In a survey of approximately three thousand five hundred girls, one in five ninth graders and two in five high-school seniors admitted to stuffing themselves with food and then forcing themselves to vomit at least once. Up to one in four U.S. teenagers binge and purge regularly. If the practice continues for three months, the young person is said to be bulimic.
Half of all anorexics have episodes of bulimia at one time or another. Like the girl who starves herself, the bulimic is dissatisfied with her body and obsessed with slimming down.
She starts to diet and may also go on an exercise campaign, but eventually surrenders to her cravings for food. Stress or strong emotions can set off a binge, in which a bulimic will devour whatever food she can lay her hands on, often starchy junk foods. It is not unheard of for girls with this eating disorder to put away three thousand to seven thousand calories in a couple of hours, stopping only after they’re too full to take another bite. In a cruel irony, bulimics barely derive any pleasure from eating; as if possessed, they chew and swallow almost mechanically.
Afterward, feeling guilty and ashamed, the teenager attempts to rid her body of the food before it is digested. Inducing vomiting by sticking her fingers down the throat is one method. Girls have also been known to take excessive doses of laxatives, diuretics or emetics, drugs that promote bowel movements, urination or vomiting, respectively. Bulimics plan their secret binges in advance—usually for times when nobody else will be home.
Behavioral Signs
Preoccupation with food and weight
Distorted body image
Long periods of time spent in the bathroom—sometimes with the faucet running, to mask the sound of vomiting
Depression
Anxious about eating, especially dining out in public
Abuse of laxatives, enemas, emetics, diuretics
Spends less time with family and friends; becomes more isolated, withdrawn, secretive
Stealing food and hoarding it in unusual places, such as in the closet or under the bed
Excitability, difficulty sitting still, easily distracted
Physical Signs
Dramatic fluctuations in weight, from alternately dieting and bingeing
Puffy face and throat from swollen salivary glands
Burst blood vessels in the face
Bags under the eyes
Indigestion, bloating, constipation, gas pains, abdominal cramps
Dehydration
Eroded tooth enamel from the gastric acid in vomit; discolored teeth
Cavities
Inflamed, bleeding gums (gingivitis)
Calluses on fingers and knuckles, from self-induced vomiting
Swelling (edema) of the feet or hands
Sore throat
Tremors
Dizziness, light-headedness, fainting spells
Stiff, achy muscles
Muscle weakness
Muscle cramps
Irregular menstruation
Extreme thirst, frequent urination
A constant sensation of coldness, especially in the hands and feet, because the body has lost its “overcoat” of fat and muscle (if underweight)
Hair loss
Blurred vision
Because a bulimic’s weight generally hovers around average or aboveaverage, she can often hide her condition for years. Despite her outwardly healthy appearance, bingeing and purging exacts a heavy toll on vital organs such as the liver, kidneys, intestines and heart. Potassium deficiency can bring about an irregular heart rhythm and possibly cardiac arrest. As in anorexia, the other major cause of death is suicide.
A diagnosis of bulimia is based on these four criteria:
Recurrent episodes of binge eating.
- Regularly purging in order to control weight, through self-induced vomiting; abuse of laxatives, diuretics, enemas, ipecac or other medications; fasting; or exercising obsessively.
- Bingeing and purging at least twice a week for three months.
- Excessive concern over weight and figure.