Bulimia nervosa involves episodes of binge eating followed by various means to purge the food. This eating disorder was first described in the medical literature in 1979 and classified as a clinical psychiatric disorder in 1980. It is most common among young adults of college age, although some high school students are also at risk. Susceptible people often have genetic factors and lifestyle patterns that predispose them to becoming overweight, and many try frequent weight-reduction diets as teenagers. Like people with anorexia nervosa, those with bulimia nervosa are usually female and successful. Unlike anorexics, however, they are usually at or slightly above a normal weight. Females with bulimia nervosa are also more likely to be sexually active than those with anorexia nervosa.
The person with bulimia nervosa may think of food constantly. In contrast to the anorexic person, who turns away from food when faced with problems, the bulimic person turns toward food in critical situations. Also, unlike those with anorexia nervosa, people with bulimia nervosa recognize their behavior as abnormal. These people often have very low self-esteem and are depressed. Approximately half of the people with bulimia nervosa have major depression. Lingering effects of child abuse may be one reason for these feelings. Many bulimic persons report that they have been sexually abused. The world sees their competence, while inside they feel out of control, ashamed, and frustrated.
Bulimic people tend to be impulsive, which may be expressed as stealing, drug and alcohol abuse, self-mutilation, or attempted suicide. Some experts have suggested that part of the problem may actually arise from an inability to control responses to impulse and desire. Some studies have demonstrated that bulimic people tend to come from disengaged families—ones that are loosely organized. Roles for family members are not clearly defined. Too little protection is provided for family members, rules are very loose, and a great deal of conflict exists. Anorexic people in comparison tend to have families so actively engaged that roles may be too well defined.
Showing posts with label Bulimia Nervosa. Show all posts
Showing posts with label Bulimia Nervosa. Show all posts
Tuesday, June 29, 2010
Treatment of Bulimia Nervosa
Therapy for bulimia nervosa, as for anorexia nervosa, requires a team of experienced clinicians. These patients are less likely than those with anorexia to enter treatment in a state of semistarvation. However, if a bulimic patient has lost significant weight, this must be treated before psychological treatment begins. Although clinicians have yet to agree on the best therapy for bulimia nervosa, they generally agree that treatment should last at least 16 weeks. Hospitalization may be indicated in cases of extreme laxative abuse, regular vomiting, substance abuse, and depression, especially if physical harm is evident.
The first goal of treatment for bulimia nervosa is to decrease the amount of food consumed in a binge session in order to decrease the risk of esophageal tears from related purging by vomiting. A decrease in the number of this type of purges will also decrease damage to the teeth.
The primary aim of psychotherapy is to improve patients' self-acceptance and help them to be less concerned about body weight. Cognitive behavior therapy is generally used. Psychotherapy helps correct the all-or-none thinking typical of bulimic persons— "If I eat one cookie, I'm a failure and might as well binge." A patient may be asked to analyze the statement as a scientist would do when testing assumptions. In this way, patient and therapist together examine the validity of food and weight beliefs. The premise of this therapy is that, if abnormal attitudes and beliefs can be altered, normal eating will follow. In addition, the therapist guides the person in establishing food habits that will minimize bingeing: avoiding fasting, eating regular meals, and using alternative methods—other than eating—to cope with stressful situations. Group therapy is often useful to foster strong social support. One goal of therapy is to help bulimic persons accept as normal some depression and self-doubt.
Although pharmacological agents should not be used as the sole treatment for bulimia nervosa, studies indicate that some medications may be beneficial in conjunction with other therapies. Fluoxetine (Prozac) is the only antidepressant that has been approved by PDA for use in the treatment of bulimia nervosa, but physicians also may prescribe other forms of antidepressants and related medications.
Nutritional counseling has two main goals: correcting misconceptions about food and re-establishing regular eating habits. Patients are given information about bulimia nervosa and its consequences. Avoiding binge foods and not constantly stepping on a scale may be recommended early in treatment. The primary goal, however, is to develop a normal eating pattern. To achieve this goal, some specialists encourage patients to develop daily meal plans and keep a food diary in which they record food intake, internal sensations of hunger, environmental factors that precipitate binges, and thoughts and feelings that accompany binge-purge cycles. Keeping a food diary not only is an accurate way to monitor food intake but also may help identify situations that seem to trigger binge episodes. With the help of a therapist, patients can develop alternative coping strategies.
