What is bulimia?

Causes and Symptoms

Bulimia is typically regarded as a psychologically based disorder caused by childhood experiences, family influences, and social pressures, particularly on young women to be thinner than natural. Many people who develop bulimia have been overweight in the past and suffer from poor self-image and depression. Body weight is often within normal limits, but persons with bulimia perceive themselves as fat and are often obsessed with their body image. Others may have a history of sexual or physical abuse or of alcohol or drug abuse. Medical research suggests that bulimia may be partially caused by impaired secretion of cholecystokinin (CKK), a hormone that normally induces a feeling of fullness after a meal, or by depletion of the chemical serotonin in the brain, which contributes to a craving for carbohydrates.

Intense preoccupation with food and weight are invariably present, and eating binges are followed with self-induced vomiting or the ingestion of laxatives to rid the body of the consumed food. Depression and suicidal feelings sometimes accompany bulimia. The disorder can cause nutritional deficiencies, dehydration, hormonal changes, gastrointestinal problems, changes in metabolism and blood chemistry, heart disorders, persistent sore throat, and teeth and gum damage as a result of the acidic nature of regurgitated food.

Treatment and Therapy

Treatment of bulimia requires a combination of nutritional counseling, medication, and psychotherapy. Psychotherapists try to get to the root of any underlying psychological problems and resolve them. Various modes of group and cognitive behavioral therapy have proven effective.

Cognitive therapy usually includes confronting people with bulimia about their inaccurate perceptions of body weight and making contracts with them to shift their focus to nutrition rather than weight gain in exchange for rewards. Group therapy has helped many bulimics stop their binge eating, while treatment with antidepressant drugs, especially fluoxetine (Prozac), has helped many bulimic patients gain partial or full relief from their symptoms. Hospitalization is common treatment and is virtually always necessary if body weight is more than 30 percent below ideal.

Perspective and Prospects

Bulimia was classified as a distinct disorder by the American Psychiatric Association in 1980; the name was officially changed to bulimia nervosa in 1987. The disorder occurs mostly in adolescent and young adult females, with only about 10 percent of cases in males. Many cases of bulimia end after a few weeks or months but may reoccur. Other cases last for years without interruption.

In 2006, researchers developed a new test that analyzes carbon and nitrogen in hair, which is suggestive of eating disorders. This technique is beneficial because eating disorders are difficult to diagnose, in part because sufferers sometimes do not know that they have an eating disorder or do not want to be honest. By analyzing just five strands of hair, researchers were able to diagnose anorexia and bulimia accurately 80 percent of the time. This test may hasten treatment and prove an effective and objective method of monitoring recovery.

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Swain, Pamela I., ed. Anorexia Nervosa and Bulimia Nervosa: New Research. New York: Nova Science, 2006.

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Wood, Debra. "Bulimia Nervosa (Bulimia)." Health Library, Sept. 10, 2012.