What makes a person vulnerable to bingeing and purging? In the second part of a series on bulimia, Merlene Michael of HealthAnswers discusses what you can do to overcome bulimia.

What Makes A Girl Vulnerable
Interestingly, medical experts still don't know exactly why one weight-conscious woman becomes bulimic while another doesn't. But researchers believe genetic factors and temperamental characteristics like low self-esteem, depression, impulsiveness, and relationship problems all play a role. You don't have to have all or any of the characteristics, but they can increase vulnerability.

Girls are especially vulnerable in early adolescence. Normal changes such as breast and hip development - which are a normal part of puberty - are seen as weight gain. Girls are also further pressured by the attention they receive from boys,and a desire to be seen as 'attractive'.

Social pressures and self-esteem issues are not even the whole story. Numerous studies show that the problem may be inherited. Some experts believe eating disorders may run in families.

In one Japanese study, for example, eating disorders were linked to an absent and detached father. One patient even claimed that she stumbled upon bulimia at her own birthday party when her mother suggested that she stick her fingers down her throat if she was afraid of getting fat. Not only did this revelation trigger the idea that she must be thin to be physically attractive, but it gave her the idea that she could use vomiting as a means of weight control.

Men Are Victims, Too
Some experts used to think there were no male victims, but increasing figures around the world say otherwise.

Recently, Britain's Eating Disorders Association (EDA), in a BBC On-line report, said doctors and psychologists were failing to identify men suffering from eating disorders. This is because they have different problems when it comes to eating disorders and the diagnosis can be more complicated.

According to the EDA: "They may not look drawn and painfully thin like female sufferers, but instead appear muscular, but they are still suffering from the same eating disorder."

Their studies found that male athletes, under pressure to maintain low weight, have been known to engage in self-induced vomiting. Experts believe that gay men area also prone to eating disorders.

Hitting Rock Bottom
Because bulimics are obsessed with counting every calorie and are preoccupied with frequent bingeing and purging, many of them overlook the serious health implications that come with it. Repeated vomiting in bulimia can, among many other things, give rise to:

• teeth erosion, cavities and gum problems caused by acids from the stomach
• a puffy face due to swollen salivary glands
• water retention and swelling, and abdominal bloating
• dehydration and low potassium levels which can cause extreme weakness and near paralysis as well as lethal heart rhythms
• acute stomach distress and even rupture of the oesophagus, or food pipe
• chemical imbalances causing kidney damage and fits.

Then, there is the self-destructive behaviour that many sufferers develop. Bulimics who are prone to depression particularly, are at risk for dangerous impulsive behaviours such alcohol and drug abuse.

Bulimics are also more often promiscuous than anorexics, and tend to be more sexually active than individuals who do not have eating disorders because sex, like bingeing, is an attempt to fill a void.

Additionally, bulimia often increases social isolation. Sufferers avoid shared meals, social occasions, and letting people get too close to them in any case their real self is discovered. They cannot tolerate any disruption of their rigid daily routine which often includes long periods of physical exercise designed to keep weight down, fixed eating times, and carefully hidden arrangements for bingeing and purging. All this leads to increased social isolation.

Break Free!
The hope for sufferers lies in the fact that most people with eating disorders can and do recover. Various forms of treatment are available such as psychotherapy - individual, group, or family - counselling, self help groups, and medication if depression is present.

Bulimics may also work with a dietician to help them restore a healthy relationship with food. Nutritional counselling can help correct misconceptions about food. This entails teaching the person about bulimia and its consequences, focusing on its extreme means of weight control. In the early stages, it may be best for a bulimic to avoid eating binge foods or stepping on the scale. The primary goal, however, is to develop a normal eating pattern.

She explains that nutritional counselling emphasises setting up regular eating habits rather than stopping the binge-purge cycle. Patients are encouraged to keep a food diary throughout the treatment. This helps the person monitor food intake as well as feelings that accompany binge-purge cycles.

Experts also recommend taking up an exercise. There is a two-fold benefit in this - getting involved in a physical activity not only keeps depression at bay, but it helps in the maintenance of a healthy weight.

As many eating disorders have their roots in the teenage years, Dr Deanna Jepson author of Eat Orgasmically and Still Lose Weight advocates teaching young people about their body types so that they won't dream of something else they are not.

She told HealthAnswers that a person's basic build or body type is genetically determined and cannot be altered even by obsessive dieting and constant exercise. "Many doctors, slimming clinics and clubs do not take into account different body types when they set target weights for dieters to work towards."

She adds: "The most useful guide to your correct weight is provided by the body mass index (BMI) which gives an acceptable weight range for any given height. This will help remind young people that not everyone can look like Kate Moss."

All said and done, the first step in treating bulimia, however, is to admit the existence of an eating disorder. Few bulimics seek treatment. This is because there is a lot of shame associated with bulimia. Many patients are also reluctant to go for treatment to a psychiatric or eating disorder facility.

By clinging to their self-destructive behaviour, sufferers are rejecting normal participation in life.

But early treatment gives a better chance of cure, and the effort to recover is rewarded by the relief that the recovery brings, both to the bulimic and their families and friends.

Date reviewed: 04 July 2000