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Quick reference medical handouts used by Pediatric offices


Bulimia: A common eating disorder


Eating disorders are serious, life-threatening medical conditions that affect 18-20% of youngsters between the ages of eleven and nineteen. Over one million teens are affected with anorexia nervosa or bulimia, the two most common forms of eating disorders. The vast majority occur in young women with a much lower incidence in boys. People are most familiar with anorexia nervosa, an eating disorder in which afflicted people are possessed by an irrational fear of becoming overweight. This spurs them into losing weight to the point of extreme emaciation.

Bulimia is another eating disorder which may occur as a complication of anorexia nervosa or as a completely separate entity. This syndrome is characterized by recurrent episodes of secretive binge eating followed by purging with laxatives, diuretics ("water pills"), and self-induced vomiting, fasting, and feelings of guilt.

Bulimia affects ten percent of women between the ages of 15 and 30, whereas anorexia nervosa affects only one percent. Like anorectics, those afflicted with bulimia are intensely preoccupied with food. Unlike those with anorexia nervosa, bulimics are frequently of normal weight. Relatively few are excessively obese or thin. However, most people with bulimia experience mild to marked weight fluctuations.

Episodes of binge eating may start in childhood. During adolescence, the pattern often progresses to binge eating followed by vomiting to relieve the discomfort of a distended stomach and to prevent a weight gain.

A typical case is a teenage girl who experiences an unwanted weight gain and perceives herself as overweight. Often, the family members and peers highly value thinness. Her loss of control over her weight elicits feelings of fear about being fat. This phobia results in strict caloric restriction and weight loss. Days to months later, this food deprivation precipitates a "hunger breakthrough" and she binges on her favorite high caloric foods. Many bulimics can describe the panic of feeling a binge taking hold much the way someone who suffers from migraines notes the symptoms that herald a headache.

After the binge, she feels ashamed, guilty, and depressed. In addition to relieving her abdominal discomfort, self-induced vomiting is a faster way to rid herself of the extra calories than mere dieting. Later, she adds laxatives and diuretics to the purging regime to enhance weight loss after a binge.

Although the frequency of binge-purging usually increases, bulimia often goes undiagnosed. The reasons are many. Bulimics know their behavior is socially unacceptable. Unlike anorectics, they realize their eating patterns are abnormal. Still, they can t control their binges. As a result, they are very secretive, and because bulimics are often near normal weight, no one suspects an eating disorder. Whereas anorexia nervosa causes many medical problems, people with bulimia generally look healthy. Bulimics are more out-going than the introverted patient with anorexia nervosa through masking their obsessive-compulsive behavior, low self-esteem, and depression. Because they seem to be well adjusted physically, socially, and psychologically, their abnormal eating behavior often goes on for many years before it comes to anyone s attention.

Although bulimics usually enjoy fairly good health, medical complications can and do arise. Roughly 20 percent of women with bulimia develop menstrual irregularities. Binge eating can cause painful dilation of the stomach. An over-full stomach can even rupture. Repeated, forceful vomiting can produce tears in the esophagus. Accidental inhalation of vomitus can lead to pneumonia. Chronic vomiting and abuse of laxatives and diuretics result in disturbances in the body s salt and water balance. Also, heart attacks are a serious consequence of low potassium levels, which are a result of frequent vomiting.

No one knows exactly what causes bulimia. Many people speculate that the cultural value placed on thinness is key in the development of both anorexia nervosa and bulimia. Societal changes such as the replacement of structured eating by "grazing; a decrease in social vs. solitary eating; publicity on fad diets; and less family supervision of adolescents have been blamed for the epidemic increase in the incidence of bulimia. Unhappy family relationships are associated with all eating disorders. Some studies suggest that abnormalities in the chemicals that transmit nervous impulses in the brain are linked with bulimia.

For those individuals who do seek professional help, treatment programs are available. In addition to nutritional counselling, some form of individual, family, or group therapy is usually employed. The objective is to eliminate the binging episodes. Once the cycle is interrupted, the purging and starvation need not follow. Patients with bulimia are taught to eat three moderate, nutritious meals a day. Skipping meals is discouraged since it can lead to overeating later. Other situations, feelings, and foods that can trigger a binge are identified and avoided. Self-help groups patterned after Alcoholics Anonymous, such as Overeaters Anonymous, can be helpful in controlling binge eating. Drug therapy with antidepressant medicines has shown promise in suppressing the appetite as well as in controlling the depression bulimics often experience.

Bulimia is a common eating disorder, particularly among adolescents, and its incidence is steadily increasing. Victims of this illness often feel terrified and lonely. Unfortunately, helping these young people can be difficult because they hide their problem so well. Parents should be alert to signs that their children have bulimia. These warning signals include preoccupation with food and weight, secretive eating behavior, fluctuations in weight, bouts of depression, complaints of abdominal pain and sore throats (from the stomach acid in vomitus), and poor school performance.

Parents who suspect that the youngster might have an eating disorder should contact their child’s physician immediately for a complete medical evaluation. A referral to a child psychiatrist or psychologist with an expertise in treating these disorders can then be made. Youngsters with eating disorder often resist professional help at first. They feel robbed of their sense of control when instructed what and how to eat. On the other hand, parents who deny the possibility that their adolescent has an eating disorder are taking a fatal gamble.

See also: Examining Eating Disorders

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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