In general, the focus is not on stopping bingeing and purging per se but on developing regular eating habits. Once this is achieved, the binge-purge cycle should stop by itself. Patients are discouraged from following strict rules about healthy food choices, because this simply mimics the typical obsessive attitudes associated with bulimia nervosa. Rather, encouraging a mature perspective on nutrient intake—that is, regular consumption of moderate amounts of a variety of foods balanced among the food groups—helps patients overcome this disorder.
Setting time limits for the completion of meals and snacks is important for people with eating disorders. Many bulimic persons eat very quickly, reflecting their difficulties with satiety. Suggesting that the patient put his or her utensil down after each bite is a behavioral technique that a therapist might try with a recovering bulimic person. (In comparison, many anorexic persons eat in an excessively slow manner—for example, taking 1 hour to eat a muffin because it was cut into tiny, bite-size pieces.)
People with bulimia nervosa must recognize that it is a serious disorder that canhave grave medical complications if not treated. Because relapse is likely, therapyshould be long term. Note that those with bulimia nervosa need professional help because they can be very depressed and are at a high risk for suicide. About 50% of people with bulimia nervosa recover completely from the disorder. Others continue tostruggle with it to varying degrees for the rest of their lives. This fact underscores theneed for prevention because treatment is difficult.
The first goal of treatment for bulimia nervosa is to decrease the amount of food consumed in a binge session in order to decrease the risk of esophageal tears from related purging by vomiting. A decrease in the number of this type of purges will also decrease damage to the teeth.
The primary aim of psychotherapy is to improve patients' self-acceptance and help them to be less concerned about body weight. Cognitive behavior therapy is generally used. Psychotherapy helps correct the all-or-none thinking typical of bulimic persons— "If I eat one cookie, I'm a failure and might as well binge." A patient may be asked to analyze the statement as a scientist would do when testing assumptions. In this way, patient and therapist together examine the validity of food and weight beliefs. The premise of this therapy is that, if abnormal attitudes and beliefs can be altered, normal eating will follow. In addition, the therapist guides the person in establishing food habits that will minimize bingeing: avoiding fasting, eating regular meals, and using alternative methods—other than eating—to cope with stressful situations. Group therapy is often useful to foster strong social support. One goal of therapy is to help bulimic persons accept as normal some depression and self-doubt.
Although pharmacological agents should not be used as the sole treatment for bulimia nervosa, studies indicate that some medications may be beneficial in conjunction with other therapies. Fluoxetine (Prozac) is the only antidepressant that has been approved by PDA for use in the treatment of bulimia nervosa, but physicians also may prescribe other forms of antidepressants and related medications.
Nutritional counseling has two main goals: correcting misconceptions about food and re-establishing regular eating habits. Patients are given information about bulimia nervosa and its consequences. Avoiding binge foods and not constantly stepping on a scale may be recommended early in treatment. The primary goal, however, is to develop a normal eating pattern. To achieve this goal, some specialists encourage patients to develop daily meal plans and keep a food diary in which they record food intake, internal sensations of hunger, environmental factors that precipitate binges, and thoughts and feelings that accompany binge-purge cycles. Keeping a food diary not only is an accurate way to monitor food intake but also may help identify situations that seem to trigger binge episodes. With the help of a therapist, patients can develop alternative coping strategies.
In general, the focus is not on stopping bingeing and purging per se but on developing regular eating habits. Once this is achieved, the binge-purge cycle should stop by itself. Patients are discouraged from following strict rules about healthy food choices, because this simply mimics the typical obsessive attitudes associated with bulimia nervosa. Rather, encouraging a mature perspective on nutrient intake—that is, regular consumption of moderate amounts of a variety of foods balanced among the food groups—helps patients overcome this disorder.
Setting time limits for the completion of meals and snacks is important for people with eating disorders. Many bulimic persons eat very quickly, reflecting their difficulties with satiety. Suggesting that the patient put his or her utensil down after each bite is a behavioral technique that a therapist might try with a recovering bulimic person. (In comparison, many anorexic persons eat in an excessively slow manner—for example, taking 1 hour to eat a muffin because it was cut into tiny, bite-size pieces.)
