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Binge eating and purging (bulimia nervosa)

Starting in the 1980's, the response to the cultural pressure to maintain this body ideal was an epidemic of a condition now called bulimia nervosa. In bulimia nervosa, (mostly) young women frequently binge eat, purge, or fast for long periods of time as a way of controlling their weight. There is an intense fear of becoming obese, so much so that the person feels an urge to purge themselves in order to avoid the possibility of gaining weight. This may be associated with an intense feeling of fullness even after a small meal.

Women with bulimia nervosa often binge up to ten or even twenty times per day. They frequently eat large quantities of carbohydrates in a single sitting and then purge themselves to eliminate the food from their bodies. As their concerns about their weight escalate, they may also turn to laxatives, diuretics, and pills as ways of maintaining their weight.  Once in place, this pattern of binge eating and purging can continue over a lifetime.

While the psychological basis of bulimia nervosa is debatable, research has shown a link between bulimia and severe depression and anxiety. A significant proportion of patients with bulimia nervosa have relatives who suffer from severe depression and/or mood swings. Approximately half of all bulimic patients become clinically depressed at some point in their course of illness, an incidence three to five times greater than in the general population.

Clinical studies have looked at the possible benefits of antidepressant medications for bulimics and have found a dramatic decline in the frequency of binge-and-purge episodes in response to antidepressants, regardless of whether the bulimic patient was suffering from depression at the time.

Researchers believe that the same chemicals that affect mood also regulate eating and satiety; thereby accounting for the effect of certain antidepressants in reducing bulimic behavior. Therefore, whether a person experiences hunger or fullness is a function not only of habit and behavior modeling, but also of specific concentrations of the neurotransmitters serotonin and norepinephrine in various nuclei (centers) in the hypothalamus, a part of the brain that regulates vital functions.

Bulimia nervosa is a potentially serious condition that disrupts the body's chemistries, causes harm to the digestive tract, erodes tooth enamel, and creates the risk of potentially fatal heart irregularities due to impaired physical health or chemical imbalances.

Most patients with bulimia nervosa can be treated in outpatient settings with a combination of psychotherapy and medications, enabling them to continue work or school. The shame and embarrassment so many bulimics share can be put aside while they learn new behaviors and coping mechanisms. In this atmosphere, the urge to binge and purge is reduced by appropriate medical and psychiatric management.

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My sincere appreciation to David Sack, M.D. for his assistance and commentary.