In this second article of my series on eating disorders, I want to discuss bulimia, another serious disorder that, unlike anorexia with its telltale symptom of extreme weight loss, can often go unnoticed.

Bulimia is marked by binge eating, which is then followed with behaviour such as purging and the use of laxatives or other inappropriate methods to control weight.

Unlike anorexics, bulimic individuals tend to remain within a normal weight range often fluctuating back and forth as they binge and purge.

Binge eating is defined as the consumption of excessively large amounts of food within a short period of time. Usually this is high fat, high calorie food that can be eaten quickly and binging is most often done in secret. During a binging episode, a bulimic person very often feels a lack of control over the situation.

Although bulimic individuals may consume a large amount of food in a day, this is accompanied by feelings of shame and disgust, which cause an irresistible urge to rid the body of the food.

In order to be diagnosed with bulimia, an individual usually must have a minimum average of two binging episodes each week for at least three months. However, many bulimics binge and purge much more often than this.

Many people with bulimia also experience impulse control problems in other areas of life, shoplifting and substance abuse are two commonly co-existing problems. Also, borderline personality disorder is common among individuals with bulimia.

As with anorexia, bulimia affects girls far more often than boys. It typically begins in adolescence and is experienced by approximately three per cent of the general population.

In any eating disorder, the first noticeable sign is a constant concern with food and weight to the exclusion of most or all else. This can gradually progress into an eating disorder for some people and should not be ignored.

Although preoccupied with thoughts of food and body, bulimia is not really about weight control. As with all eating disorders, it becomes a kind of coping system for reducing feelings of anxiety, tension and painful emotions.

Unfortunately, this way of coping is dangerous and can even be fatal. While starvation is not the issue in bulimia, there is often extensive damage to the body.

Tooth enamel is damaged by the acidity of vomit, hands are often scarred from the act of inducing vomiting and menstrual periods become irregular from the constant fluctuations in weight. Frequent sore throats, swollen parotid glands and abdominal discomfort are other health concerns common for bulimics.

Serious complications occur as the binge and purge behaviours can cause electrolyte imbalance, dehydration, cardiac complications and sometimes sudden death. Occasionally, binge eating can even cause the stomach to rupture while purging can bring on heart failure. Clearly, bulimia is not a disorder to take lightly.

Although it is not entirely understood what causes bulimia in young women, there are likely a variety of contributing factors including genetic and environmental aspects as discussed in last week's column on anorexia.

Treating any eating disorder can be difficult and bulimia is no exception. First, it is often difficult to see that there is a disorder since normal weight is maintained and binging and purging are usually done in secret. However, unlike anorexic patients, most people with bulimia do recognize that their behaviours are not normal and that they could be dangerous to their health.

Treatment can typically be done on an outpatient basis with cognitive behavioural therapy to change negative thought patterns and to learn to self-monitor behaviour. Nutrition counseling, group therapy and support groups can also help in effective treatment. Selective serotonin reuptake inhibitor (SSRI) antidepressants have been shown to be effective in many controlled clinical trials. If you fear someone you love may have bulimia, encourage them to seek professional help as soon as possible.


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