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COL Bulimics must change outlook

By Dr. Allen Douma

Tribune Media Services

Q: I saw your recent article about anorexia nervosa being a serious eating disorder. Could you also give me some information about bulimia? Isn't bulimia just as serious as anorexia?

A: Yes, bulimia can be a serious eating disorder, especially if left untreated.

Bulimia nervosa is an eating disorder characterized by frequent uncontrollable bouts of binge eating, followed by inappropriate compensatory behavior known as purging. Purging includes induced vomiting and use of laxatives and diuretics.

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Other ways people compensate for the effects of binge eating involve rigorous dieting and excessive exercise.

Most people with bulimia are young (the condition usually starts at ages 18-20) white women (90 percent are female) who are overly concerned about body weight and shape. They are typically from middle and upper socioeconomic classes, but the condition can afflict both sexes and all races and classes.

No definitive cause of this eating disorder has been identified, but many researchers feel that there is a genetic tie-in and a neurochemical component.

Bulimia is different from anorexia nervosa. In bulimia, the body weight tends to be within the normal range. People are more aware of their behavior and more likely to seek treatment.

This is good because bulimia is more difficult to diagnose on the basis of symptoms -- no excessive weight loss and limited menstrual problems. Sometimes blood tests can show evidence of dehydration.

Women with bulimia tend to be high achievers. Although they are more outgoing and impulsive, people with bulimia are also more prone to depression. Psychological symptoms include obsessive fear of obesity; high concern about sexual attractiveness; and feelings of shame, self-reproach and guilt.

The most common medical complications are dehydration and electrolyte imbalance. But changes in bone and the brain are often significant. Repeated vomiting can play havoc with the digestive system, from loss of dental enamel to changes in the walls of the intestine. The use of emetics to induce purging can permanently damage the heart.

Like anorexia, bulimia is potentially fatal. Heart problems and suicide are the major causes of death in people with bulimia.

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Episodes of binge eating are often accompanied by a sense of lack of control and symptoms of depression. People with bulimia often have a drug or alcohol problem.

Bulimia and other eating disorders can be mild or very severe psychological problems that require psychotherapeutic treatment. This means supportive care with psychotherapy and antidepressant drugs, both of which require professional input.

Group therapy may be particularly helpful, by providing an opportunity to talk about the condition without feeling judged or isolated. Family therapy may help with younger people and their families.

But regardless of what psychological support is obtained, people with bulimia should also retrain their thinking in a couple of very important ways. The first is to acknowledge that physical appearance is only a small part of who one is, and not what really matters. Secondly, a better way to control appearance is through appropriate exercise and rational eating habits.

Dr. Allen J. Douma writes a daily column on a variety of medical and health issues. Write to him in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1500, Chicago, IL 60611; or contact him at DRFamily@aol.com.

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