8. BULIMIA IN FEMALES BEYOND AGE THIRTY

Bulimia may be underreported in women over age 30. Population surveys have uncovered fewer older bulimic patients. Jonas [50] reported a 56-year-old woman with rapid-cycling bipolar disorder and unexplained vomiting. She had no prior history of an eating disorder, and during hospitalization the staff discovered surreptitious vomiting. Bulimia disappeared with individual medication trials, first with imipramine, and then phenelzine. Older patients with affective disorder and unexplained vomiting not secondary to psychotropic drug toxicity should be screened for bulimia. Lithium use may be hazardous, therapeutically unpredictable, or lethal in patients with self-induced, surreptitious vomiting, due to electrolyte disturbance. Patients taking lithium for bipolar disorder, emotionally unstable character disorder, or recurrent unipolar depression should be screened for bulimia. Bipolar patients with bulimia may respond to carbamazepine [51] as an alternative to lithium carbonate.