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Health Issues

Eating Disorders: Bulimia

In a survey of approximately three thousand five hundred girls, one in five ninth graders and two in five high-school seniors admitted to stuffing themselves with food and then forcing themselves to vomit at least once. Up to one in four U.S. teenagers binge and purge regularly. If the practice continues for three months, the young person is said to be bulimic.

Half of all anorexics have episodes of bulimia at one time or another. Like the girl who starves herself, the bulimic is dissatisfied with her body and obsessed with slimming down.

She starts to diet and may also go on an exercise campaign, but eventually surrenders to her cravings for food. Stress or strong emotions can set off a binge, in which a bulimic will devour whatever food she can lay her hands on, often starchy junk foods. It is not unheard of for girls with this eating disorder to put away three thousand to seven thousand calories in a couple of hours, stopping only after they’re too full to take another bite. In a cruel irony, bulimics barely derive any pleasure from eating; as if possessed, they chew and swallow almost mechanically.

Afterward, feeling guilty and ashamed, the teenager attempts to rid her body of the food before it is digested. Inducing vomiting by sticking her fingers down the throat is one method. Girls have also been known to take excessive doses of laxatives, diuretics or emetics, drugs that promote bowel movements, urination or vomiting, respectively. Bulimics plan their secret binges in advance—usually for times when nobody else will be home.

Behavioral Signs

  • Preoccupation with food and weight
  • Distorted body image
  • Long periods of time spent in the bathroom—sometimes with the faucet running, to mask the sound of vomiting
  • Depression
  • Anxious about eating, especially dining out in public
  • Abuse of laxatives, enemas, emetics, diuretics
  • Spends less time with family and friends; becomes more isolated, withdrawn, secretive 
  • Stealing food and hoarding it in unusual places, such as in the closet or under the bed 
  • Excitability, difficulty sitting still, easily distracted

Physical Signs

  • Dramatic fluctuations in weight, from alternately dieting and bingeing
  • Puffy face and throat from swollen salivary glands
  • Burst blood vessels in the face
  • Bags under the eyes
  • Indigestion, bloating, constipation, gas pains, abdominal cramps
  • Dehydration
  • Eroded tooth enamel from the gastric acid in vomit; discolored teeth
  • Cavities
  • Inflamed, bleeding gums (gingivitis)
  • Calluses on fingers and knuckles, from self-induced vomiting
  • Swelling (edema) of the feet or hands
  • Sore throat
  • Tremors
  • Dizziness, light-headedness, fainting spells
  • Stiff, achy muscles
  • Muscle weakness
  • Muscle cramps
  • Irregular menstruation
  • Extreme thirst, frequent urination
  • A constant sensation of coldness, especially in the hands and feet, because the body has lost its “overcoat” of fat and muscle (if underweight) 
  • Hair loss
  • Blurred vision

Because a bulimic’s weight generally hovers around average or aboveaverage, she can often hide her condition for years. Despite her outwardly healthy appearance, bingeing and purging exacts a heavy toll on vital organs such as the liver, kidneys, intestines and heart. Potassium deficiency can bring about an irregular heart rhythm and possibly cardiac arrest. As in anorexia, the other major cause of death is suicide.

A diagnosis of bulimia is based on these four criteria:

  1. Recurrent episodes of binge eating.
  2. Regularly purging in order to control weight, through self-induced vomiting; abuse of laxatives, diuretics, enemas, ipecac or other medications; fasting; or exercising obsessively.
  3. Bingeing and purging at least twice a week for three months.
  4. Excessive concern over weight and figure.
Last Updated
Caring for Your Teenager (Copyright © 2003 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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