BULIMAREXIA. It is a strange word for a strange and secret compulsion. It thrives where women strive--in professions, in responsible jobs. It is rampant, almost epidemic, say researchers, on college campuses.
Overwhelmingly its victims are women.
Most often they have all the trappings of success. They are competitive, perfectionist, attractive, middle-class and well-educated.
Kelly is 21 years old. She is a perfectly beautiful young woman. She is slim and leggy. Her jeans fit her the way Brooke Shields' Calvins fit her. Kelly could be on the cover of Glamour or Cosmo, easy. Her complexion is rosy. Her smile is wide and warm. She is bright, a student at a local university -- articulate and open.
Until last July she was a prisoner of bulimarexia, and had been for about four years, close to the average for those who seek professional help. Bulimarectics, phobic about fatness, have an all-but-irresistible compulsion to gorge enormous amounts of food -- perhaps 10,000 calories at a sitting or even more -- and then purge it either by self-induced vomiting or abuse of laxatives or diuretics.
Kelly is not her real name. In fact, none of the women at a recent group therapy session would permit use of their names. "We wouldn't be here if you were to use our names," one said flatly. "My husband doesn't know about me," said another. "My co-workers don't know about me," said another. "My parents would just die . . ." "What would my professors say? . . ."
Bulimarexia is, say the specialists, more secret, more in-the-closet even than homosexuality was 15 years ago. The percentage of women who are afflicted by this particular eating disorder may be much higher even than the estimated 20 percent, particularly among the most susceptible groups.
Kelly is an almost classic example. She still must fight the compulsion but she is, she feels, getting it together.
A typical episode -- she says she wrote them down because she knew she'd never believe it later -- might include eating at one sitting "three shrimp crepes, half a cake, a dozen cookies, the rest of the cake, the rest of the cookies, a quart of ice cream, potatoes, potato chips, more ice cream . . ."
Mary Beth, who is 47 years old and has been bulimarectic for about 15 years, laughs, but bitterly. That, she says, would have been only the beginning for her.
There were eight women in the group. Two of them were recovering anorexics. The rest were women who engaged in bulimarexia.
For these women it is as irresistible a compulsion as the drug addict's for the nickel bag.
The gorge-purge ritual may be once a month at first. Eventually, possibly because the body's hunger cues have been confounded, it happens as often as three times a day, even up to 10 episodes daily. It often starts after a diet has been completed successfully and, like anorexia, it appears related to separation -- either from home for the young adult or from a broken romance.
It may go on for years with no one suspecting.
It is capricious, though, and it may kill at any time with a sudden and irrevocable cessation of heartbeat. "Cardiac arrest," says a woman, is "the ultimate answer to your weight problem."
"Oooh," says the average person who hears about the syndrome that is sometimes called (inaccurately) bulimia (from the Greek, meaning ox hunger) or even bulimia nervosa. "How disgusting. How loathsome."
Part of its tragedy, of course, is that it is often no less gross to its victims. Their self-loathing is equaled only by their abhorrence of fat in general, and especially of being fat. And by their helplessness to break free of this aberrant and ritualistic eating behavior, even when they want to.
There are men who do it, but they are far fewer than women. Like anorexia, it is much more prevalent among models and ballerinas than in the general population.
"Do you remember that skit they did on "Saturday Night Live" about the vomitorium?" one woman asked.
"Oh gross," said another.
"I turned it off," said another.
"Yes," said another. "Somebody stood there to tickle somebody's throat with a feather -- Belushi, was it? And another one shoveled the vomit . . ."
"Gross," repeated one of the women.
There was a pause. Then an older woman said, "Well, I saw it and it really worried me. Because at the time, my husband didn't know I had done it and I felt like they were doing it to punish people like me. I thought they were making fun of women who do it. I really thought it was aimed at me . . ."
Another agreed. "When you do something like that you think everybody's talking about that. That everybody knows . . ."
Judith Asner, a clinical social worker in Maryland, recently placed a small personal advertisement in Washingtonian magazine offering help for the syndrome. She received 20 phone calls before the magazine was technically on the stands.
With almost no advance publicity, a Georgetown University Diet Management Center seminar on bulimarexia drew some 50 people on a recent Saturday morning. Almost all were suffering from the syndrome. Georgetown has been treating bulimarexia and the closely related anorexia for about two years.
Dr. Martin Caesar, the Georgetown unit's psychiatric consultant, and other experts would not be surprised to find a heavy concentration of the problem in the Washington area. But its existence is so passionately guarded by those who engage in it, and they are so isolated, even alienated, that estimates remain only that: estimates.
Kelly attended the Georgetown seminar in part to represent the support group she attends each Thursday evening in suburban Maryland.
Becky also attended the seminar. She came to the next meeting of the support group.
Becky is small, about 5 feet 3, trim and quick. She represents another common aspect of bulimarexia: the out-of-control impulse. The gorging may take the form of an impulsive, uncontrolled buying binge, an impulsive personal relationship, even kleptomania, the specialists say.
Becky spoke shyly at first, but the other women gently drew her out, and in the end she described how her weight problem -- she's gained and lost 100 pounds, she said -- led her to bulimarexia. But, she confided, she'd also been impulsively into drugs, sex -- "you name it," she said softly.
