Bulimia has its origins in the same mind-set as anorexia and is not that uncommon particularly in young women. As with anorexia it is based on a fear of fatness but the affected person tends to be of normal weight. This is because the person alternates over-eating (sometimes called binge-eating) with a method of shedding weight. This could be vomiting, excessive use of laxatives or excessive vigorous exercise. In women periods may be irregular and people who vomit are prone to a number of ailments including bad teeth (stomach acid rots the enamel), puffy face (due to swollen salivary glands), irregular heartbeats, muscle weakness, kidney problems and fits (all due to imbalance of important chemicals). Additionally people who abuse laxatives may have tummy pain, swollen fingers and damage to bowel muscles, which leads to long term constipation (and therefore makes it difficult to stop the vicious circle).
In fact the vicious circle of bingeing and vomiting is also very difficult to break out of and the person is often so ashamed of what they do that they have become very good at keeping it a secret. They usually feel very guilty about this and it is also very exhausting and time consuming. Peoples’ lives usually revolve around the binge-vomit cycle and it can become increasingly difficult to have any sort of social life. Yet even those who are nearest to them may not know the full extent of the problem and the affected person, thinking they cannot be helped may not tell anyone just how bad they feel. Hence when their secret is finally revealed there is often great relief.
It is important, therefore, to do something once the person has admitted there is a problem. The aim should be to get the person to seek professional help. Trying a ‘DIY’ approach may help in borderline cases but can be very stressful for the ‘carer’. The first port of call is usually the general practitioner and it is a good idea to accompany the person both to give a full picture and to provide moral support. He or she will usually want to refer the person to a specialist service – this may be a psychiatric team or a psychologist. This person will have more time and will want to get as much information as possible from the person in order to try and understand more about her and how she feels. Being weighed is part of the consultation and physical examination and blood tests may also be necessary.
Most people can be treated in the community but there needs to be close supervision and continued discussion with family or friends as well as with the patient. Treatment is based on talking to the patient about how she is feeling and what led to the situation as well as trying to change her outlook. Alongside this, however, it is vital that she agrees to a programme of eating which enables her to stabilise her weight. Dietary information needs to be given and any associated conditions addressed. There is some evidence that antidepressant medication can assist the ‘talking therapy’ and can certainly be useful if the patient is also depressed. Because sufferers are usually living away from their families support from afar can be difficult and the therapist relies more on getting the patient to keep an ‘eating diary’ and to gradually develop control of their eating. Joining a self-help group can be very supportive and family and carers can also get involved and increase their knowledge and understanding.