Is Bulimia A Form of Addiction?

Bulimia, the binge-and-purge disorder that tends to afflict young women, resembles addiction in several important ways.There is often a family history of alcoholism and other eating disorders, for starters. And bulimia’s impact on the brain’s reward center is quite direct, judging by the high relapse rates among bulimics. In addition, PET scans have demonstrated that  ex-bulimics exhibit a marked decrease in serotonin receptor activation. Alterations in the brain’s serotonin pathways often persist after recovery from bulimia, and may represent permanent changes in brain chemistry.

Bulimics often maintain a normal weight, but can suffer serious physical consequence—heart rhythm irregularities, electrolyte imbalances, low blood pressure, and damage to the esophagus. Once the binge-purge cycle has been established, some researchers believe, drug-like changes in serotonin receptor distributions help reinforce the pattern. There is a definite “high,” which comes with the purging, and which has no analogue in anorexia.

Nicotine expert Cynthia Pomerleau of the University of Michigan thinks it’s likely that some women “use nicotine to hold the symptoms of bulimia in check; when they quit, the underlying predisposition reemerges—which helps to explain why these women may be more prone to larger weight gain than other quitting smokers.” It is not surprising to learn that Prozac and other serotonin-active antidepressants have proven helpful for many bulimics. Clinical studies showed median reductions in binging of as much as 67 per cent for Prozac, compared with 33 per cent for placebo. Vomiting was reduced by 56 per cent, compared to 5 per cent for female placebo users. (About 10 per cent of diagnosed bulimics are males.)

Bulimia, like alcoholism, smoking, and other drug addictions, has its psychosocial side, too, but twins studies show that there is very probably a genetics of bulimia to be pursued.  A combination of SSRI drugs and some form of structured cognitive therapy is the recommended approach at present.