Diseases & Conditions



A destructive pattern of overeating followed by vomiting or other purging behaviors in order to control weight. Unlike girls with ANOREXIA, those with bulimia eat large amounts of food and then get rid of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all of these. Because many girls with bulimia binge and purge in secret and maintain normal or above-normal body weight, they often can successfully hide their problem from others for years. Bulimia becomes a serious problem when a girl is bingeing and purging at least twice a week for three months, while becoming excessively worried about her body shape and weight. Dieting heavily between episodes of bingeing and purging is common; eventually, half of girls with anorexia will develop bulimia. About 2 percent to 3 percent of young girls develop bulimia. Cause Certain personality characteristics seem to be associated with bulimia, including a fear of losing control, inflexible thinking, perfectionism, dissatisfaction with body shape, and an overwhelming desire to be thin. Bulimia has also been linked to mood disturbances such as DEPRESSION or social anxiety. As with anorexia, bulimia typically begins during adolescence and occurs most often among girls. Girls with bulimia deny their hunger and restrict their food intake for several days or weeks at a time, but sooner or later, they begin to eat and cannot stop eating until they have stuffed themselves. Experts think this overeating compensates for the prior calorie restriction. Binge eating may also be related to problems with feeling satisfied after meals, since many bulimics report that they have trouble feeling full unless they eat large amounts of food. Symptoms Even bulimia patients at normal weight can severely damage their bodies by frequent binge eating and purging. In rare instances, binge eating causes the stomach to rupture; purging may lead to heart failure because of loss of vital minerals, such as potassium. Constant vomiting causes other less deadly, but serious problems; the acid in vomit wears down the outer layer of the teeth, the esophagus becomes inflamed, and glands near the cheeks become swollen. As with anorexia, bulimia may lead to irregular menstrual periods. Some girls with bulimia also struggle with addictions, including abuse of drugs and alcohol, or compulsive stealing. Many suffer from clinical depression, anxiety, obsessive-compulsive disorder, and other mental health problems. These problems, combined with impulsive tendencies, place them at increase risk for suicide. Treatment In treating bulimia, doctors must first deal with any serious physical complications. In some cases the binge-purge cycle is so severe that the girl cannot stop on her own and hospitalization may be necessary, followed by individual counseling, sometimes combined with medication. Counseling may last for about four to six months; group therapy is also very helpful for bulimics. Antidepressants may also be effective in treating girls with bulimia. In outpatient treatment, bulimic patients are often asked to keep a food intake diary, making sure they eat three meals a day of moderate caloric intake, even if they are still binge eating. Exercise is limited, and if the girl becomes compulsive about it, is not permitted at all. Bulimia is a chronic disorder that comes and goes. Of those girls who are treated, three years later less than a third will be fully recovered; more than one-third will show some improvement in symptoms, and the final third will have relapsed.