People with bulimia nervosa must recognize that it is a serious disorder that canhave grave medical complications if not treated. Because relapse is likely, therapyshould be long term. Note that those with bulimia nervosa need professional help because they can be very depressed and are at a high risk for suicide. About 50% of people with bulimia nervosa recover completely from the disorder. Others continue tostruggle with it to varying degrees for the rest of their lives. This fact underscores theneed for prevention because treatment is difficult.
Saturday, June 26, 2010
Nutritional counseling for Bulimia Nervosa
Treatment of Bulimia Nervosa
Nutritional counseling has two main goals: correcting misconceptions about food and re-establishing regular eating habits. Patients are given information about bulimia nervosa and its consequences. Avoiding binge foods and not constantly stepping on a scale may be recommended early in treatment. The primary goal, however, is to develop a normal eating pattern. To achieve this goal, some specialists encourage patients to develop daily meal plans and keep a food diary in which they record food intake, internal sensations of hunger, environmental factors that precipitate binges, and thoughts and feelings that accompany binge-purge cycles. Keeping a food diary not only is an accurate way to monitor food intake but also may help identify situations that seem to trigger binge episodes. With the help of a therapist, patients can develop alternative coping strategies.
In general, the focus is not on stopping bingeing and purging per se but on developing regular eating habits. Once this is achieved, the binge-purge cycle should stop by itself. Patients are discouraged from following strict rules about healthy food choices, because this simply mimics the typical obsessive attitudes associated with bulimia nervosa. Rather, encouraging a mature perspective on nutrient intake—that is, regular consumption of moderate amounts of a variety of foods balanced among the food groups—helps patients overcome this disorder.
Setting time limits for the completion of meals and snacks is important for people with eating disorders. Many bulimic persons eat very quickly, reflecting their difficulties with satiety. Suggesting that the patient put his or her utensil down after each bite is a behavioral technique that a therapist might try with a recovering bulimic person. (In comparison, many anorexic persons eat in an excessively slow manner—for example, taking 1 hour to eat a muffin because it was cut into tiny, bite-size pieces.)
People with bulimia nervosa must recognize that it is a serious disorder that can
have grave medical complications if not treated. Because relapse is likely, therapy
should be long term. Note that those with bulimia nervosa need professional help be
cause they can be very depressed and are at a high risk for suicide. About 50% of people with bulimia nervosa recover completely from the disorder. Others continue to
struggle with it to varying degrees for the rest of their lives. This fact underscores the
need for prevention because treatment is difficult.
Nutritional counseling has two main goals: correcting misconceptions about food and re-establishing regular eating habits. Patients are given information about bulimia nervosa and its consequences. Avoiding binge foods and not constantly stepping on a scale may be recommended early in treatment. The primary goal, however, is to develop a normal eating pattern. To achieve this goal, some specialists encourage patients to develop daily meal plans and keep a food diary in which they record food intake, internal sensations of hunger, environmental factors that precipitate binges, and thoughts and feelings that accompany binge-purge cycles. Keeping a food diary not only is an accurate way to monitor food intake but also may help identify situations that seem to trigger binge episodes. With the help of a therapist, patients can develop alternative coping strategies.
In general, the focus is not on stopping bingeing and purging per se but on developing regular eating habits. Once this is achieved, the binge-purge cycle should stop by itself. Patients are discouraged from following strict rules about healthy food choices, because this simply mimics the typical obsessive attitudes associated with bulimia nervosa. Rather, encouraging a mature perspective on nutrient intake—that is, regular consumption of moderate amounts of a variety of foods balanced among the food groups—helps patients overcome this disorder.
Setting time limits for the completion of meals and snacks is important for people with eating disorders. Many bulimic persons eat very quickly, reflecting their difficulties with satiety. Suggesting that the patient put his or her utensil down after each bite is a behavioral technique that a therapist might try with a recovering bulimic person. (In comparison, many anorexic persons eat in an excessively slow manner—for example, taking 1 hour to eat a muffin because it was cut into tiny, bite-size pieces.)
People with bulimia nervosa must recognize that it is a serious disorder that can
have grave medical complications if not treated. Because relapse is likely, therapy
should be long term. Note that those with bulimia nervosa need professional help be
cause they can be very depressed and are at a high risk for suicide. About 50% of people with bulimia nervosa recover completely from the disorder. Others continue to
struggle with it to varying degrees for the rest of their lives. This fact underscores the
need for prevention because treatment is difficult.
