What is Bulimia?

Bulimia as a behavioral pattern, including eating massive quantities of food followed by purging, has been known since the feasts of ancient Roman times. The epidemic of the clinical syndrome of Bulimia Nervosa, appears to date from the era of Twiggy and the fashion industry of Carnaby Street in London of the early 1960's. Somehow Western cultural expectations for ideal body shape and weight for woman changed radically from the Hollywood era of Marilyn Monroe of the 1950's to the early Beatles era of the 1960's.

Bulimia nervosa is a condition characterized by eating binges followed by emergency measures to deal with the consequences of the binge. An eating binge includes a large amount of food consumed in a relatively short period of time with a sense of loss of control by the binge eater. The emergency measures most commonly used to purge include self-induced vomiting and laxative abuse, both of which can have dire physical consequences, as well as extreme or compulsive exercise and severely restrictive eating.

For most individuals, the symptoms of bulimia nervosa appear to be a direct consequence of excessive dietary restriction. As individuals attempt to restrict their food intake well below their biological needs, the body fights back. Basically, you can't fight Mother Nature. Individuals experience extreme hunger, increased awareness of food and food related cues in the environment, and increased emotional distress including irritability, anxiety and depression. Not surprisingly, people then start to eat everything in sight. While initially the binger tries to slow themselves down, usually the process quickly swings out of control because of the intense hunger and sense of deprivation. As this happens, intense guilt sets in and the bulimic individual feels they have to do something to keep their weight in check and meet those strict societal standards. Thus, they turn to purging.

Unfortunately, soon this becomes a pattern: dietary restriction leads to binging which is followed by intense guilt and purging. And on, and on. For a smaller number of individuals grappling with bulimia nervosa, in addition to dietary restriction, preexisting emotional distress, either from depression, anxiety, alcohol or chemical dependency, prior sexual or physical abuse or other poor interpersonal experiences, triggers binge eating and purging episodes. For these individuals, dealing with the causes of emotional distress will also be an important focus of treatment. We also know that over one-third of individuals with Bulimia Nervosa have a prior history of anorexia nervosa. Dietary restriction, cultural pressures and a variety of sources of emotional distress probably cause both disorders.

Bulimia nervosa can have dire physical consequences. Most of the medical risks associated with bulimia are a result of purging. Both self-induced vomiting and laxative abuse can cause electrolyte disturbances which may lead to heart arrhythmias. This risk is enhanced when individuals are either also low weight or use multiple methods of purging. A more common, but not lethal risk is severe tooth decay; basically stomach acids were not meant to frequently come in contact with dental enamel. Some individuals have required tens of thousands of dollars of dental work following self-induced vomiting. Finally, dehydration secondary to purging can cause kidney damage necessitating dialysis or transplant. These are just a few of the potential medical risks associated with bulimia nervosa.

Effective treatment requires medical care for the physical consequences of bulimia nervosa and may include medication for underlying depression or anxiety disorders, when present. Resolving the symptoms of bulimia requires dietary normalization (learning to eat regular meals and snacks), some level of exposure to forbidden foods, learning to change or at least neutralize those self-critical thoughts about body shape and weight, and learning to deal with the emotional triggers for binging and purging.