substance abuse. Bouts of bulimia may be triggered by stress.

What are the symptoms?

Binge-eating followed by vomiting may occur once or several times a day. Over time, bulimia causes psychological and physical symptoms. The psychological symptoms include:

  • A constant craving for food.

  • Feelings of isolation as a result of eating alone and in secret.

  • Guilt and disgust after binge-eating.

There may also be symptoms of depression and anxiety (see Anxiety disorders). The physical symptoms caused by repeated episodes of binge-eating and vomiting include:

  • Severe abdominal pain and swelling immediately following a binge.

  • Physical weakness.

  • Erosion of tooth enamel by stomach acids contained in vomit.

  • Lesions on the knuckles from using fingers to induce vomiting.

  • Bleeding from injuries to the lining of the oesophagus caused by vomiting.

Bulimia is unlike anorexia nervosa in that it rarely leads to severe weight loss. However, repeated excessive vomiting may cause dehydration and chemical imbalances in the blood. These imbalances sometimes lead to irregular heart rhythms (see Arrhythmias) that, very rarely, cause sudden death.

What might be done?

People with bulimia may be distressed by their behaviour and seek medical help themselves, or a family member or friend may encourage a person to see a doctor. The doctor will establish the severity of the illness by asking the person about his or her attitude to food. The doctor will look for signs of psychological problems, such as depression, anxiety, and substance abuse, and may arrange for blood tests to look for chemical imbalances in the blood.

The doctor may recommend a psychological therapy, such as cognitive–behavioural therapy, with a therapist who specializes in eating disorders. The goal of treatment is to boost self-esteem and help develop a rational approach to eating, while establishing a regular eating pattern. The doctor may prescribe antidepressant drugs because they can be helpful even if a person with bulimia does not feel depressed.

What is the prognosis?

It is rare for bulimia to disappear spontaneously. In many cases, there is a risk of relapse weeks or even months after treatment is completed. However, in about 4 out of 5 cases, the frequency of binge-eating is reduced by therapy.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

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