In bulimia, eating binges may occur as often as several times a day. Induced vomiting known as purging allows the eating to continue without the weight gain; it may continue until interrupted by sleep, abdominal pain, or the presence of another person.

The person is usually aware that their eating pattern is abnormal and may experience fear or guilt associated with the binge-purge episodes. The behavior is usually secretive, although clues to this disorder include overactivity, peculiar eating habits, eating rituals, and frequent weighing. Body weight is usually normal or low, although the person may perceive themselves as overweight.

The exact cause of bulimia is unknown, but factors thought to contribute to its development are family problems, maladaptive behavior, self-identity conflict, and cultural overemphasis on physical appearance. Bulimia may be associated with depression. The disorder is usually not associated with any underlying physical problem although the behavior may be associated with neurological or endocrine diseases. The disorder occurs most often in females of adolescent or young adult age. The incidence is estimated to be 3% in the general population; but 20% of college women suffers from it.

• binge eating followed by purging
• self-induced vomiting
• inappropriate use of diuretics and laxatives
• menstruation, absent or decreased
• overachieving behavior

Dental exam may show dental cavities or gum infections (such as gingivitis). The enamel of the teeth may be eroded or pitted because of excessive exposure to acid in vomitus.

A chem-20 may show an electrolyte imbalance (such as hypokalemia) or dehydration.

Treatment focuses on breaking the binge-purge cycles of behavior since the person is usually aware that the behavior is abnormal. Outpatient treatment may include behavior modification techniques and individual, group, or family counseling.

Antidepressant drugs may be indicated for some whether or not they have coincident depression.

Participation in self-help groups such as Overeaters Anonymous may be of benefit. American Anorexia/Bulimia Association is a source of information about this disorder. See eating disorders - support group.

With treatment up to one half of those affected continue to experience behavior and psychiatric problems. Death due to bulimia is very rare.

• pancreatitis
• dental cavities
• inflammation of the throat
• electrolyte abnormalities
• dehydration
• constipation
• hemorrhoids
• esophageal tears/rupture

Call for an appointment with your health care provider if you (or your child) are exhibiting behaviors of any eating disorder, including bulimia.

A cultural and family de-emphasis on physical appearance may eventually reduce the incidence of this disorder.