Melissa was a bright, attractive, popular teenager with everything going for her. People didn't know she secretly ate huge amounts of food, and vomited it wherever she could: the toilet at home or friend's houses; the garbage disposal; paper bags she would throw out of her car; and even bathrooms in all-you-can-eat restaurants. Her heart dropped when her boyfriend told her that he knew she was overeating and vomiting. He insisted she see a psychologist on campus immediately. She reluctantly agreed, and soon began to understand what was happening to her....

Bulimia Nervosa is an eating disorder characterized by:

• Recurrent binge eating (eating a much larger amount of food than most individuals would eat under similar circumstances);
• Recurrent purging behavior (self-induced vomiting, misuse of laxatives, diuretics, enemas, fasting, and/or excessive exercise);
• Bingeing and purging behavior both occur at least twice a week for 3 months;
• Extreme preoccupation with body appearance and weight.

Bulimia Nervosa usually starts to develop with:

1. an extreme preoccupation with food;
2. binge eating triggered by feelings, mood states, stressful situations; and
3. obsessive concern about body shape and weight.

A repetitive pattern then emerges, as bulimia becomes a habit, a way of coping with life and its stresses.

There can be many serious repercussions to repetitive bulimic behavior (e.g.. tooth decay, gum disease, malnutrition, digestive problems, and electrolyte imbalances which can effect critical organs including the heart). Additionally, relationships often suffer as the individual with bulimia becomes increasingly withdrawn and secretive. Generally, individuals with bulimia nervosa deny that the problem is serious until it gets so out of control that they get scared. Each person's bottom line is different. For some it is purging twice a week, for others it is purging 15 times a day.

The good news is that we have solid knowledge and understanding about how to treat bulimia nervosa today. A combination of individual psychotherapy, group psychotherapy, antidepressant medication, and education, is the most effective approach. Nonprofit organizations such as Overeaters Anonymous can offer helpful support and structure.

Suggestions for those seeking recovery:

• Seek professional help.
• Tell at least one good friend of the problem.
• Go to a local bookstore and read about bulimia.
• Through journal writing and therapy, increase self-awareness of feelings and needs.
• Develop constructive strategies for coping.
• Learn and practice assertiveness.

Suggestions for families or friends of individuals with bulimia nervosa:

• Let them know that they are loved - NO MATTER WHAT.
• Do not try to control their food intake.
• Be a good listener.
• Be patient.
• Educate yourself on bulimia.
• Encourage them to meet with a psychologist or counselor trained in eating disorders treatment.

5/28/98

Dr. Diana K. Weiss is a licensed psychologist (PSY #12476) in private practice in Del Mar, CA. Stress management, cardiac psychology, optimal performance, depression, and anxiety are her areas of specialty. She is a speaker and recent author. Her book on preventing heart disease will be released soon. Dr. Weiss can be reached at (619) 259-0146 240 9th Street Del Mar, California, 92014.