WHAT IS IT?
Bulimia nervosa is a serious eating disorder in which people develop a secret pattern of binge eating (eating large amounts of food at one time), followed by purging. Purging is the process of getting rid of the food and calories by self-induced vomiting or taking laxatives and/or diuretics. The person may also fast or exercise vigorously, only to binge again. Bulimia nervosa is considered a mental illness, and is usually accompanied by symptoms of depression and obsessive-compulsive disorder.

Profile of a Bulimic
All victims of bulimia are plagued by irresistible urges to binge on food. During a binge,bulimics often choose foods—such as ice cream,candy bars, puddings and cookies—that are high-fat,high-sugar,easy-to-swallow,and easy-to-vomit afterward.Bulimics usually gorge in secret.A binge typically lasts about 2 hours—although some are shorter or longer—and only stops when the bulimic gets a stomachache,feels sleepy,or is interrupted.

After a binge,self-induced purging is the norm.Bulimics usually make themselves vomit or use laxatives,diuretics,or diet pills to get rid of all the excess food.Some then follow a strict diet or exercise compulsively to undo the damage until the cycle begins all over again.

Women with this eating disorder often feel depressed,ashamed,and guilty after a binge.They realize that their behavior is abnormal,and that they are out of control.

The pattern of binge eating varies.Some bulimics binge several times a day for a few days,then not at all for a long time.Others follow a predictable pattern,such as binging and purging 3 times a week.Some binge only in response to certain stressful situations.The behavior may go on for years,although many bulimics often eat normally between phases of binging and purging.A few bulimics are totally given over to the binge and purge pattern and never maintain a normal diet.The amount of food consumed during a binge also varies considerably,but is always much more than the bulimic would ordinarily eat in a day.

HOW COMMON IS BULIMIA/WHO IS AT RISK?
While young and middle or upper class women are particularly susceptible to bulimia, the disorder strikes people of all economic backgrounds and is found among all ethnic groups. The illness usually begins between the ages of 15 and 24, but it can occur in younger or older women and in men. If you are a young woman, your odds of developing bulimia are estimated to be between 1 and 2 in 100. The disorder strikes males at only a tenth of the rate experienced by women.

Studies have shown that bulimics frequently have obese parents or siblings, which may explain their exceptional fear of becoming fat themselves. Studies have also found that close family members of bulimics suffer from depression more often than would be expected.

Some bulimics adopt this abnormal eating pattern for professional reasons.Dancers,actors,models,and athletes whose careers depend on low body weight often stay thin by purging themselves with laxatives or inducing vomiting.They do not,however,always indulge in binge eating.

Most people with bulimia nervosa are females, ranging in age from the teens to early 20s, who are preoccupied with their weight and body image.Bulimia nervosa affects all races, but is most often diagnosed in Caucasian women.

Bulimics,usually are extroverted before their illness, are inclined to be overweight, have voracious appetites and have episodes of binge eating.They have been characterized as relatively more social, impulsive, and affectively labile.

In early reports on bulimia, a connection was made between compulsive eating and stealing.Some reports have made mention of stealing behavior as an aspect of "impulsivity" in eating disordered patients The majority of bulimic shoplifters reported stealing something which was involved with their eating disorder (e.g., food money, laxatives, diuretics, or diet pills) and they indicated that embarrassment and shame over buying these items was the main reason to shoplift.

BULIMIA & SUBSTANCE ABUSE
Impulsivity is a key feature of both bulimia and substance abuse.The self-medication hypothesis suggests that eating disordered individuals begin abusing chemical substances in an effort to treat their eating problems,as a means of coping with the worry caused by these problems.Additionally,an association between eating disorders and familial drug abuse,usually alcoholism,suggests the possibility of biological similarities or links between substance abuse and eating disorders.

Here is the diagnostic criterias, from the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-IV):

Diagnostic criteria for 307.51 Bulimia Nervosa

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:     (1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances     (2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Specify type:    Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas    Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

WHO IS AT RISK?

People who become bulimic often have problems with anxiety, depression, and impulse control; for example, shoplifting, casual sexual activity, binge shopping, alcohol and drug abuse, and cutting and other self-harm behaviors. They do not handle stress gracefully. They may be dependent on their families even though they fiercely profess independence. Many have problems trusting other people. They have few or no truly satisfying friendships or romantic relationships.

They may diet,thinking to improve their lives and feel better about themselves.The deprivation leads to hunger,which leads to powerful cravings,which lead to binge eating.Feeling guilty,and afraid of weight gain,they try to remove calories from their bodies by vomiting,laxative abuse,fasting,or other methods of purging.

WHAT ARE THE SYMPTOMS?

