The Baltimore Sun

As the holiday season hits full swing, stress mounts, too. Let's face it, anyone who watches his weight, worries about how he looks or has issues with his family, can be susceptible to holiday-induced anxieties.

But for some people - including those with bulimia nervosa - this time of year may be particularly challenging, says Dr. Harry A. Brandt, director of the Center for Eating Disorders at Sheppard Pratt Health System and head of the department of psychiatry at St. Joseph Medical Center. About 1.5 million to 2 million people in the United States have this eating disorder that in its most severe cases can be fatal.

What is bulimia?

It is an eating disorder that is especially common in young women, though it can exist in both sexes and at all ages. About 3 percent to 4 percent of young women may suffer from it, but an increasing number of men are being diagnosed with the illness.

Bulimia generally is found in a person of normal or above-normal weight and is characterized by binge eating followed by feelings of depression or guilt, then purging. A person is worried about gaining weight; he or she binges and then purges to avoid weight gain.

What's its cause?

Many, many factors. There is a genetic piece: Studies have shown that eating disorders can run in families and are related to temperamental factors. People who are bulimic have certain traits. They might be obsessive or overly focused on body traits or impulsive in some ways.

Then we move into the psychological factors: People who are bulimic often are perfectionists and have unrealistic expectations of themselves or others. They are typically very achievement-focused. Body shape, weight and appearance are inextricably linked to their self-esteem. They don't feel good about themselves, and their behavior confirms this. They know it is unhealthy behavior, and they are often ashamed of it.

Some family factors have been identified as being associated with bulimia - although people without these factors can develop the disorder. These include an overemphasis on eating behaviors; daughters of mothers or fathers who are overly concerned about their appearance can develop it. There also are emotional triggers - stress certainly plays a role. Do cultural influences play a role?

Yes, in our society, thinness is emphasized as inextricably linked to attractiveness. The media has played a role by barraging young people with images of extreme thinness. What are the symptoms?

A history of dieting is a major risk factor for development of bulimia. But symptoms include episodes of binge eating - maybe as much as you would eat all day. These are discrete episodes of intense eating to the point of feeling out of control or engorged. The episodes are often terminated by some counteractive measures to stop weight gain. These may include using laxatives, fasting, compulsively exercising - some effort to undo the caloric gain.

To fit the definition of bulimia, this has to happen at least a couple times per week for a few months. If someone just has a few episodes of this, they wouldn't meet the formal criteria for the disorder. But they may be significantly impaired. What are the health risks associated with this disorder?

[The person] may be depressed. Other health issues, some life-threatening, may include electrolyte disturbances that can predispose you to cardiac problems.

Often a person with bulimia has exceedingly poor nutrition, so she may be malnourished or dehydrated. There may be erosion of teeth from the acid in the mouth, or gastric dilation [dilation of the stomach]. Sometimes the esophagus can be torn. We were just not designed to vomit several times a day.

On the psychiatric front, a person with bulimia may show impulsivity in other ways including substance abuse, alcohol abuse, shoplifting. When should someone consult a doctor?

Although I have painted an ominous picture - this disorder can devastate families - bulimia also is a very treatable disease. The longer the patterns go on, the more deeply engrained they become, so early treatment is important. Warning signs include someone who is over-focused on weight and appearance, who seems very fearful in eating situations or is actually observed eating voraciously or who gets up to go to the bathroom several times during meals.

Perhaps it is someone who is withdrawing from friends or becoming preoccupied with body shape.

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