What is bulimia?

Bulimia is an eating disorder. It often begins as rigid dieting that leads to poor nutrition, hunger and fatigue. This can later develop into an out-of-control cycle of rapid binging on extraordinary amounts of high calorie food - such as ice cream or pastries - often followed by purging. Eating may be triggered by psychosocial stress and can occur several times in one day. Between these bouts, most people with bulimia can accept some healthy nutrition.

About 90% of those diagnosed with the eating disorder bulimia are young females. Unlike anorexia nervosa, most women are usually of normal weight for their height and age. About 1% to 3% of young women are estimated to have bulimia.

Bulimia has been defined as two binge-eating episodes a week for at least three months, although sensible steps to remedy the illness can be taken earlier. Patients tend to be more aware and remorseful about their eating behaviour and less likely to deny it, compared to people suffering from anorexia.

People with bulimia compensate for their eating episodes by self-induced vomiting, laxative or diuretic misuse, fasting or excessive exercise. They often feel ashamed when they binge and relieved when they purge. Bulimic eating and purging behaviour often occurs in secret, and is sometimes hard to identify because of this extreme secrecy.

As with anorexia nervosa, people with bulimia may fear gaining weight or want to lose weight, and may feel intensely unhappy with their bodies - however, most tend to fluctuate around their normal body weight, although some people may be obese.

Most health complications from bulimia occur because of purging. Vomiting can cause tooth decay caused by enamel erosion by stomach acid and painless swelling of the parotid (salivary) glands. Some patients may also have scarred knuckles through self-induced vomiting. Hypokalemia (potassium deficiency), fluid and other electrolyte imbalances may occasionally occur.

Treatment for bulimia

Those with bulimia also need to realise they have a serious problem. The treatment goals are similar to patients with anorexia, ie, change eating habits to reduce binging and purging, and improve psychiatric symptoms and social functioning. Specialist referral is required.

Treatment strategies include:

• establishing regular, non-binge eating patterns to reduce binging and subsequent purging
• psychotherapy and treatment of co-existing mood or anxiety disorders
• encouraging healthy, rather than excessive, exercise.

Original material provided by Eating Disorders Association (NZ) Inc. and Pharmacy Today. Edited by everybody.