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hi. please help me. my boyfriend is suffering from bulimia. he is 18 years old, 186 cm tall and 64 kg. one year ago he was fat, he lost 50 kg in a year. he has changed a lot. he wants to work as a model now, he has a very strait diet too, with all these calorie counting stuff. fruit, vegetable, fish, mineral water. he has a depressed mode very often. he told me the whole thing once when he was very drunk, the day after he denied it. and a couple of days later he told me everything again, this time sober. now he thinks that i love him less, but it's not true i just feel that i can't handle this thing alone. he throws up 2 or 3 times a day. his hands are purple and he is very skinny. i think he is depressed, too. he needs professional help. he doesn't want to tell it to his mother, or an other grown up. i love him very much and i'm very afraid because of the things i read about bulimia on the internet. i want to support him, but i don't know where to start.

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Category: Family Physician-GP
 29 Doctors Online

Thank you for consulting with us at Doctor spring. I understand that you are worried about your boyfriend's health and the possibility of him having Bulimia.

There are several inciting agents for Bulimia Nervosa including a higher than expected prevalence of childhood and parental obesity. Several cultural factors are also important which in your boyfriend's case has been his desire to lose weight in order to become a model. Once it has begun, several biochemical abnormalities at the level of the brain help to perpetuate Bulimia. This includes changes in the levels of a chemical called serotonin in the brain which is important in eating behavior and regulation of chemical release form the intestines which indicate satiety (or that you've eaten enough).

The onset of Bulimia is usually in the late adolescent period or in early adulthood during or following a diet in association with a depressed mood. The self- imposed diet leads to hunger and thus to over eating. But the patient is aware of the fact that they have to lose weight and so, they induce vomiting or take laxatives or diuretics or engage in some other kind of compensatory behaviour. During the episodes of binge eating, the person usually consumes high calorie sugar rich foods like desserts and chocolates. At first, the patient experiences a sense of happiness that good food can be eaten without gaining weight. But as the disorder progresses, patients start feeling that they have no control or reduced control over their binges which tend to get larger in frequency and in number.

Eventually, in between binges the person reduces calorie intake and his in turn increases their hunger and they go on larger binges. Patients with bulimia place an unusual emphasis on weight and shape as a basis for their self esteem.

The physical abnormalities associated with bulimia are mainly due to their purging behaviour.

1. Swelling of the salivary glands which can be observed between the ears and the cheek.

2. Injuries on the hands because they often induce vomiting by forcing the hand into the throat.

3. Chipping and erosion of the front teeth because of the acid from the vomitus.

4. Electrolyte abnormalities due to loss of large volumes of water and electrolytes in the vomitus.

Bulimia has a good course in comparison with its more serious partner Anorexia nervosa. Full recovery can be hoped for in 50% of patients.

I would suggest that you inform your boyfriend's parents first because it is important that he receive care in the proper hands. Visit you doctor and take his help to get referral to a Psychiatrist.

Bulimia can be treated on an Outpatient basis. The most established method of treatment is a procedure called Cognitive Behaviour Therapy in which the psychiatrist helps to bring about a change in the thoughts regarding binge eating, dieting, concern over image etc. If necessary, a combination of anti depressants along with CBT may be opted for which may be beneficial than either mode alone.

Hope this information was of use to you.

Dr. John Monheit
Category: Family Physician-GP
Residecny: North Colorado Family Medicine
Medical School: The Chicago Medical Center
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