Bulimia Nervosa: History, Symptoms, Causes, and Treatment

Introduction

Bulimia is a serious eating disorder, but it does not receive the same media coverage or public understanding as anorexia. One reason for this is that bulimic patients are typically of normal weight. People around them may not realize they have a problem or that they suffer from disordered eating of any kind. Those who have bulimia are characterized by a cycle of binging on food and then purging through vomiting or the use of laxatives (Hay & Claudino, 2010; Palmer, 2004). Some bulimics also take stimulants or diuretics, and they may exercise excessively (Hay & Claudino, 2010). Because the people around them see them eating relatively normally, they may not realize there are serious physical and psychological issues at play.

The bulimic individual, however, generally knows that his or her disordered eating patterns are not normal. Depending on the reasons behind the eating disorder, he or she may not be able to stop the behavior without serious help and intervention from outside sources (Hay & Claudino, 2010; Russell, 2009).

While the majority of bulimics are women, there are also men who have the disorder (Russell, 2009). Some studies indicate that men may be underrepresented among those diagnosed with bulimia, and there may actually be many more cases than first thought. Men may hide the problem better than women, and they are generally not suspected of having eating disorders (Russell, 2009). That can cause the issue to go unnoticed by friends and family. However, even if the bulimic person appears to be of normal weight, he or she may be doing significant damage to the esophagus and teeth, along with various organs and bodily systems (Palmer, 2004). The binging and purging that comes with bulimia can rob the body of vital nutrients and cause issues with proper growth and development, especially in young people (Palmer, 2004). It is therefore very important that bulimia is identified early so it can be treated successfully and the patient can move forward with his or her life.

History of Bulimia

Bingeing on food and then vomiting or purging through other means is not a new phenomenon. Bulimia is discussed more openly today because it is a recognized disorder, but such behaviors have been recorded as far back as 970 B.C., when ancient Greeks documented purging practices (Patton et al., 2008). Additionally, ancient Egypt had recommended purging rituals in which people participated once per month for three days at a time (Patton et al., 2008). The prevailing theory at that time was that food itself caused illness, and that purging helped to purify the body and prevent disease (Hay & Claudino, 2010; Patton et al., 2008).

Some ancient Roman emperors also commonly purged, as they were obese and gluttonous. Christian saints have some recorded bulimic behaviors as well. Some of these saints believed that their binging was the work of the devil, and their purging was an act of repentance (Hay & Claudino, 2010). Several died of starvation because they purged and fasted for extended periods in an effort to atone for what they perceived as sinful behavior, as treatment for such disorders was not available at the time (Hay & Claudino, 2010; Patton et al., 2008; Russell, 2009).

It was not until the 20th century that bulimia — or, more specifically, bulimia nervosa — was listed as an actual symptom of disordered eating (Hay & Claudino, 2010). It was not immediately classified as its own disorder, however. Instead, purging was viewed as a symptom displayed by anorexics, and the cause of the purging was believed to be stomach pain (Palmer, 2004). From the 1930s through the 1950s, bulimic behaviors were more commonly observed, but the disorder had still not become "official" — it was not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This made it impossible for anyone during that period to receive a formal diagnosis of bulimia, despite exhibiting its specific characteristics. In 1980, bulimia became a recognized disorder, which led to the diagnosis of a significant number of cases in the early part of that decade (Hay & Claudino, 2010). The number of diagnoses decreased slightly in the late 1980s but still remained higher than the number of those diagnosed with anorexia (Russell, 2009).

Signs and Symptoms

There are a number of signs and symptoms associated with bulimia. The most obvious for diagnostic purposes are binging on food followed by purging, but these can be difficult to detect because many bulimics have learned to hide them relatively well (Russell, 2009). Bingeing takes the form of eating that is completely out of control and very rapid. It may stop because someone else has entered the room, or it may not stop until the bulimic is in pain from the over-extension of the stomach (Russell, 2009). Either way, this binge is usually followed by self-induced vomiting (Hay & Claudino, 2010). Some bulimics purge in other ways, but vomiting is the most common method (Russell, 2009). This binge-purge cycle often occurs more than once per week, and in extreme cases may be repeated several times per day (Russell, 2009).

There are common signs a bulimic person may exhibit, especially as the disorder becomes more severe. These include:

Additionally, a number of symptoms can develop and worsen over time in a person with bulimia. Not every bulimic individual will experience all of these, but they typically include:

Other symptoms of bulimia include weight fluctuations, constipation, ulcers, and infertility (Palmer, 2004). The constant bingeing and purging creates a number of unhealthy conditions and imbalances across numerous bodily systems.

Conclusion

Because bulimia is such a significant health issue, especially for adolescents, the study of it is very important. Ever since it became an official disorder in the Diagnostic and Statistical Manual of Mental Disorders, it has received greater attention. This increased recognition is significant and highly valuable for understanding what causes someone to develop bulimia and how those who are affected can best be treated. While not every bulimic patient can be treated successfully, the overarching goal is to ensure that anyone struggling with an eating disorder has access to help. Whether that help comes through medication, therapy, or a combination of both is ultimately less important than simply ensuring that individuals in need receive appropriate support.