Eating disorders; when thinness becomes an obsession - includes related article on tips for parents

FDA Consumer, May, 1986 by Dixie Farley

Ordinarily, bulimia begins between ages 17 and 25. However, because many bulimics are deeply ashamed of their bingeing and purging and therefore keep these activities a guarded secret, an actual diagnosis may not be made until a patient is well into her 30s or 40s. In Cosmopolitan (January 1985), for example, actress Jane Fonda revealed that she had been a secret bulimic from age 12 until her recovery at age 35--bingeing and purging as much as 20 times a day.

Bulimia usually begins in conjunction with a diet. But once the binge-purge cycle becomes established, it can get out of control. Some bulimics may be somewhat underweight and a few may be obese, but most tend to keep a nearly normal weight. In many, the menstrual cycle becomes irregular. Sexual interest may diminish. Bulimics may exhibit impulsive behaviors such as shoplifting and alcohol and drug abuse. Many appear to be healthy and successful, perfectionists at whatever they do. Actually, most bulimics have very low self-esteem and are often depressed.

Binges may last eight hours and result in an intake at 20,000 calories (that's roughly 210 brownies, or 5-1/2 layer cakes, or 18 dozen macaroons). One study, however, showed the average binge to be slightly less than 1-1/4 hours and slightly more than 3,400 calories (an entire pecan pie, for instance). Most binges are carried out in secret. Bulimics often spend $50 or more a day on food and may even steal (food or money) to support the obsession.

To lose the gained weight, the bulimic begins purging, which may include using laxatives--from 50 to 100 or more tablets at one time--or diuretics (drugs to increase urination) or self-induced vomiting caused by gagging, using an emetic (a chemical substance that causes vomiting), or simply mentally willing the action. Between binges, the person may fast or exercise excessively.

Bulimia's binge-purge cycle can be devastating to health in a number of ways. It can upset the body's balance of electrolytes--such as sodium, magnesium, potassium and calcium--which can cause fatigue, seizures, muscle cramps, irregular heartbeat, and decreased bone density, which can lead to osteoporosis. Repeated vomiting can damage the esophagus and stomach, cause the salivary glands to swell, make the gums recede, and erode tooth enamel. In some cases, all of the teeth must be pulled prematurely because of the constant wash by gastric acid. Other effects may be rashes, broken blood vessels in the cheeks, and swelling around the eyes, ankles and feet. For diabetics, bingeing on high-carbohydrate foods and sweets is particularly hazardous, since their bodies cannot properly metabolize the starches and sugars.

Bulimia's severe health risks and potential for becoming obsessive do not bode well for a decision to "try it out." Dr. Bailey points out, "Very rarely do I hear someone say, 'Oh yes, I had bulimia for three years and I just stopped one day and now I'm fine.' It's very hard to give up the behavior. Once somebody tells me they've done this several times--in my mind, they're probably hooked."