In all, said Becky, "It takes about four hours of your time--about 2 1/2 hours for the binge-purge and the rest procuring the food. I really have hardly any social life because of that."
It is also expensive. One of Asner's clients said she was spending something like $600 a week to feed her addiction.
One of the first major researchers on bulimarexia in this country was Craig Johnson, PhD, director of the anorexia nervosa project at the Michael Reese Medical Center in Chicago. Some months ago he described the syndrome at a Kennedy Institute conference in Baltimore. (Bulimarexia is included under anorexia projects because the disorders are related and, because the starvation of anorexia is so hard to hide, it became known first.)
Johnson prefers the word gorge to binge to describe the bulimarectic behavior because, he says, "If you ask a roomful of women how many have binged, they'll all say yes."
One of the problems, he notes, is the very attractiveness of the bulimarectics. "People in the clinic who watched them walk to my office told me if I could put whatever caused it into a bottle and market it I'd be a rich man. There is a subtle envy of women who seem to be able to eat whatever they want and yet be able to maintain the weight.
"It's very difficult to take that gratification away from them . . . they sense this very dramatically."
Not that the women enjoy the food.
"Oh," says Kelly, "the first part of a planned binge you may enjoy, but then you're just like a stuffing machine. You don't know what you're doing. You don't know what you're eating.
"You have to eat enough to enable yourself to vomit."
The women talked about eating raw oatmeal, half-cooked potatoes and unfrozen frozen foods. "Really weird things," said Kelly.
Nevertheless, they speak of a sense of gratification when the cycle is completed.
"What we do," said Kelly, "instead of dealing with reality, we create our own reality and it's between eating and not eating, between thin and fat. Instead of dealing with real problems and stresses, we just deal in that little box."
Said Becky, "If I'm anxious, I calm down. While I'm doing it I forget all my problems. Not that I feel good. It's just that I don't feel . . . Anorectics starve themselves to death. With bulimarectics it is usually an imbalance of electrolytes that induces cardiac arrest. Or esophageal rupture. Bulimarexia combined with alcohol or sedatives or tranquilizers or sleeping pills is also potentially fatal.
But there are other more subtle health problems that can make the bulimarectic fatally vulnerable to illnesses -- flu, for example -- that healthier people can withstand.
Aaron Altschul, director of the Diet Management program at Georgetown and a PhD. nutritionist, describes a series of nutritional upsets, including the loss of protein when the digestive process is interrupted.
Other ills the bulimarectics suffer include incredible tooth decay and wearing away of tooth enamel -- caused by the acid in the vomit. Also infections of the salivary glands, dry skin, acne, muscle spasms, falling hair, bloodshot eyes, kidney and liver damage, as well as constipation and hormonal imbalances among other unpleasantries.
It can, researchers are finding, be caused by specific physiological disorders, including tumors of the hypothalamus and forms of epilepsy. There is often a clinical depression connected with it.
Sometimes anti-convulsive drugs or anti-depressants may be used along with psychotherapy.
In any case, the sooner the disorder is diagnosed and treated, the more likely it is that it can be cured, or at least controlled. The more entrenched the behavior is, the more addictive it becomes and the more difficult to treat.
Caesar believes there may be a genetic vulnerability. "Eating," he says, "is like a headache. It is a symptom of a whole host of related problems having to do with impulse control. It can be around sexual feelings, intake of food, around acquisition in general. It is a problem of addiction . . . And the really addictive part in some is the major concern. In most there are problems of identity, but there are also competitive issues, issues about acquisition of power, getting ahead."
The women themselves and many experts blame the cultural emphasis on thinness and the pressures on women today to succeed.
"I think," says Caesar, "culture points the direction of how symptoms might be expressed." He also sees factors such as family relationships in early childhood as crucial.
Cultural emphasis on thinness has been intensifying in the last two decades or so. Johnson cites a study of 23 years of Playboy centerfolds. The researchers "did a weight-per-cubic-inch ratio and found a dramatic decline over the past 23 years," he told the Kennedy Institute group. "They also noted a gradual kind of move toward smaller busts, smaller waists, thinner hips -- very dramatic. They did the same thing for Miss Americas and found the same relationship . . ."
The women themselves feel caught in the conflict of "diets on one page of a magazine and Sara Lee ads on the next."
On a recent Charlie Rose segment on bulimarexia, the host spoke passionately about how the emphasis on thinness has distorted "the psyches of American women," and cut away for a commercial. The commercial was for a new diet product.
Dodi Ardalan, a counselor in the Georgetown program, works with imagery, hypnosis and other techniques to help the bulimarectic client get back in touch with herself and refocus the distorted sense of her body image.
Kelly believes she has been helped by this sort of treatment, along with relaxation and meditation. She says, "Like, once you learn your feelings are okay, you don't have to stuff yourself to the point that you don't feel, because that's what we're doing. Once you stop, then all of a sudden you start feeling emotions. After I stopped for three weeks, I felt something. You're not even conscious of the fact that you don't feel until you do."
The support group, she says, was crucial.
"Finding other people who are like me . . . God, for four years I didn't know anyone else in the world who was doing this same thing. You know, I thought I was just nuts."