In my practice here in Palm Beach, I see patients who are fighting a war on two fronts. One battle is against their own bodies, and the other is against the toxic relationships that often fuel their illness. Bulimia Nervosa is overwhelmingly more common in females, and it is rarely just about food. It is about a desperate search for validation in a world that feels out of control.

At Mark G. Agresti, MD, LLC, we look beyond the symptoms to understand why this is happening—analyzing everything from your blood work to the person you are dating.

The “Typical” Boyfriend: A Pattern of Pain

One of the most heartbreaking patterns I see in young women with bulimia is the type of romantic partner they choose. We often replicate what we know, and for many of my patients who grew up with critical or controlling parents, love feels like “performance.”

The Magnetism of the Unavailable Partner

The “typical” boyfriend of a bulimic patient often shares specific, damaging characteristics:

• The Critical Narcissist: He is often charming but emotionally unavailable. He may make subtle (or overt) comments about other women’s bodies or his girlfriend’s weight, reinforcing her belief that she must be “perfect” to be loved.

• The Controller: Just like the eating disorder, he dictates the terms of the relationship. He is often unpredictable, leaving the patient in a constant state of anxiety.

• The Dynamic: The patient uses her bulimia to manage the anxiety this relationship creates. The more insecure she feels with him, the more she binges and purges to numb the pain. It is a vicious cycle: she starves and purges to be “good enough” for him, but the secrecy of the illness creates a wall that prevents true intimacy.

The Body Keeps the Score: Physical Devastation

While the emotional toll is heavy, the physical price of bulimia is catastrophic. The body cannot sustain the violence of bingeing and purging forever. In my office, I educate patients on the harsh reality of what is happening inside them.

1. The Visible Decay: Hair, Skin, and Teeth

• Hair Loss: Due to malnutrition and the stress of the cycle, many patients experience telogen effluvium—their hair thins rapidly and falls out in clumps.

• Dry, Graying Skin: Chronic dehydration sucks the life out of the skin. It becomes dry, flaky, and prone to premature aging.

• “Bulimia Teeth”: This is often the first sign. Stomach acid is incredibly corrosive. Frequent vomiting rots the enamel from the back of the teeth, leading to yellowing, sensitivity, and eventual tooth loss.

2. Internal Damage: Throat and Gut

• Esophagitis: The esophagus isn’t lined to handle acid. It becomes raw, inflamed, and painful. In severe cases, we worry about Mallory-Weiss tears—actual rips in the throat lining that can cause bleeding.

• G.I. Paralysis: For those who abuse laxatives, the bowel eventually “forgets” how to work on its own. This leads to severe, chronic constipation and bloating, which ironically makes the patient feel “fat” and triggers more purging.

3. The Silent Killer: Electrolytes and Hormones

• Cardiac Arrest: Purging depletes potassium. When potassium drops too low (hypokalemia), the heart’s electrical system fails. This is how young, otherwise healthy women die suddenly from bulimia.

• Reproductive Shutdown: The body senses it is in crisis and shuts down non-essential functions. Periods become irregular or stop completely (amenorrhea), leading to potential long-term fertility issues.

Case Vignette: Sarah’s Struggle for Control

Let’s revisit the case of “Sarah” to see how these dynamics play out.

The Family Trap

Sarah, 26, was trapped in a high-stakes game of control with her mother—a status-seeking, overbearing socialite who demanded perfection. Sarah’s body was the battleground. The sicker Sarah got, the more her mother had to pay attention to her, rather than the gala she was planning. It was dysfunctional, but it was effective.

The Boyfriend Factor

To complicate matters, Sarah was dating a man who was a “junior version” of her mother. He was a successful investment banker who was obsessed with appearances. He wouldn’t explicitly call her fat, but he would praise her only when she looked “tiny” or “fit.” Sarah lived in terror of his rejection. She would binge to stuff down her anger at him, then purge to ensure she stayed the size he “preferred.”

The Breaking Point

Sarah came to see me not because she wanted to stop, but because her body was failing. Her hair was falling out in the shower, and she had fainted at work due to electrolyte imbalance. We had to confront the truth: her eating disorder wasn’t keeping her safe; it was slowly killing her to please people who refused to accept her as she was.

The Path Out: Treatment at Mark G. Agresti, MD, LLC

We stabilized Sarah with a combination of:

• Medical Monitoring: Weekly EKGs and blood work to correct electrolytes.

• Medication: High-dose Fluoxetine to curb the compulsive urges and Topiramate to manage binge cravings.

• Psychotherapy: We used DBT to give her new coping skills and intense family therapy to reset the boundaries with her mother. We also helped her find the strength to leave the toxic relationship.

A Healing Environment

Recovery is hard, but your environment shouldn’t be. My practice is designed to be a sanctuary.

• The Location: We are located at 44 Coconut Row, right on the Intracoastal Waterway. The view of the water and the Breakers Hotel golf course offers a peaceful perspective that helps you breathe easier.

• The “Bella” Therapy: You aren’t just a chart number here. You’ll likely be greeted by Bella, my Boykin Spaniel. There is nothing quite like the non-judgmental love of a dog to help you feel safe enough to speak your truth.

Take Your Life Back

You do not have to lose your teeth, your hair, or your future to this illness. You deserve relationships that build you up, not tear you down.

Call us today: 561-744-0744

Visit: drmarkagresti.com

Location: 44 Coconut Row, M 202, Palm Beach, FL 33480

Next-day appointments available.

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