Health Problems Stemming from Bulimia Nervosa
The vomiting that many bulimic sufferers induce is the most physically destructive method of purging. Indeed, the majority of health problems associated with bulimia nervosa arise from vomiting:
• Repeated exposure of teeth to the acid in vomit causes demineralization, making the teeth painful and sensitive to heat, cold, and acids. Eventually, the teeth may severely decay, erode away from fillings, and finally fall out. Dental professionals are sometimes the first health professionals to notice signs of bulimia nervosa. Until vomiting ceases, it is important to rinse the mouth with water after a vomiting episode, especially before brushing the teeth.
• Blood potassium can drop significantly with regular vomiting or the use of certain diuretics. This can disturb the heart's rhythm and even produce sudden death.
• Salivary glands may swell as a result of infection and irritation from persistent vomiting.
• Stomach ulcers and bleeding and tears in the esophagus develop in some cases.
• Constipation may result from frequent laxative use.
• Ipecac syrup, sometimes used to induce vomiting, is toxic to the heart, liver, and kidneys. It has caused accidental poisoning when taken repeatedly.
Overall, bulimia nervosa is a potentially debilitating disorder that can lead to death, usually from suicide, low blood potassium, or overwhelming infections.
• Repeated exposure of teeth to the acid in vomit causes demineralization, making the teeth painful and sensitive to heat, cold, and acids. Eventually, the teeth may severely decay, erode away from fillings, and finally fall out. Dental professionals are sometimes the first health professionals to notice signs of bulimia nervosa. Until vomiting ceases, it is important to rinse the mouth with water after a vomiting episode, especially before brushing the teeth.
• Blood potassium can drop significantly with regular vomiting or the use of certain diuretics. This can disturb the heart's rhythm and even produce sudden death.
• Salivary glands may swell as a result of infection and irritation from persistent vomiting.
• Stomach ulcers and bleeding and tears in the esophagus develop in some cases.
• Constipation may result from frequent laxative use.
• Ipecac syrup, sometimes used to induce vomiting, is toxic to the heart, liver, and kidneys. It has caused accidental poisoning when taken repeatedly.
Overall, bulimia nervosa is a potentially debilitating disorder that can lead to death, usually from suicide, low blood potassium, or overwhelming infections.
Typical Behavior in Bulimia Nervosa
Many people with bulimic behavior are probably never diagnosed. The strict diagnostic criteria specify that, in order to be classified as having bulimia nervosa, a person must binge and purge at least twice a week for 3 months. People with bulimia nervosa lead secret lives, hiding their abnormal eating habits. Moreover, it is impossible to recognize people with bulimia nervosa simply from their appearance. Because most diagnoses of bulimia nervosa are based on self-reports, current estimates of the number of cases are probably low. The disorder, especially in its milder forms, may be much more widespread than commonly thought.
Among sufferers of bulimia nervosa, bingeing often alternates with attempts to rigidly restrict food intake. Elaborate food rules are common, such as avoiding all sweets. Thus, eating just one cookie or donut may cause bulimic persons to feel they have broken a rule. Then the objectionable food must be eliminated. Usually, this leads to further overeating, partly because it is easier to regurgitate a large amount of food than a small amount. For intake to qualify as a binge, an atypically large amount of food must be consumed in a short time, and the person must exhibit a lack of control over this behavior.
Binge-purge cycles may be practiced daily, weekly, or at longer intervals. A special time is often set aside. Most binge eating occurs at night, when other people are less likely to interrupt, and usually lasts from '/> to 2 hours. A binge can be triggered by a combination of hunger from recent dieting, stress, boredom, loneliness, and depression. It often follows a period of strict dieting and thus can be linked to intense hunger. The binge is not at all like normal eating; once begun, it seems to propel itself. The person not only loses control but generally doesn't even taste or enjoy the food that is eaten during a binge. This separates the practice from simple overeating.
