Eating Disorders - fieldi

Medical Aspects of Anorexia and Bulimia 13
BULIMIA
Anorexia and bulimia sometimes overlap. About 50 percent of
patients with anorexia develop bulimic symptoms during their illness.
This subset of patients has an especially high incidence of both
medical and psychiatric difficulties. The vast majority of patients
with bulimia are of normal weight. In fact, up to one-third were
overweight in the past.
Bulimics binge; that is, they have episodes of uncontrollable eating,
usually consuming large volumes of food. For some, however, binges
are subjective; a normal meal or a forbidden food is experienced as
excessive. Fearing weight gain, bulimics compensate for their binges.
Nonpurging bulimics engage in excessive dieting or exercise. Purging
bulimics most commonly induce vomiting. Laxatives, diet pills, or
diuretics may also be used in futile attempts to lose weight
Though some patients with bulimia feel well, most experience
both emotional and physical discomforts. Bulimics often feel
ashamed, secretive, isolated, depressed, out of control. Like anorexics,
they are often preoccupied with food and weight in a constant,
bothersome way that soon intrudes on other spheres of their lives.
Patients with bulimia may also suffer from a wide range of distressing
symptoms, including wide weight swings, insomnia, weakness,
heartburn, bloating, swollen glands, and irregular periods.
PHYSICAL TOLLS OF BULIMIA
Bulimia can cause pervasive physical damage. Often, however, this is
mainly internal and may not produce visible signs. As with anorexia,
the physical examination and laboratory tests may be deceptively
normal (Becker et al. 1999).
The purging of bulimia usually impacts the gastrointestinal system.
Chronic vomiting bathes the esophagus in stomach acid, causing
inflammation. Esophageal tears are also common, resulting in
pain and the vomiting of blood. The sphincter between the esophagus
and stomach becomes impaired, and reflux is common. The
stomach empties poorly, producing bloating after meals.