Does Your Child Have Bulimia?

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In a recent study, one in five 9th graders and two in five 12th graders (high school seniors) admitted to stuffing themselves with food and then forcing themselves to vomit, at least once. In the entire population, one in four U.S. teenagers are believed to binge and purge regularly. This is known as bulimia, often accompanied by anorexia but not necessarily.

Lauren Adler, MD, FAAP

Eating disorders like bulimia are serious health conditions that can be both physically and emotionally destructive, particularly for teenagers. Here at Westchester Health Pediatrics, we have a number of teenage patients who suffer from bulimia, and we want to stress to parents that early diagnosis and intervention make a big difference in recovery. Affecting boys as well as girls, eating disorders can escalate into life-threatening conditions and require professional help.

How bulimia differs from anorexia

Teens suffering from anorexia eat very little and are at least 15% below their ideal body weight. They are dissatisfied with their bodies, have an intense fear of weight gain, are obsessed with their weight, and go to extreme measures to slim down and prevent gaining weight.

Teens with bulimia are also obsessed with not gaining weight but their method is to eat huge amounts of foods followed by purging, either by vomiting, using laxatives or diuretics, or by spending abnormal amounts of time doing strenuous physical exercise. They often report feelings of being out of control during their binge-eating episodes. Half of all anorexics have episodes of bulimia at one time or another.

A diagnosis of bulimia is based on these 6 criteria:

  1. Recurrent episodes of binge eating
  2. Regularly purging in order to control weight through self-induced vomiting, laxatives, diuretics, enemas, ipecac or other medications
  3. Fasting
  4. Exercising obsessively
  5. Binging and purging at least twice a week for three months
  6. Excessive concern over weight and figure

Red flags to watch out for

Because a bulimic teen’s weight generally hovers around average or above average, he/she can often hide the condition for years. In most cases, a teen with bulimia starts to diet and may also start an exercise campaign, but eventually surrenders to cravings for food. Stress or strong emotions can set off a binge, during which bulimics will devour whatever food they can lay their hands on, often starchy junk foods. It is not unheard of for teens with this eating disorder to consume 3,000-7,000 calories in a couple of hours, stopping only after they’re too full to take another bite. Somewhat ironically, bulimics barely derive any pleasure from eating, and tend to chew and swallow almost mechanically.

After the binge eating, feeling guilty and ashamed, bulimic teenagers attempt to rid their bodies of the food before it is digested. Inducing vomiting by sticking their fingers down their throat is one method. They can also take excessive doses of laxatives, diuretics or emetics, drugs that promote bowel movements, urination or vomiting.

Be aware that bulimics are very secretive and plan their binges in advance—usually when nobody else is around.

Behavioral signs of bulimia

Does your teen exhibit any of these behaviors? If so, please take him/her to a pediatrician or mental health professional right away.

  • Preoccupation with food and weight
  • Distorted body image
  • Long periods of time spent in the bathroom—sometimes with the faucet running, to mask the sound of vomiting
  • Depression
  • Anxious about eating, especially dining out in public
  • Abuse of laxatives, enemas, emetics, diuretics
  • Spends less time with family and friends; becomes more isolated, withdrawn, secretive
  • Stealing food and hoarding it in unusual places, such as in the closet or under the bed
  • Excitability, difficulty sitting still, easily distracted

Physical signs of bulimia

Again, if your teen exhibits any of these physical signs, please take him/her to a pediatrician or mental health professional right away.

  • Dramatic fluctuations in weight, from alternately dieting and binging
  • Puffy face and throat from swollen salivary glands
  • Burst blood vessels in the face
  • Bags under the eyes
  • Indigestion, bloating, constipation, gas pains, abdominal cramps
  • Dehydration
  • Eroded tooth enamel from the gastric acid in vomit
  • Discolored teeth
  • Cavities
  • Inflamed, bleeding gums (gingivitis)
  • Calluses on fingers and knuckles from self-induced vomiting
  • Swelling (edema) of the feet or hands
  • Sore throat
  • Tremors
  • Dizziness, light-headedness, fainting spells
  • Stiff, achy muscles
  • Muscle weakness
  • Muscle cramps
  • Irregular menstruation
  • Extreme thirst, frequent urination
  • A constant sensation of coldness, especially in the hands and feet, because the body has lost its fat and muscle (if underweight)
  • Hair loss
  • Blurred vision

The physical damage caused by bulimia

Despite an outwardly healthy appearance, binging and purging exacts a heavy toll on vital organs and can lead to diseases of the liver, kidneys, intestines and heart. Potassium deficiency can bring about an irregular heart rhythm and possibly cardiac arrest. As in anorexia, the other major cause of death is suicide.

Along with dangerously low body weight, teens suffering from bulimia can lose their menstrual
periods. This can cause irreversible early bone loss (osteoporosis) that can lead to serious bone fractures later in life. Bulimia can also cause multiple cavities and long-term dental problems.

Can eating disorders be treated?

Although there is no quick and easy treatment for eating disorders, they are indeed treatable. This can include mental health therapy, nutritional feeding, medical monitoring and medication. Generally, the goals of eating disorder treatment are to restore the person to a healthy weight, treat any psychological problems related to the disorder, and reduce behaviors or thoughts that contribute to the eating disorder. Continuing therapy may be needed to prevent relapse and to treat related psychological problems.

The good news: we’re here to listen…and to help

At Westchester Health Pediatrics, we want you to know that we care deeply about your child’s well-being and will do all we can to help him/her overcome bulimia, or any other eating disorder. Please come in and talk with us—your teen alone, you and your teen, or you by yourself—about body image, eating habits, self-esteem, relationships, school, grades…anything.

If, together, we decide your child does in fact suffer from bulimia or another eating disorder, we’ll go over all the available options and make the appropriate referrals. Plus, we have an on-staff nutritionist who can help your child make smart, healthy choices about food, calories and nutrition. Most of all, we want to help your teen feel good about herself/himself and be healthy, now and throughout life. Whenever, wherever you need us, we’re here for you.

More information on eating disorders

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By Lauren Adler, MD, FAAP, a pediatrician with Westchester Health Pediatrics

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About the Author: ML Ball