What is Bulimia?

The late Princess Diana had the unenviable reputation of being the world’s most famous bulimic. Back in the 1990s when the rumors of her eating disorder were finally acknowledged by her in one of her many authorized biographies, she became the flagship for sufferers the world over.

Bulimia is a disorder that strikes people from all walks of life, as the tragic story of Princess Diana clearly indicates. It affects one in six teenage girls and a slightly lesser percentage of women in their twenties. However as noted in a previous article (see The Desperate Housewives’ Syndrome), the condition is becoming increasingly prevalent among women in their thirties and even forties. No respecter of social standing, wealth, or educational achievements, bulimia can also occur in males, but is less common.

Like anorexia, (see What is Anorexia? and Anorexia: Symptoms and Treatment), the exact cause of bulimia is poorly understood and is likely due to a number of contributing factors. However, the incidence of the condition is on the rise and the pattern of the development of the disorder is well known.

The textbook sufferer of bulimia is a high achieving, often highly intelligent, female teenager. On paper, the sufferer may appear to “have it all”. However, as with anorexia, there is a disturbance in thinking in regard to bodily appearance, but also an insatiable need to gain control of a life that feels, to the sufferer, out of control. Meals are missed in an attempt to lose weight. But to the bulimic, losing weight and the self-denial involved in losing weight, represents supreme control over their emotions and their world.

However, the urge to eat often results in an episode of binge eating, resulting in morbid self-hatred and loss of control. In order to regain a sense of mastery, the bulimic induces vomiting to regurgitate the food. Once this pattern has become a habit, the pathway to severe bulimia has begun.

Initially, the ability to both eat and then regurgitate provides the sufferer with an enormous feeling of elation and self control over their life. It is not hard to imagine the thoughts of a person in this stage of the disorder: “Now I can eat anything I want and not put on weight!” Small wonder this condition has such an addictive allure.

The sufferer rapidly learns what foods are easiest to vomit, and will also consume large quantities of water in order to stave off hunger pangs. When hunger takes control again, further binge eating occurs followed by the onset of purging. This pattern repeats itself over a period of months and years, as long as the sufferer feels a need to exert strong control over the situation they find themselves in. Clearly Princess Diana was profoundly unhappy in her personal life, although on the surface, she contributed much to her public duties. Inside, however, she admitted to being a mass of childhood insecurities which were compounded by a deeply unhappy marital situation.

Clearly these behaviors have enormous repercussions on the health of the individual. Repeated vomited erodes the enamel of the teeth, and well as the lining of the esophagus. Cardiac arrhythmias and kidney failure caused by erratic levels of sodium and potassium in the blood are serious complications of the disturbed eating patterns of bulimics and are the most common cause of death. The face often displays a puffy appearance due to the enlargement of the salivary glands as a result of frequent purging. This latter side effect often masks the condition from friends and family for considerable periods of time as the face retains a full and healthy appearance, unlike that of the anorexia sufferer who quickly gains the tell-tale gaunt appearance of this disorder.

Bulimia sufferers are also plagued by numerous emotional problems including guilt, self-revulsion, depression, and anxiety. This is in addition to the problems that initially set the person off into the underworld of binge-purge-binge behaviors. Laxative abuse, a common addition to the bulimia arsenal of weight loss, eliminates vital trace eliminates and causes dehydration, again interfering with the body’s delicate electrolyte balance. Diuretics are also favored tools used to eliminate bloating caused by excessive water intake.

Next blog, we will look at diagnostic criteria and treatment options.

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