Most commonly, bulimic people consume cakes, cookies, ice cream, and similar high-carbohydrate convenience foods during binges because these foods can be purged relatively easily and comfortably by vomiting. In a single binge, foods supplying up to 3,000 kcal or more may be eaten. Purging follows in hopes that no weight will be gained. However, even when vomiting follows the binge, 33% to 75% of the food energy taken in is still absorbed, which causes some weight gain. When laxatives or enemas are used, about 90% of the energy is absorbed, as these act in the large intestine, beyond the point of most nutrient absorption. The common belief of bulimic persons that purging soon after bingeing will prevent excessive energy absorption and weight gain is clearly a misperception.
Early in the onset of bulimia nervosa, sufferers often induce vomiting by placing their fingers deep into the mouth. They may inadvertently bite down on these fingers. The resulting bite marks around the knuckles are a characteristic sign of this disorder. Once the disease is established, however, a person can often vomit simply by contracting the abdominal muscles. Vomiting may also occur spontaneously.
Another way bulimic people attempt to compensate for a binge is by engaging in excessive exercise to expend a large amount of energy. Some bulimic people try to estimate the amount of energy eaten in a binge and then exercise to counteract this energy intake. This practice, referred to as "debiting," represents an effort to control their weight.
People with bulimia nervosa are not proud of their behavior. After a binge, they usually feel guilty and depressed. Over time, they experience low self-esteem and feel hopeless about their situation. Compulsive lying and drug abuse can further intensify these feelings. Bulimic people caught in the act of bingeing by a friend or family member may order the intruder to "get out" and "go away." Sufferers gradually distance themselves from others, spending more and more time preoccupied by and engaging in bingeing and purging.
Among sufferers of bulimia nervosa, bingeing often alternates with attempts to rigidly restrict food intake. Elaborate food rules are common, such as avoiding all sweets. Thus, eating just one cookie or donut may cause bulimic persons to feel they have broken a rule. Then the objectionable food must be eliminated. Usually, this leads to further overeating, partly because it is easier to regurgitate a large amount of food than a small amount. For intake to qualify as a binge, an atypically large amount of food must be consumed in a short time, and the person must exhibit a lack of control over this behavior.
Binge-purge cycles may be practiced daily, weekly, or at longer intervals. A special time is often set aside. Most binge eating occurs at night, when other people are less likely to interrupt, and usually lasts from '/> to 2 hours. A binge can be triggered by a combination of hunger from recent dieting, stress, boredom, loneliness, and depression. It often follows a period of strict dieting and thus can be linked to intense hunger. The binge is not at all like normal eating; once begun, it seems to propel itself. The person not only loses control but generally doesn't even taste or enjoy the food that is eaten during a binge. This separates the practice from simple overeating.
Most commonly, bulimic people consume cakes, cookies, ice cream, and similar high-carbohydrate convenience foods during binges because these foods can be purged relatively easily and comfortably by vomiting. In a single binge, foods supplying up to 3,000 kcal or more may be eaten. Purging follows in hopes that no weight will be gained. However, even when vomiting follows the binge, 33% to 75% of the food energy taken in is still absorbed, which causes some weight gain. When laxatives or enemas are used, about 90% of the energy is absorbed, as these act in the large intestine, beyond the point of most nutrient absorption. The common belief of bulimic persons that purging soon after bingeing will prevent excessive energy absorption and weight gain is clearly a misperception.
Early in the onset of bulimia nervosa, sufferers often induce vomiting by placing their fingers deep into the mouth. They may inadvertently bite down on these fingers. The resulting bite marks around the knuckles are a characteristic sign of this disorder. Once the disease is established, however, a person can often vomit simply by contracting the abdominal muscles. Vomiting may also occur spontaneously.
Another way bulimic people attempt to compensate for a binge is by engaging in excessive exercise to expend a large amount of energy. Some bulimic people try to estimate the amount of energy eaten in a binge and then exercise to counteract this energy intake. This practice, referred to as "debiting," represents an effort to control their weight.
People with bulimia nervosa are not proud of their behavior. After a binge, they usually feel guilty and depressed. Over time, they experience low self-esteem and feel hopeless about their situation. Compulsive lying and drug abuse can further intensify these feelings. Bulimic people caught in the act of bingeing by a friend or family member may order the intruder to "get out" and "go away." Sufferers gradually distance themselves from others, spending more and more time preoccupied by and engaging in bingeing and purging.
