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BULIMIA: WHEN STAYING THIN IS A THICKNESS
You may be bulimic and hide it from yourself. Here are some of the signs:
1. Eating huge amounts of food
2. Vomiting or using laxatives to purge
3. Hiding your binges from others
4. Trying to control your weight by binging and purging
5. Feeling out of control once you start eating
Bulimics may maintain normal body weight and look healthy, but they are prone to such ailments as swollen salivary glands, an inflamed pancreas, and gallbladder problems. Constant vomiting harms the stomach and food pipe, or esophagus. Stomach acid coming up into the mouth erodes tooth enamel. I saw a bulimic with so much enamel gone; only tiny stubs of teeth remained.
At its worst, bulimia can kill. Purging empties the body of potassium; this makes the heart irritable and prone to stop. The estimated death rate for severe bulimics is 1 to 10 percent.
Some bulimics spend up to 300 dollars on food. They isolate themselves at work and at home, even from their spouses. Sometimes they cannot work and lose their jobs.
Bulimia is related to anorexia nervosa, a condition in which patients refuse to eat anything at all and waste away.
Dr. C. Philip Wilson, Columbia University’s College of Physicians and Surgeons in New York City, calls anorexia nervosa and bulimia two sides of the same coin because both are rooted in the fear of becoming fat. Every bulimic I spoke to confessed that fear.
Nobody knows why the binge-purge syndrome snares mostly women. Dr. Pope and Dr. James I. Hudson, also of McLean Hospital, call bulimia a form of a major depressive disorder. Says Dr. Pope, “Among our bulimic patients, 80 percent suffer from major depression or manic depressive illness.”
Dr. B. Timothy Walsh, of Columbia University’s College of Physicians and Surgeons, reports success with antidepressant drugs. “Bulimics not only stop binging and purging,” he says. “For the first time, they feel better.”
One of Dr. Pope’s patients, Sheri Swanson, bulimic since she was 18, says she hid the problem from everyone: “It’s so shameful.” All treatments failed until Dr. Pope prescribed an antidepressant drug, desipramine. Sheri noticed a difference right away. She says, “This oppressive cloud was lifted. Within a matter of weeks, the binging was gone. It was astonishing.”
Studies also show that bulimic women have other psychological disturbances. Up to a third have attempted suicide. Bulimics tend to abuse alcohol and street drugs. “We think a third of our patient have kleptomania too,” says Dr. Pope. “Imagine a middle-class woman who can buy anything she wants yet steals a bottle of perfume.”
Treatment for bulimia varies. Daniel Baker, Ph.D., director of the eating disorder program at University Hospital of the University of Nebraska Medical Center, Omaha, trains bulimics to turn away from food and build self-esteem.
Associates for Bulimia and Related Disorders, a group of psychologists in New York City, teaches clients to turn to other people rather than to food. Says Ellen Schor, Ph.D., a co-director, “We tell them, ‘You have a food addiction. Food has been your secret lover, your confidant, and worst enemy. If you go on like this, you will never get close to people.’” In groups, patients are taught the facts about bulimia, urged to keep diaries and to make contracts with themselves to change. Co-director Judith Brisman, Ph.D., reports that after a year, a third of the group no longer binged and another third cut their gorging by half.
When all else fails, Dr. Katherine Halmi, of Cornell University Medical College in White Plains, New York, takes a drastic step. She hospitalizes her patients for an average of 3 months. Hospitalization keeps the bulimic away from food; in serious cases, it can save the person’s life. Step by step, patients are taught to eat normally.
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