Like anorexia, bulimia results in starvation. But there are behavioral, physical and psychological differences between the two conditions. Bulimia is much more difficult to detect because people who have it tend to be of normal weight or overweight, and they hide their habit of binge eating followed by purging, vomiting, or using laxatives. In fact, bulimia was not widely recognized, even among medical and mental health professionals, until the 1980s. Unlike anorectics, bulimics (people with bulimia) are aware that their eating patterns are abnormal, and they often feel remorse after a binge. For them, overeating offers an irresistible escape from stress. Many suffer from depression, repressed anger, anxiety, and low self esteem, combined with a tendency toward perfectionism. About 20% of bulimics also have problems with alcohol or drug addiction, and they are more likely than other people to commit suicide.
Many people occasionally overeat, but are not considered bulimic. According to the American Psychiatric Association's definition, a bulimic binges on enormous amounts of food at least twice a week for three months or more.
Bulimics plan their binges carefully, setting aside specific times and places to carry out their secret habit. They may go from restaurant to restaurant, to avoid being seen eating too much in any one place. Or they may pretend to be shopping for a large dinner party, when actually they intend to eat all the food themselves. Because of the expense of consuming so much food, some resort to shoplifting.
During a binge, bulimics favor high carbohydrate foods, such as doughnuts, candy, ice cream, soft drinks, cookies, cereal, cake, popcorn, and bread, consuming many times the amount of calories they normally would consume in one day. No matter what their normal eating habits, they tend to eat quickly and messily during a binge, stuffing the food in their mouths and gulping it down, sometimes without even tasting it. Some say they get a feeling of euphoria during binges, similar to the "runner's high" that some people get from exercise.
The self-induced vomiting that often follows eating binges can cause all sorts of physical problems, such as damage to the stomach and esophagus, chronic heartburn, burst blood vessels in the eyes, throat irritation, and erosion of tooth enamel from the acid in vomit. Excessive use of laxatives can be hazardous, too. Muscle cramps, stomach pains, digestive problems, dehydration, and even poisoning may result. Over time, bulimia causes vitamin deficiencies and imbalances of critical body fluids, which in turn can lead to seizures and kidney failure.
Some researchers believe that an imbalance in the brain chemical serotonin underlies bulimia, as well as other types of compulsive behavior. The production of serotonin, which influences mood, is affected by both antidepressant drugs and certain foods. But most research on bulimia focuses on its psychological roots.
Bulimia is not as likely as anorexia to reach life-threatening stages, so hospitalization is not usually necessary. Treatment generally involves psychotherapy and sometimes the use of antidepressant drugs. Unlike anorectics, bulimics usually admit they have a problem and want help overcoming it. Estimates of the rates of recovery from bulimia vary widely, with some studies showing low rates of improvement and others suggesting that treatment is effective. Even after apparently successful treatment, some bulimics relapse.