This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 14 of season 1, named Control, a young ambitious CEO named Carly presents to the hospital with severe leg pain. During her hospital stay it is found that she also has heart failure. After the usual series of misdiagnoses House arrives at the conclusion that she has been abusing a drug called ipecac, used to induce vomiting, since she has bulimia nervosa. The ipecac syrup caused the damage to her heart, and probably also the damage to her leg’s muscles.

Photo by Fox.

What is it?

Bulimia nervosa (BN) is an eating disorder in which people eat a large amount of food in a short time and then get rid of the food they just ate.

Who gets it?

Like other eating disorders, mostly women (there are probably 10 times more women with the condition than men). It usually starts in teenage years or early twenties.

It is believed that in the US about 1-3% of women of high school or college age have the condition.

What causes it?

As with other mental illnesses, the exact cause isn’t known. It may be a mix of a few elements -

• Society – The modern Western world gives more and more importance to body image. Magazines and TV shows are scattered with images of thin individuals. Some people tend to equate thinness with success and worthiness. Add to that pressure from friends and the surroundings.
  
  A mannequin. With display windows showing such slim bodies, many women feel overweight. Photo by The Life of Bryan
• Emotional health – People with eating disorders may have psychological problems contributing to the condition, such as low self esteem, perfectionism (like the woman on the House episode), impulsiveness, family or relationship conflicts, and so on.
• Biology – It turns out there are genetics involved. If you have siblings or parents with the condition you may be more likely to develop it yourself.
• Occupation – If you have a job or do a sport that give an importance to body size, such as ballet, modeling, or gymnastics, you may be more likely to develop bulimia (other things considered…).

How does it feel?

People with bulimia repeatedly eat in binges – this means they eat large amounts of food within a short time. They tend to do it secretly. The food tends to contain high calories, such as ice cream and cake, and can sometimes reach thousands of calories. They may eat such large quantities that their stomach and esophagus may be damaged or torn in the process.

After eating comes the purging phase, in which they get rid of what they just ate. Ways of doing that include vomiting on purpose, taking laxatives (like the woman on the House episode), doing hard diets or fasting, over-exercising, or any combination of the above.

The vomiting can erode our teeth, since vomit includes acid. It can also enlarge our salivary glands and cause damage to the esophagus. It can change the level of salts in our body, putting the body in risk of abnormal heart rhythms and sudden death.

And, as was seen on the House episode, laxatives such as ipecac are dangerous to the heart.

This video tells the story of Sarah Siskin, who died of bulimia:

How is it discovered?

When the doctor sees a person in the right age (and gender) that expresses concern about gaining weight combined with weight fluctuations, signs of laxative use, and other signs (such as scars on the knuckles from inducing vomiting, swollen salivary glands, etc.) their suspicion rises.

The only way to be sure of the diagnosis is by having the patient tell, which doesn’t always happen.

How is it treated?

There are 2 ways to treat bulimia:

Psychological: A therapy called cognitive-behavioral therapy is usually used, in which the wrong thoughts that led to the behavior are faced with, and people are helped to give them up.

Medication: A type of antidepressant drug is given and may help.

What happens after treatment?

There’s no sure path. With some people the disease may be related to life crises and pass when they do. For others, it may be fluctuating over many years. That also depends on how compliant the person is with their treatment.

What next?

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