Bulimia Nervosa

• Recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months)
• A feeling of lack of control over eating during the binges
• Regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise
• Persistent over-concern with body shape and weight.

The National Center for Health Statistics estimates that about 9,000 people admitted to hospitals were diagnosed with bulimia in 1994. Studies indicate that by their first year of college, 4.5 to 18 percent of women and 0.4 percent of men have a history of bulimia.

Males account for only 5 to 10 percent of bulimia and anorexia cases. While people of all races develop the disorders, the vast majority of those diagnosed are white.

Most people find it difficult to stop their bulimic behavior without professional help. If untreated, the disorder may become chronic and lead to severe health problems, even death. Antidepressants are sometimes prescribed for people with bulimia.

There are many theories for the cause of bulimia. One is that some young women feel abnormally pressured to be as thin as the "ideal" portrayed by magazines, movies and television. Another is that defects in key chemical messengers in the brain may contribute to the disorders' development or persistence.

Once people begin bingeing and purging, usually in conjunction with a diet, the cycle easily gets out of control. While cases tend to develop during the teens or early 20s, many bulimics successfully hide their symptoms, thereby delaying help until they reach their 30s or 40s. Several years ago, actress Jane Fonda revealed she had been a secret bulimic from age 12 until her recovery at 35. She told of bingeing and purging up to 20 times a day.

Many people with bulimia maintain a nearly normal weight. Though they appear healthy and successful--"perfectionists" at whatever they do--in reality, they have low self-esteem and are often depressed. They may exhibit other compulsive behaviors. For example, one physician reports that a third of his bulimia patients regularly engage in shoplifting and that a quarter of the patients have suffered from alcohol abuse or addiction at some point in their lives.

While normal food intake for women and teenagers is 2,000 to 3,000 calories in a day, bulimic binges average about 3,400 calories in 1 1/4 hours, according to one study. Some bulimics consume up to 20,000 calories in binges lasting as long as eight hours. Some spend $50 or more a day on food and may resort to stealing food or money to support their obsession.

To lose the weight gained during a binge, bulimics begin purging by vomiting (by self-induced gagging or with an emetic, a substance that causes vomiting) or by using laxatives (50 to 100 tablets at a time), diuretics (drugs that increase urination), or enemas. Between binges, they may fast or exercise excessively.

Extreme purging rapidly upsets the body's balance of sodium, potassium, and other chemicals. This can cause fatigue, seizures, irregular heartbeat, and thinner bones. Repeated vomiting can damage the stomach and esophagus (the tube that carries food to the stomach), make the gums recede, and erode tooth enamel. (Some patients need all their teeth pulled prematurely). Other effects include various skin rashes, broken blood vessels in the face, and irregular menstrual cycles.

Early treatment is vital. As bulimia becomes more entrenched, its damage becomes less reversible.

Usually, the family is asked to help in the treatment, which may include psychotherapy, nutrition counseling, behavior modification, and self-help groups. Therapy often lasts a year or more--on an outpatient basis unless life-threatening physical symptoms or severe psychological problems require hospitalization. If there is deterioration or no response to therapy, the patient (or parent or other advocate) may want to talk to the health professional about the plan of treatment.

If you think a friend or family member has bulimia, point out in a caring, nonjudgmental way the behavior you have observed and encourage the person to get medical help. If you think you have bulimia or anorexia, remember that you are not alone and that this is a health problem that requires professional help. As a first step, talk to your parents, family doctor, religious counselor, or school counselor or nurse.

For more information about bulimia, contact

American Anorexia/Bulimia Association, Inc.

239 Central Park West

Suite 1R

New York, NY 10024

212-501-8351

National Association of Anorexia Nervosa and Associated Disorders

P.O. Box 7

Highland Park, IL 60035

847-831-3438

(Reprinted with permission from the United States Food and Drug Administration)

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