Typical Behavior in Bulimia Nervosa
Many people with bulimic behavior are probably never diagnosed. The strict diagnostic criteria specify that, in order to be classified as having bulimia nervosa, a person must binge and purge at least twice a week for 3 months. People with bulimia nervosa lead secret lives, hiding their abnormal eating habits. Moreover, it is impossible to recognize people with bulimia nervosa simply from their appearance. Because most diagnoses of bulimia nervosa are based on self-reports, current estimates of the number of cases are probably low. The disorder, especially in its milder forms, may be much more widespread than commonly thought.
Among sufferers of bulimia nervosa, bingeing often alternates with attempts to rigidly restrict food intake. Elaborate food rules are common, such as avoiding all sweets. Thus, eating just one cookie or donut may cause bulimic persons to feel they have broken a rule. Then the objectionable food must be eliminated. Usually, this leads to further overeating, partly because it is easier to regurgitate a large amount of food than a small amount. For intake to qualify as a binge, an atypically large amount of food must be consumed in a short time, and the person must exhibit a lack of control over this behavior.
Binge-purge cycles may be practiced daily, weekly, or at longer intervals. A special time is often set aside. Most binge eating occurs at night, when other people are less likely to interrupt, and usually lasts from '/> to 2 hours. A binge can be triggered by a combination of hunger from recent dieting, stress, boredom, loneliness, and depression. It often follows a period of strict dieting and thus can be linked to intense hunger. The binge is not at all like normal eating; once begun, it seems to propel itself. The person not only loses control but generally doesn't even taste or enjoy the food that is eaten during a binge. This separates the practice from simple overeating.
Most commonly, bulimic people consume cakes, cookies, ice cream, and similar high-carbohydrate convenience foods during binges because these foods can be purged relatively easily and comfortably by vomiting. In a single binge, foods supplying up to 3,000 kcal or more may be eaten. Purging follows in hopes that no weight will be gained. However, even when vomiting follows the binge, 33% to 75% of the food energy taken in is still absorbed, which causes some weight gain. When laxatives or enemas are used, about 90% of the energy is absorbed, as these act in the large intestine, beyond the point of most nutrient absorption. The common belief of bulimic persons that purging soon after bingeing will prevent excessive energy absorption and weight gain is clearly a misperception.
Early in the onset of bulimia nervosa, sufferers often induce vomiting by placing their fingers deep into the mouth. They may inadvertently bite down on these fingers. The resulting bite marks around the knuckles are a characteristic sign of this disorder. Once the disease is established, however, a person can often vomit simply by contracting the abdominal muscles. Vomiting may also occur spontaneously.
Another way bulimic people attempt to compensate for a binge is by engaging in excessive exercise to expend a large amount of energy. Some bulimic people try to estimate the amount of energy eaten in a binge and then exercise to counteract this energy intake. This practice, referred to as "debting," represents an effort to control their weight.
People with bulimia nervosa are not proud of their behavior. After a binge, they usually feel guilty and depressed. Over time, they experience low self-esteem and feel hopeless about their situation. Compulsive lying and drug abuse can further intensify these feelings. Bulimic people caught in the act of bingeing by a friend or family member may order the intruder to "get out" and "go away." Sufferers gradually distance themselves from others, spending more and more time preoccupied by and engaging in bingeing and purging.
Among sufferers of bulimia nervosa, bingeing often alternates with attempts to rigidly restrict food intake. Elaborate food rules are common, such as avoiding all sweets. Thus, eating just one cookie or donut may cause bulimic persons to feel they have broken a rule. Then the objectionable food must be eliminated. Usually, this leads to further overeating, partly because it is easier to regurgitate a large amount of food than a small amount. For intake to qualify as a binge, an atypically large amount of food must be consumed in a short time, and the person must exhibit a lack of control over this behavior.
Binge-purge cycles may be practiced daily, weekly, or at longer intervals. A special time is often set aside. Most binge eating occurs at night, when other people are less likely to interrupt, and usually lasts from '/> to 2 hours. A binge can be triggered by a combination of hunger from recent dieting, stress, boredom, loneliness, and depression. It often follows a period of strict dieting and thus can be linked to intense hunger. The binge is not at all like normal eating; once begun, it seems to propel itself. The person not only loses control but generally doesn't even taste or enjoy the food that is eaten during a binge. This separates the practice from simple overeating.
