Bulimia = aberrant eating
Bulimia is an eating disorder. The essential features of bulimia are binge-eating, interrupted by deliberate efforts to avoid the consequences of over-eating by vigorous exercise, fasting, self-induced vomiting, and purging with laxatives. Bulimics report foods cravings and loss of control during food binges; they are overwhelmed by short-term gratification and are often ambivalent about treatment attempts. Bulimics often use and abuse drugs and have high rates of alcoholism. Between 33 and 83 percent of bulimics may have a first-degree relative suffering from alcohol abuse or alcoholism.
The bulimic pattern is associated with guilt feelings, secrecy, and overt depression. Binge-eaters sometimes report extravagant food intake with prolonged feasts of many foods in bizarre combinations - the Roman banquet effect. The basic technique is to eat until your stomach is full, retreat to the nearest bathroom, and then induce vomiting by putting your index finger down your throat. For those of us who find vomiting an unpleasant experience, the idea of voluntary vomiting is a little hard to accept. But, an experienced regurgitator can induce vomiting with little effort, and thinks nothing of several vomiting sessions a day.
The effect on body weight varies with each person. Many bulimics have a history of weight fluctuations, usually within a range they attempt to control by vomiting. Some are overweight, but most are within a normal weight range. Some bulimics lose weight progressively, alternating between binges, purges and food restriction. Popular media repeats the myth "Most bulimics are focused on weight control" This is often a ruse, a convenient and widely accepted explanation.
Losing and Regaining Control
Among our patients, there is a consensus that eating-control is difficult to achieve, even when wrong food choices involve risk of serious illness. The consensus is also that some foods trigger compulsive eating, uncontrollable by ordinary acts of consciousness. We compare binge eating with binge drinking and find compelling similarities.
There are many theories of causation and a variety of treatment strategies. "Eating disorders" are often interpreted as personal and social problems and not related to food choices. Self-induced vomiting in the bulimic patient is a rather complex behavior that involves a rational component - avoiding the consequences of eating the wrong food and an irrational, compulsive component. If you eat compulsively, you know you have lost control; one way to regain control is to induce vomiting and get rid of the food that you did not want to eat in the first place.
The rational concern is not just avoiding weight gain, but also avoiding the awful feelings that can follow bingeing. Many bulimics with food allergy, initially vomited spontaneously after eating offending foods, only to feel much relieved; they then learned self-induced vomiting as a method of avoiding food- related symptoms. Some bulimics have a split personality or different eigenstates. Foods act as molecular switches, often changing the eigenstate abruptly. Here are three typical eigenstates:
Many fail to recognize their food addiction, and do not admit that they are ill. They will seem surprised when it is suggested that food allergy may be involved and resist advice that "favorite" foods such as bread and cheese may be a problem. They are involved in typical addictive denial. Their denial that food makes them ill is often reinforced by treatment programs that fail to recognize food allergy symptoms and discourage efforts to change food choices. Some bulimics are also alcoholics; the patterns are similar in any case since compulsive drinking of alcoholic beverages is just another type food addiction.
Psychogenic explanations of binge-eating focus on the personalities of the women involved. The personality profile suggests that women who are high-achievers, perfectionistic, lonely, dissatisfied, and frustrated are at high risk. A phobic fear of being too fat is usually mentioned as the cause of fasting, purging, and vomiting. The psychological or psychogenic explanations take the easy route. They simply restate a description of the problem and say it is the cause. If the patient says: "I am intense, frustrated, and concerned about my body weight...", the psychological rendering just turns this around: "Women become bulimic because they are intense, frustrated, and are concerned about their body weight.
Many patients with compulsive eating and eating disorders wisely and appropriately do not accept the psychological explanations. Patients often describe, "...something inside is not working properly; there is something chemically wrong with me". One patient stated it succinctly: "I think there is a little gizmo in my brain gone crazy...if you can only get in there and fix it, I'll be OK again."
The practical biological questions are:
Hunger is the monitor image of appetite, the drive to get food. Appetites create ready-for-action states known as "drives". Drives produce seeking behaviors, which get results. If the drive for food produces wrong results, further drives emerge to renew the opportunity to get what is needed. An automatic brain system regulates food-seeking behavior and food intake. If we move into this system, toward the molecular level of function, our description will have to account for the effect of incoming food molecules on the brain. We would recognize that the systems which determine appetite and eating behavior monitor chemicals in the blood and receive information from diverse body systems about their chemical environments. The same system projects an image of body states into consciousness.