Dear Curious,

The world of eating disorders is complex; many individuals may have unhealthy behaviors or tendencies related to eating that do not fit neatly into diagnostic categories. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association and universally used in diagnosing eating disorders, bulimia includes both binging and purging, which is mostly likely what your professor was referencing. By contrast, sufferers of anorexia nervosa attempt to lose weight by inducing starvation, often coupled with rigorous exercise, and may also attempt to accelerate weight loss by vomiting, taking laxatives, and/or using diuretics.

It seems that your behavior may be a conglomerate of a few different eating disorder tendencies. Even though not everyone fits neatly into a specific diagnosis, this does not mean that health consequences associated with bulimia or anorexia will be absent. Repeated, self-induced vomiting packs a serious punch in terms of health risks.

Some risks that may occur regularly and/or immediately following episodic vomiting include:

• Fatigue, which may become chronic or persistent
• Sore throat
• Tooth decay and/or tooth pain
• Puffiness in cheeks and strained or broken blood vessels underneath eyes

More serious health consequences of frequent purging include:

• Constant electrolyte imbalance as a result of frequent vomiting can overly stress the heart, leading to irregular heartbeats and possible heart failure
• Inflammation and possible rupture of the esophagus
• Chronic constipation and/or irregular bowel movements
• Developing ulcers or pancreatic disease

While there is a clear physiological component to purging, there is undeniably also a psychological component that is driving your actions. You may want to ask yourself what motivates you to purge frequently. As you probably know, many eating disorders stem from a deep-seeded discomfort with one's own body or an intense fear of becoming fat or gaining weight. Do you feel any of these fears apply to you? It may be useful for you to explore your own thinking and feelings about this issue as well as consider physical consequences of your routine. If you are a Columbia student, you can make an appointment with a professional on the eating disorders team in either Counseling and Psychological Services or Primary Care Medical Services. For counseling, you can make an appointment by calling x4-2878; for a medical appointment, you can call x4-2284 or log on to Open Communicator. Outside Columbia, some starting points are the National Institute of Mental Health's page on Eating Disorders, the National Association of Anorexia Nervosa and Associated Disorders (ANAD), and the National Eating Disorders Association, all with loads of information on how to approach this issue on a personal and medical level.

In terms of your birth control pills, typically five to six hours is long enough for the pill to absorb into a woman's system. But keep in mind that frequent purging is highly stressful for your body, and is likely to disrupt normal bodily response to birth control pills or other medications, possibly including digestion and metabolism of birth control pills. Your contraceptive method will be most effective if you are successfully managing other medical conditions, such as eating disorder tendencies, with your health care provider's knowledge and support.

Eating disorders are complex and confusing; asking questions about the impact that purging can have on your health can be a great first step on the path toward managing and recovering from any type of disordered eating. Good luck along the way,

Alice

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