Bulimia: What To Look For [Guest Post]

Signs and symptoms of a dangerous disorder.

[Today’s guest post was contributed by Heidi Taylor. I include it here as part of a continuing series of guest posts having to do with the so-called “lifestyle addictions,” such as perceived addictions to gambling, sex, video games, or shopping—areas in which I can claim no special expertise, and diagnoses which remain controversial among addiction researchers. However, I do strongly believe that the case has been made for the addictive nature of certain eating disorders—bulimia and carbohydrate-craving obesity in particular—in which the ingested substance is food, not “drugs” as we commonly think of them. Eating is one of the most obvious ways in which we alter the neurochemistry of our brains every day. As for treatment, serotonin abnormalities are believed to be the culprit. Many bulimics improve on SSRI antidepressants.]
--Dirk Hanson

Detecting Bulimia in a Loved One

It’s not a disease that’s visible at first or even second sight, but even so, it is one that’s largely ignored and left untreated more because most people are not even aware of its existence. But bulimia, or to be exact, bulimia nervosa is an eating disorder that could end up having physical, psychological and sociological consequences that are hard to digest. Bulimics tend to eat more than they should – in fact, they gorge on food – and then force themselves to throw up using emetics, visit the toilet with laxatives, or go without food for the next day or so. In short, they compensate for their over-eating in ways that are neither healthy nor advisable.

While it may not seem like a dangerous disorder, bulimia can have devastating consequences if left unchecked – people affected are prone to suffer from an inflamed throat and neck glands, a torn esophagus, decaying and unhealthy teeth, acid reflux disorder, ruptured intestines, irritable bowels, dehydration and malfunctioning kidneys. Besides these physical symptoms, they’re also going to be obsessed with their weight, suffer from depression and anxiety, and face other mental and social problems. So if you suspect a loved one may be bulimic, here are a few symptoms that will help you detect the disorder and get them professional help as soon as possible:

• Eating more than the normal amount possible in a single meal or over the course of a few meals.
• Frequent visits to the toilet after a meal.
• A washed out and drained look that happens because they’re dehydrated and their body is low in minerals from all the purging and use of laxatives.
• Mood swings that seem to come on for no apparent reason.
• Sores in the mouth and/or on their fingers (because they may be sticking it in their throats to induce vomiting).
• Inflamed throats and bad teeth.
• Bouts of depression or uncalled for anxiety attacks.
• Exercising for a long time, at odd hours of the day and being obsessed with the way they look.
• It’s the women and the teenagers who are more susceptible to this disorder because of their obsession with their weight and the way they look. So if you have a daughter or a close female friend or relative who acts in a way that points suspicion to bulimia, talk to them and get them much-needed medical intervention before the situation worsens.

Even if you just suspect bulimia and are not really sure, you’d do well to talk to the person concerned and get them to see a doctor who can help. Remember, it may sound like a minor thing, but bulimia is a very serious disorder.
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This post was contributed by Heidi Taylor, who writes about the Masters in Healthcare. She welcomes your feedback at HeidiLTaylor006 at gmail.com

Graphics Credit: Graham Menzies Foundation

The Biology of Bulimia

The binge-and-purge addiction.

By 2000, the biological substrate unifying alcoholism, addiction, depression, and certain eating disorders had become irrefutable. Population surveys had shown that nearly half of alcoholic patients had a long history of coexisting depression and/or anxiety disorders. Overall, about a third of patients with depression or panic disorder have had lifelong problems with drug abuse. These are estimates, best clinical guesses, but associating depression and addiction is no longer a speculative venture.

As with more familiar forms of addiction, bulimia was coming to be seen as another serotonin/dopamine-mediated medical condition. As noted, serotonin is involved in both the binge and the purge. Once researchers began performing the necessary double blind, placebo-controlled studies, it became clear that serotonin-boosting drugs dramatically lessened bulimic behavior in general, and associated carbohydrate binging in particular, in a large number of diagnosed bulimics. (Anorexia nervosa, another eating disorder, does not show the same serotonin affinities in action.)

Bulimics often maintain a normal weight, but can suffer serious physical consequence—heart rhythm irregularities, electrolyte imbalances, low blood pressure, and damage to the esophagus. Once the binge-purge cycle has been established, some researchers believe, drug-like changes in serotonin 5HT receptor distributions help reinforce the pattern. It is not surprising to learn that Prozac and other serotonin reuptake inhibitors such as dexfenfluramine were prominent among the drugs being tested against bulimia in the 1990s. By 1995, a paper presented at the National Social Science Association Conference in San Diego stated: “The serotonin hypothesis of bulimia nervosa suggests that bulimia is the behavioral manifestation of functional underactivity of serotonin in the central nervous system.”

In 1997, Prozac became the first drug ever licensed by the Food and Drug Administration (FDA) for the treatment of bulimia nervosa, as this chronic disorder is officially known. The drug’s formal approval was based on three clinical studies showing median reductions in binging of as much as 67 per cent for Prozac, compared with 33 per cent for placebo. Vomiting was reduced by 56 per cent, compared to 5 per cent for female placebo users. (About 10 per cent of diagnosed bulimics are males.) There is often a family history of alcoholism and/or eating disorders. The locus of “serotonergic dysfunction” appears to be the hypothalamus. Low levels of serotonin and dopamine metabolites have been documented in the cerebrospinal fluid of bulimic patients. Evidence exists for the involvement of norepinephrine as well.

Bulimia, like alcoholism and other drug addictions, has its psychosocial side, but twins studies show that there is very probably a genetics of bulimia to be pursued. In one influential study, an identical twin stood a one-in-four chance of developing bulimia, if the other twin was diagnosed with the disorder. A combination of SSRI drugs and some form of structured cognitive therapy is the recommended approach.

--Excerpted from
The Chemical Carousel: What Science Tells Us About Beating Addiction © Dirk Hanson 2008, 2009

Photo Credit: Graham Menzies Foundation