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What
is bulimia nervosa?
Bulimia nervosa is a serious eating disorder marked by a destructive
pattern of binge-eating and recurrent inappropriate behavior
to control one's weight. It can occur together with other
psychiatric disorders such as depression, obsessive-compulsive
disorder, substance dependence, or self-injurious behavior.
Binge eating is defined as the consumption of excessively
large amounts of food within a short period of time. The food
is often sweet, high in calories, and has a texture that makes
it easy to eat fast. "Inappropriate compensatory behavior"
to control one's weight may include purging behaviors (such
as self-induced vomiting, abuse of laxatives, diuretics, or
enemas) or non-purging behaviors (such as fasting or excessive
exercise). For those who binge eat, sometimes any amount of
food, even a salad or half an apple, is perceived as a binge
and is vomited.
People
with bulimia nervosa often feel a lack of control during their
eating binges. Their food is usually eaten secretly and gobbled
down rapidly with little chewing. A binge is usually ended
by abdominal discomfort. When the binge is over, the person
with bulimia feels guilty and purges to rid his or her body
of the excess calories. To be diagnosed with bulimia, a person
must have had, on average, a minimum of two binge-eating episodes
a week for at least three months. The first problem with any
eating disorder is constant concern with food and weight to
the exclusion of almost all other personal concerns.
Who
develops bulimia?
Bulimia nervosa typically begins in adolescence or early adulthood.
Like anorexia nervosa, bulimia mainly affects females. Only
ten percent to 15 percent of affected individuals are male.
An estimated two percent to three percent of young women develop
bulimia, compared with the one-half to one percent that is
estimated to suffer from anorexia. Studies indicate that about
50 percent of those who begin an eating disorder with anorexia
nervosa later become bulimic.
It
is believed that more than five million individuals experience
an eating disorder (bulimia nervosa or anorexia nervosa) in
this country alone. It is ten times more common in women than
men, with greatest prevalence occurring in adolescents and
college-age young adults. This indicates a need for concern
and preventive measures on college campuses across the country,
especially for female students.
How
do people with bulimia control their weight?
People with bulimia are overly concerned with body shape and
weight. They make repeated attempts to control their weight
by fasting and dieting, vomiting, using drugs to stimulate
bowel movements and urination, and exercising excessively.
Weight fluctuations are common because of alternating binges
and fasts. Unlike people with anorexia, people with bulimia
are usually within a normal weight range. However, many heavy
people who lose weight begin vomiting to maintain the weight
loss.
What
are the common signs of bulimia?
Constant concern about food and weight is a primary sign of
bulimia. Common indicators that suggest the self-induced vomiting
that persons with bulimia experience are the erosion of dental
enamel (due to the acid in the vomit) and scarring on the
backs of the hands (due to repeatedly pushing fingers down
the throat to induce vomiting).
A
small percentage of people with bulimia show swelling of the
glands near the cheeks called parotid glands. People with
bulimia may also experience irregular menstrual periods and
a decrease in sexual interest. A depressed mood is also commonly
observed as are frequent complaints of sore throats and abdominal
pain. Despite these telltale signs, bulimia nervosa is difficult
to catch early. Binge eating and purging are often done in
secret and can be easily concealed by a normal-weight person
who is ashamed of his or her behavior, but compelled to continue
it because he or she believes it controls weight. Characteristically,
these individuals have many rules about food-e.g. good foods,
bad foods-- and can be entrenched in these rules and particular
thinking patterns. This preoccupation and these behaviors
allow the person to shift their focus from painful feelings
and reduce tension and anxiety perpetuating the need for these
behaviors.
Are
there any serious medical complications?
Persons with bulimia--even those of normal weight--can severely
damage their bodies by frequent binging and purging. Electrolyte
imbalance and dehydration can occur and may cause cardiac
complications and, occasionally, sudden death. In rare instances,
binge eating can cause the stomach to rupture, and purging
can result in heart failure due to the loss of vital minerals
like potassium.
Do
we know what causes bulimia?
The current obsession with thinness in our culture certainly
has a large influence. There is some evidence that obesity
in adolescence or familial tendency toward obesity predisposes
an individual to the development of the disorder. Parents’
anxiety over a chubby child can perhaps also be a contributor.
Some individuals with bulimia report feeling a "kind
of high" when they vomit. People with bulimia are often
compulsive and may also abuse alcohol and drugs. Eating disorders
like anorexia and bulimia tend to run in families, and girls
are most susceptible. Recently, scientists have found certain
neurotransmitters (serotonin and norepinephrine) to be decreased
in some persons with bulimia. Most likely, it is a combination
of environmental and biological factors that contribute to
the development and expression of this disorder. During the
early 1970s, before the prevalence of bulimia was more widely
recognized, almost all persons with an eating disorder believed
they had invented the behaviors and that no one else had such
a problem. As in anorexia nervosa, the behaviors associated
with bulimia provide temporary relief from tension and allow
ill persons to focus less on problems perceived as unresolvable
and to instead focus on body weight and food.
Is
treatment available for persons with bulimia?
Most
people with bulimia can be treated through individual outpatient
therapy because they aren't in danger of starving themselves
as are persons with anorexia. However, if the bulimia is out
of control, admission to an eating disorders treatment program
may help the individual let go of their behaviors so they
can concentrate on treatment.
Group
therapy is especially effective for college-aged and
young adult women because of the understanding of the group
members. In group therapy they can talk with peers
who have similar experiences. Additionally, support groups
can be helpful as they can be attended for as long as necessary,
have flexible schedules, and generally have no charge. Support
groups, however, do not take the place of treatment. Sometimes
a person with an eating disorder is unable to benefit from
group therapy or support groups without the encouragement
of a personal therapist.
Cognitive-behavioral
therapy, either in a group setting or individual therapy
session, has been shown to benefit many persons with bulimia.
It focuses on self-monitoring of eating and purging behaviors
as well as changing the distorted thinking patterns associated
with the disorder. Cognitive-behavioral therapy is often combined
with nutritional counseling and/or antidepressant medications
such as fluoxetine (Prozac).
Treatment
plans should be adjusted to meet the needs of the individual
concerned, but usually a comprehensive treatment plan involving
a variety of experts and approaches is best. It is important
to take an approach that involves developing support for the
person with an eating disorder from the family environment
or within the patient’s community environment (support
groups or other socially supportive environments).
What
about prevention?
Prevention research is increasing as scientists study the
known "risk factors" to these disorders. Given that
bulimia and other eating disorders are multi-determined and
affect young women, there is preliminary information on the
role and extent such factors as self esteem, resilience, family
interactions, peer pressure, the media and dieting might play
in its development. Advocacy groups are also engaged in prevention
through efforts such as removing damaging articles from teen
magazines on "dieting’" and the importance
of "being thin."
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