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What Is Bulimia?

Bulimia, also known as bulimia nervosa, is a disease of eating too much. People who have bulimia may be purging, that is, they induce vomiting to remove the food they have just eaten from their stomachs, or non-purging, attempting to get rid of excess calories by fasting (or telling themselves they will avoid food for a set period whether they have the willpower or not), exercise, or taking diet pills. Bulimia nervosa is the "flip side" of anorexia nervosa, a condition of not eating at all.


Bulimia manifests itself as a struggle between appetite and body image. 


While some studies report that it is up to 20 times more common in women than in men, many men have subclinical or "mild" cases of bulimia. Wrestlers may purge after a meal so they can make the weigh-in for their weight class. Active-duty military may fast or do excessive exercise or purge so they can eat meals with their buddies but maintain fitness for their next evaluation. The notion that the typical bulimic is a teenage girl who wants to look good in a prom dress is not only sexist but seriously inaccurate. Latest statistics show that about one in 60 women and one in 150 men, at least in the US, develops the condition at some point in life.

Although the need to keep weight down for competitions or promotions is one factor in the illness, in many cases bulimia is associated with autoimmune disease.  The average age of onset is 19, although the condition has been observed in young children and in the elderly. Bulimia occurs in all races, all ethnic groups, and at all economic levels, although in the US it is particularly common, for reasons researchers don't understand, in the states of North Carolina and Virginia.

Bulimia: Spotting The Signs

How can you recognize bulimia in a family member, a child, or a colleague or comrade?

  • Bulimics tend to eat large amounts of food quickly while alone. Someone who is always ordering a lot of food, or spending a lot of money on food, who isn't unusually overweight, may have this problem.
  • Purgers tend to have bad teeth. Forced vomiting brings up stomach acid that erodes dental enamel. They also tend to have laryngitis (also from stomach acid) and a tendency toward aspiration, getting food into their lungs. Aspiration can cause choking or pneumonia, but just a little aspiration may appear to be a cold.
  • Very few bulimics are obese. The obese don't do anything to offset excess food consumption. Very few bulimics are underweight, either.
  • Purgers who use emetics, medications to induce vomiting, such as ipecac, tend to have low potassium levels. They may become weak, glassy-eyed, and listless because they lose too much potassium from their digestive tracts.
  • Women of reproductive age who have bulimia tend to have irregular menstrual periods.
  • Bulimics may be very careful to avoid favorite foods until they binge, eating a whole cake or a couple of boxes of doughnuts, for example. They then purge in private.

Some purgers can vomit reflexively, on mental command. Some stick a finger or a toothbrush down their throats, risking damage to the throat. Those who use emetic medications are at special risk.

Friends will notice that bulimics say they are fat when other people think they are thin. Bulimics will be obsessed with food, although they may tend to eat it in secret. Bulimics will tend to be people who "eat themselves sick" but don't think this is abnormal.

Helping Someone With Bulimia

What can you do to help somone who has bulimia? First of all, speak up when the symptoms suggest a problem that isn't full-blown bulimia. Treat the condition seriously. About 7 percent of people who have it die of complications from it. 

A great way to "be there" for a friend who has buliimia is to schedule regular outdoor activities. Bright light, preferably sunlight but even a sun lamp, helps the brain use amino acids to make serotonin, easing the symptoms of the disease. Interaction with a non-judgmental friend stimulates the production of dopamine, the feel-good brain chemical, which reduces the need for food.  Encourage your friend of family member to continue medical supervision, realizing the recovery process may be slow, months or years.

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