By Jose Pujalte Jr.
“Let us eat and drink; for to-morrow we shall die.” — The Holy Bible. Isaiah xxii. 13.
In a country with starving people in the millions, bulimia nervosa is both ironic and obscene. Yet, it is an eating disorder worth understanding because it could happen to you, to your teenaged daughter, or a dear friend – food aplenty or not.
Definition. Also known as “binge-purge” behavior, bulimia is defined as “an illness in which a person binges on food or has regular episodes of significant overeating and feels a loss of control.” (US National Institutes of Health). This is followed by vomiting or laxative abuse to prevent weight gain.
Causes. You don’t need to be a celebrity or movie star to be bulimic. Any typical adolescent could suffer from it as she (sometimes, he) caves in to the tremendous peer pressure of looking a certain way. Coaches and trainers can be guilty of demanding their priced athletes to weigh within a narrow range. A person with a bulimic mother or sister is highly susceptible, as well as individuals with low self-esteem or perfectionism by nature.
Diagnostic Criteria. As a recognized eating disorder, bulimia is listed in the mental health professional’s DSM (Diagnostic and Statistical Manual of Mental Disorders). The criteria include: Repeated episodes of binge eating, including abnormally large amount of food then feeling no control; repeated efforts to make up for the bingeing by self-induced vomiting, excessive exercise, fasting, abuse of laxatives, enemas, diuretics; behaviors occurring at least twice a week for at least three months; self-evaluation over-influenced by body shape and weight; and these behaviors NOT occurring during periods of anorexia (more next week).
Tests and Evaluation. Initially, you may need to bring the bulimic to a favorite doctor (primary care physician, pediatrician or other specialist) who will conduct a thorough physical examination. A bulimic can be anemic, can have: weak bones that may have already fractured, swollen lymph nodes, dehydration, rotting teeth and gums, irregular or with no menstruation, and irregular heartbeat. A mental health provider can then take over to conduct the psychological examination. The DSM criteria are applied.
Treatment. Correcting physical complications is a good start. Anemia, infections, fractures, bowel problems must be treated. Psychotherapy may mean counseling by a qualified therapist and/or cognitive behavioral therapy in which identified unhealthy habits are replaced with positive ones. Antidepressants may be prescribed. Finally, a dietitian can design an eating plan that can return the bulimic to a healthy, acceptable weight.
Coping with Bulimia. Who’s to blame? Advertisers? Media? The sociocultural demand to look like a Greek goddess (or god) is unfair. I guess that’s why there’s PhotoShop® because even models, who by our jiggling thighs and beer-bellied standards are already perfect, still aren’t perfect for print. Resist the urge to skip meals or diet in extreme. These may trigger a binge-purge cycle. This is the bulimic on full-throttle, the endpoint is death amidst food in abundance.
Dr. Pujalte is an orthopedic surgeon. e-mail: [email protected]