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Adolescents and Bulimia Nervosa

Like anorexia, bulimia nervosa is an eating disorder. Unlike an anorexic who rejects food, severely restricts caloric intake, and appears emaciated, a bulimic adolescent’s weight will appear near normal even though she indulges in food binges and followed by self-induced vomiting, abuse of laxatives, enemas, or diuretics to purge the calories from her system. Bulimia is derived from the Greek ‘bous limos’, meaning “ox hunger” and was first identified as a sub-category of anorexia nervosa, but is now considered a separate eating disorder complete with its own identifying characteristics: repeated episodes of binge eating over which the individual has no control in combination with recurrent excessive compensatory behavior to avoid weight gain – self-induced vomiting; inappropriate use of laxatives, enemas, diuretics; fasting; or excessive exercise occurring an average of twice a week over a period of at least 3 months coupled with lowered self-esteem affected by body image. Bulimia is more common than anorexia and is diagnosed in about 2% - 3% of females ranging in age from the late teens to early twenties. This disorder is rarely seen in males.

While seated at the dinner table, bulimic adolescents may appear to be eating normally as most binging behavior takes place secretly with stashing of high-calorie “junk food” in the bedroom closet or under the bed or in the trunk of the car. Often binges occur every day with the typical binge session lasting about an hour and containing somewhere between 3,500 – 10,000 calories. The gorging typically continues until she feels guilt or acute gastrointestinal discomfort. Then she will induce vomiting. In the early stages of the disorder, the bulimic will stick her finger down her throat to trigger the “gag reflex”. After repeated incidents, many bulimics can vomit automatically.

Unlike anorexics who deny their unhealthy relationship with food, bulimics are acutely aware that their behavior is far from normal, which often adds to their sense of guilt, shame, and poor self-esteem. Bulimics are likely to adapt their lives to the disorder for several years before seeking help. Medical complications associated with the disorder may prompt bulimics to address concomitant symptoms. Dental cavities are common with bulimics due to the high sugar content of their binging foods and the enamel erosion cause by regurgitated stomach acids. Other health concerns associated with bulimia include electrolyte imbalances due to frequent vomiting and laxative abuse; irregular heartbeat; cardiac arrest, pneumonia due to aspirated vomit; and gastrointestinal issues.

The family dynamics of bulimics tend to be disorganized, stressful, and compartmentalized. Parents of bulimics often emphasize appearances, fitness, and success. Treatment often focuses on correcting the irrational beliefs held by the bulimic using cognitive-behavioral therapy in conjunction with family therapy to address unhealthy relational issues.

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