People with bulimia nervosa cannot control the urge to eat large amounts of food at one time because it makes them feel better. Afterward, however, feelings of guilt and remorse lead them to purge the food. The purging process progresses until they may purge after any meal, no matter what size. Vomiting not only gets rid of the food, but also some important minerals that the body needs to remain healthy. Loss of minerals such as potassium can lead to heart failure. The acids in vomit can wear away tooth enamel,called erosion; enlarge the salivary glands in the cheeks;irritate the fingers,which are often used to trigger vomiting;and inflame the esophagus, the tube leading from the mouth to the stomach.Excessive dieting and exercise can lead to irregular menstrual periods. In rare cases, a bulimic person may eat so much food at once that the stomach ruptures.But a stomach rupture is most likely to occur when someone is throwing up: the actual FORCE that is exerts on the person's body may cause this to happen. Because bulimia is linked to obsessive-compulsive disorder and depression,people who are bulimic are more likely to abuse substances such as drugs or alcohol,and perform other obsessive-compulsive rituals.Those close to the bulimic person may notice that he or she is unnaturally concerned with body weight and appearance,and finds a reason to use the bathroom right after a meal.Severe bulimia can lead to malnutrition and death.

PSYCHOLOGICAL MOTIVATION OF BULIMIA:
People who suffer from bulimia are also afraid of being fat. Most often they will weigh a normal size because they still enjoy eating. People with bulimia over eat; they consume huge quantities of food in one sitting. The food is usually junk food or comfort foods. They know they will get fat if they don’t get rid of the food they just consumed. So to control the weight gain, they take laxatives, diuretics, and induce vomiting. Bulimics understand that they have a problem with food, they just are unable to control it. They usually have impulsive, addictive personalities.

WHAT CAUSES IT?

The exact cause of bulimia is unknown.However,because this disorder tends to run in families, there may be a genetic link.Many young women cite pressures to conform to society’s or their family’s image of the perfect woman.Others find that the bingeing and purging is one factor in their lives that they can control.The bulimic person uses the bingeing and purging process to relieve stress and anxiety.For some bulimics,the binge/purge pattern is a component of obsessive-compulsive disorder,an anxiety disorder in which a person has repeated unwanted thoughts,ideas,images,or impulses,called obsessions,over which they feel they have no control.The patient uses food to make these thoughts or images go away and to relieve the anxiety they cause.Studies have also found that people with bulimia may have malfunctioning brain chemicals,called neurotransmitters.

NEWS:
In a new study, Dr. Walter Kaye, a University of Pittsburgh psychiatry professor, has found evidence that bulimic women have altered brain chemistry, possibly from birth, which puts them at higher risk for eating disorders—even long after they’ve recovered from bulimia.

A new study adds to evidence that the eating disorder bulimia springs at least in part from a chemical malfunction in the brain and not merely from excessive desire to remain thin, researchers say.

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CONSEQUENCES OF BULIMIA:
This destructive behavior eventually takes a toll on the body...

HOSPITALIZATION CRITERIAS:

Severe weight loss and malnutrition: -Weight <75% of ideal body weight; -Weight loss of (>/=)=30% in 3 mo; -BMI < 14 and inability/unwillingness to gain weight.

Dehydration

Electrolyte abnormalities: -Hypokalemia, especially if K is <2.5 mmol/L; -Prolonged QTc; -Arrhythmia; -Marked hypophosphatemia (<1.0 mg/dL)

Physiologic instability: -Severe bradycardia (<40 bpm); -Hypotension (systolic BP <70); -Hypothermia (<35°C); -Orthostatic changes in HR and BP, syncope.

Arrested growth and development

Failure of outpatient treatment:=>(usually 3-6 mo,but sooner if medical condition deteriorates)

Acute food refusal

Uncontrollable binge eating and purging

Acute medical complications of malnutrition: -Syncope; -Seizures (hypoglycemic,hyponatremic,bupropion and other medications) -Cardiac failure; -Arrhythmia; -Mallory-Weiss esophageal tear; -Gastric rupture; -Pancreatitis

Acute psychiatric emergencies: -Suicidal ideation; -Acute psychosis

Comorbid diagnosis that interferes with treatment of the eating disorder: -Severe depression -Obsessive-compulsive disorder; -Severe family dysfunction; -Substance abuse

WHAT IS THE TREATMENT?

It is important to begin treatment as soon as possible before permanent physical damage is done. The most common and effective treatment is a combination of psychotherapy and drugs. The goal of psychotherapy is to address the anxieties that are at the root of the bulimic behavior. Individual and family therapy are beneficial because the bulimic person needs a strong support system to break the binge/purge pattern and to reinforce a positive body and food image. Many patients also find group therapy very helpful because they can learn from the experiences of others. Antidepressants are the most effective drug treatment. A nutritionist can help the patient develop a diet plan that is healthy and realistic.

SELF-CARE TIPS:

Although there is no known medical treatment to prevent bulimia, recognizing the signs and symptoms of this disorder are important to early diagnosis and treatment, which prevents long-term physical damage. Parents and caregivers can help develop a positive body image in their female children, especially, by encouraging healthy eating and exercise, promoting a realistic model of healthy body shapes and sizes, and providing a positive role model in terms of moderation in eating. It is important not to place too much emphasis on appearance and weight as a child is growing and developing.

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Click here to see how it can destroy your body...Even if you think you're "alright"!...

YOU CAN DIE FROM BULIMIA!
That,at ANY weight!
OK??Is this clear??It can kill you!
PLEASE THINK TWICE ABOUT THE CHOICES YOU'RE MAKING...