444 CHAPTER 10
Often, people with bulimia don’t simply eat normally at meals and then
binge between meals (Walsh, 1993). Rather, they try to control what they eat, re-
stricting their caloric intake at meals (trying to be “good” and eat less), but later
become ravenous and their hunger feels out of control. They then binge eat, which
in turn makes them feel physically and emotionally “bad” because they “lost con-
trol” of themselves. As a result of such feelings, they may purge and subsequently
strive to eat less, restricting their caloric intake at meals and creating a vicious cycle
of restricting, bingeing, and usually purging. As one woman notes: “I don’t eat all
day and then I come home from work and binge. I always tell myself I’m going to
eat a normal dinner, but it usually turns into a binge” (Fitzgibbon & Stolley, 2000).
In Case 10.2, Gabriella tells a similar story.CASE 10.2 • FROM THE OUTSIDE: Bulimia Nervosa
[Gabriella is] a young Mexican woman whose parents moved to the U.S. when she
was just a child. While her mother and father continue to speak Spanish at home and
place a high value on maintaining their Mexican traditions, Gabriella wants noth-
ing more than to fi t in with her friends at school. She chooses to speak only English,
looks to mainstream fashion magazines to guide her clothing and make-up choices,
and wants desperately to have a fashion-model fi gure. In an attempt to lose weight,
Gabriella has made a vow to herself to eat only one meal a day—dinner—but on her
return home from school, she is rarely able to endure her hunger until dinnertime.
She often loses control and ends up “eating whatever I can get my hands on.” Frantic
to keep her problem hidden from her family, she races to the store to replace all the
food she has eaten.
(Fitzgibbon & Stolley, 2000)Medical Effects of Bulimia Nervosa
Like anorexia, bulimia can lead to signifi cant physical changes and medical problems.
For instance, chronic vomiting, a purging method used by Marya Hornbacher, can
cause the parotid and salivary glands (in the jaw area) to swell (creating a kind of
“chipmunk” look) and can erode dental enamel, making teeth more vulnerable to
cavities and other problems. Those who use syrup of ipecac (which is toxic) to induce
vomiting may develop heart and muscle problems (Pomeroy, 2004; Silber, 2004).
Furthermore, many people with bulimia use laxatives regularly, which can lead
to a permanent loss of intestinal functioning as the body comes to depend on the
chemical laxatives to digest food and eliminate waste. In such cases, the malfunc-
tioning intestinal section must be surgically removed (Pomeroy, 2004). Bulimia can
also produce constipation, abdominal bloating and discomfort, fatigue, and irregular
menstruation (Pomeroy, 2004). As noted earlier in the section on anorexia, all forms
of purging can cause dehydration and an imbalance of the body’s electrolytes, which
disrupt normal neural transmission and heart conductance. Case 10.3 illustrates how
the medical effects of bulimia can create signifi cant—and enduring—problems.Frequent vomiting can permanently erode dental
enamel, shown here, and lead to cavities and
related problems.Dr. Craig Mabrito
CASE 10.3 • FROM THE INSIDE: Bulimia Nervosa
A 32-year-old woman describes how bulimia nervosa has affected her:
My life revolves around food and exercise. Because of my abuse of diet pills and purging, I had
a stroke when I was 23. I now have headaches. I am at risk of having another stroke, and this
time I have a high chance of not coming out of it. Emotionally, it’s a daily battle. I’m depressed
because I want to eat, and I’m depressed because I know if I do eat, I’ll get fat and gain all the
weight back that I have lost.