Bulimia
Medical Revising Author: Melissa Conrad Stöppler, MD
Medical Revising Editor: William C. Shiel Jr., MD, FACP, FACR
Drunkorexia, Manorexia, Diabulimia: New Eating Disorders?
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
In recent weeks, I have read media reports that mentioned both "drunkorexia"
and "manorexia." I have fielded questions about "diabulimia" from coworkers and
friends. From the sound of these terms, it appears that there are a lot of new
and recently discovered eating disorders. I certainly did not hear the word drunkorexia in medical school.
Actually, these new terms (which, by the way, are not official or standard
medical terms) simply refer to subcategories of the well-known eating disorders
anorexia nervosa and bulimia nervosa, both of which affect up to 1% of women and
a lower percentage of men at some point in their lives.
Diabulimia is a form of eating disorder that affects people taking insulin to
treat diabetes. It refers to the practice of minimizing insulin dosages by
patients with type 1 diabetes mellitus in an attempt to control body weight.
Since insulin encourages fat storage, the manipulation of insulin dose is an
attempt to reduce weight gain. The term does not refer to a recognized medical
condition but to a practice recognized by diabetes experts. Diabulimia is most
common in young girls and women with type 1 diabetes.
What is bulimia?
Bulimia, also called bulimia nervosa, is an eating disorder. Bulimia is characterized by episodes of secretive
excessive eating (bingeing) followed by inappropriate methods of weight control,
such as self-induced vomiting (purging), abuse of laxatives and diuretics, or
excessive exercise. Like anorexia, bulimia is a psychological disorder. It is
another condition that goes beyond out-of-control dieting. The cycle of overeating and
purging can quickly become an obsession similar to an addiction to drugs or
other substances. The disorder generally occurs after a variety of unsuccessful
attempts at dieting.
Bulimia is estimated to affect between 3% of all women in the U.S. at some
point in their lifetime. About 6% of teen girls and 5% of college-aged females
are believed to suffer from bulimia. These numbers are somewhat lower than
earlier estimates of the prevalence of bulimia
due to the precise criteria now established for the diagnosis (see below).
Approximately 10% of identified bulimic patients are men. Bulimics are also
susceptible to other compulsions, affective disorders, or addictions. Twenty to 40% of women with bulimia also have a history of problems related to drug or alcohol use, suggesting that many affected women may have difficulties with control of behavioral impulses.
Unlike
anorexics, bulimics experience significant weight fluctuations, but their weight
loss is usually not as severe or obvious as anorexics. The long-term prognosis
for bulimics is slightly better than for anorexics, and the recovery rate is
felt to be higher. However, many bulimics continue to retain slightly abnormal
eating and dieting behaviors even after the recovery period.
The secrecy of bulimia stems from the shame that
bulimics often attach to the disorder. Binge eating is not triggered by intense
hunger. It is a response to depression, stress, or other feelings related to body weight, shape, or food.
Binge eating often brings on a feeling of calm or happiness (euphoria), but the
self-loathing because of the overeating soon replaces the short-lived euphoria.
Often, the individual will feel an impairment or loss of
control during the binge eating and the purging becomes a way of regaining
control. Not all bulimics engage in self-induced vomiting or the misuse of
laxatives, diuretics, or enemas during the current episode. Some may fast for
days following a binge episode. Others may resort to excessive exercise as a
method to regain their control and rid their body of the possible weight gained
during the binge. Excessive exercise is that which interferes with normal daily
activities or when it occurs at inappropriate times or in inappropriate
settings, or when it continues despite illness or injury.
Next: What causes bulimia? »
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