Most commonly, bulimic people consume cakes, cookies, ice cream, and similar high-carbohydrate convenience foods during binges because these foods can be purged relatively easily and comfortably by vomiting. In a single binge, foods supplying up to 3,000 kcal or more may be eaten. Purging follows in hopes that no weight will be gained. However, even when vomiting follows the binge, 33% to 75% of the food energy taken in is still absorbed, which causes some weight gain. When laxatives or enemas are used, about 90% of the energy is absorbed, as these act in the large intestine, beyond the point of most nutrient absorption. The common belief of bulimic persons that purging soon after bingeing will prevent excessive energy absorption and weight gain is clearly a misperception.
Early in the onset of bulimia nervosa, sufferers often induce vomiting by placing their fingers deep into the mouth. They may inadvertently bite down on these fingers. The resulting bite marks around the knuckles are a characteristic sign of this disorder. Once the disease is established, however, a person can often vomit simply by contracting the abdominal muscles. Vomiting may also occur spontaneously.
Another way bulimic people attempt to compensate for a binge is by engaging in excessive exercise to expend a large amount of energy. Some bulimic people try to estimate the amount of energy eaten in a binge and then exercise to counteract this energy intake. This practice, referred to as "debting," represents an effort to control their weight.
People with bulimia nervosa are not proud of their behavior. After a binge, they usually feel guilty and depressed. Over time, they experience low self-esteem and feel hopeless about their situation. Compulsive lying and drug abuse can further intensify these feelings. Bulimic people caught in the act of bingeing by a friend or family member may order the intruder to "get out" and "go away." Sufferers gradually distance themselves from others, spending more and more time preoccupied by and engaging in bingeing and purging.
Bulimia Nervosa
Bulimia nervosa involves episodes of binge eating followed by various means to purge the food. This eating disorder was first described in the medical literature in 1979 and classified as a clinical psychiatric disorder in 1980. It is most common among young adults of college age, although some high school students are also at risk. Susceptible people often have genetic factors and lifestyle patterns that predispose them to becoming overweight, and many try frequent weight-reduction diets as teenagers. Like people with anorexia nervosa, those with bulimia nervosa are usually female and successful. Unlike anorexics, however, they are usually at or slightly above a normal weight. Females with bulimia nervosa are also more likely to be sexually active than those with anorexia nervosa.
The person with bulimia nervosa may think of food constantly. In contrast to the anorexic person, who turns away from food when faced with problems, the bulimic person turns toward food in critical situations. Also, unlike those with anorexia nervosa, people with bulimia nervosa recognize their behavior as abnormal. These people often have very low self-esteem and are depressed. Approximately half of the people with bulimia nervosa have major depression. Lingering effects of child abuse may be one reason for these feelings. Many bulimic persons report that they have been sexually abused. The world sees their competence, while inside they feel out of control, ashamed, and frustrated.
Bulimic people tend to be impulsive, which may be expressed as stealing, drug and alcohol abuse, self-mutilation, or attempted suicide. Some experts have suggested that part of the problem may actually arise from an inability to control responses to impulse and desire. Some studies have demonstrated that bulimic people tend to come from disengaged families—ones that are loosely organized. Roles for family members are not clearly defined. Too little protection is provided for family members, rules are very loose, and a great deal of conflict exists. Anorexic people in comparison tend to have families so actively engaged that roles may be too well defined.
The person with bulimia nervosa may think of food constantly. In contrast to the anorexic person, who turns away from food when faced with problems, the bulimic person turns toward food in critical situations. Also, unlike those with anorexia nervosa, people with bulimia nervosa recognize their behavior as abnormal. These people often have very low self-esteem and are depressed. Approximately half of the people with bulimia nervosa have major depression. Lingering effects of child abuse may be one reason for these feelings. Many bulimic persons report that they have been sexually abused. The world sees their competence, while inside they feel out of control, ashamed, and frustrated.
Bulimic people tend to be impulsive, which may be expressed as stealing, drug and alcohol abuse, self-mutilation, or attempted suicide. Some experts have suggested that part of the problem may actually arise from an inability to control responses to impulse and desire. Some studies have demonstrated that bulimic people tend to come from disengaged families—ones that are loosely organized. Roles for family members are not clearly defined. Too little protection is provided for family members, rules are very loose, and a great deal of conflict exists. Anorexic people in comparison tend to have families so actively engaged that roles may be too well defined.
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