Bulimia

What is Bulimia?
Bulimia is an eating disorder where people overeat (binge) and then purge by vomiting, using a laxative and/or diuretic, or exercise excessively. Uncontrollable periods of overeating occur as a means to suppress or numb out feelings. The act of purging symbolically flushes feelings away and produces a cleansing effect. Bulimia tends to develop in females, age 13-40.

What causes Bulimia?
An eating disorder occurs when a person begins to focus obsessively on food and weight. It can develop without intent or awareness, and involves a shift from healthy to unhealthy use of food. Some causes are:

• Biology - Evidence is beginning to show some people genetically may be more prone to developing an eating disorder.
• Family of Origin - How food is used and viewed within a family, i.e. "comfort food."
• Individual - Using food to avoid direct conflict resolution, gain control, suppress emotions, or avoid the responsibilities of adulthood.
• Society's Expectations - Society expects individuals (especially women) to appear thin, beautiful, physically fit, and successful.

Typically people with bulimia desire achievement, perfection, and acceptance. This causes pressure and stress. The person may use "comfort food" to cope with life's stressors instead of addressing and resolving them. Often bulimia begins as a convenient way to eat whatever one wants and not gain weight because of the purging. Feeling a lack of control in life may compel a person to start controlling food intake and weight. Individuals may also begin dieting as a way to gain approval, attention, and worth.

Signs and Symptoms
People with bulimia don't usually look or act like they have an eating disorder. They tend not to be underweight and don't avoid food. They are, however, more secretive, and may binge on the way home from school or work so their family doesn't find out. Other signs and symptoms include:

• Binging - eating large amounts of food in a very short period - at least twice a week for three months
• Purging - self-induced vomiting
• Menstrual irregularities
• Swollen glands
• Frequent fluctuations in weight
• Inability to voluntarily stop eating/feeling guilty or ashamed about eating
• Depressive moods
• Persistent overconcern with body shape and weight
• Overeating in reaction to emotional stress
• Laxatives, diuretics, Ipecac syrup, or diet pills hidden in purses, drawers or other places
• Excessive amounts of fast food bags in the car
• Food disappearing from pantry or refrigerator faster than usual
• Going to the bathroom immediately after eating
• Turning on the faucet or shower while in the bathroom (to mask the sound of vomiting)

Treatment Options
Any treatment must be tailored to the specific needs of each person, but there are some general principles that apply to treating eating disorders. The first step in treatment is to complete a thorough evaluation of the person, including a medical evaluation by a qualified physician and a psychosocial evaluation by a qualified mental health professional. Keep in mind these professionals should have experience with eating disorders. This information will be used by the mental health professional, the patient, and other members of the treatment team (physician, dietitian/nutritionist, family, etc.) to develop a treatment plan.

Treatment is done primarily in an outpatient setting and usually includes individual therapy, group therapy, and family therapy. Medication may also be necessary and helpful if the patient is experiencing depression or compulsive behavior. Length of treatment can vary from weeks to months and even years. However some progress should be seen early in the treatment process.

In severe cases where there are significant physical complications (change in vital signs or blood chemistry, severe weight loss, dehydration, abnormal EKG, etc.), co-existing psychiatric disorders, or other unusual circumstances (such as significant resistance to treatment), inpatient hospitalization and treatment may be necessary.

Information Source: Pine Rest TODAY Magazine, "Eating Disorders."
© June, 1995.