Bulimia Nervosa Overview
Bulimia nervosa ("bulimia") is characterized by repeatedly eating abnormally large amounts of food in a short period of time and then trying to compensate for the binge by purging (i.e., engaging in self-induced vomiting, using laxatives or diuretics), exercising excessively, or fasting. Feelings of self-worth in a person with bulimia often depend on body shape and weight.
Unlike anorexics, bulimics are usually aware of their behavior, are unable to stop, are within their normal body weight range. They may be slightly over- or underweight. Bulimics are usually ashamed of their binge behavior and do it secretly. They are often depressed or anxious and about one-third abuse drugs (particularly stimulants) or alcohol.
Many people overeat occasionally, but bulimics do so on a regular basis, sometimes as often as 5 times a day, 7 days a week. A binge might include, for example, half a cake, a pint of ice cream, several donuts, half a pizza, a bag of chips, and a half-pound of cheese. Binge foods usually include sweet, high-calorie foods like cakes and ice cream, though the food chosen varies.
The average age of onset for bulimia is 18 years, but it occurs in children as young as 9 and adults into their mid-40s and older. Most bulimics go through a period of prolonged dieting or restricted eating before the cyclic binging-purging episodes begin. Researchers have identified several events that can trigger the onset of bulimia, such as family problems, problems in romantic relationships, and failure in school and work.
Bulimia is classified into two types, according to how compensation for binging (also spelled bingeing) is achieved. People who regularly engage in self-induced vomiting or the misuse of laxatives or diuretics following a binge have purging bulimia. People who compensate for binging by fasting or exercising excessively and do not regularly vomit or misuse laxatives or diuretics have nonpurging bulimia.
Diagnosis of Bulimia
Bulimia nervosa is classified as a mental disorder according to the American Psychiatric Association's DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition). According to the manual, the following criteria are used to diagnose bulimia nervosa:
- Repeated episodes of binge eating. A binge involves eating a larger-than-normal amount of food within a period of time (e.g., within 2 hours). Eating a large amount of food at a holiday dinner or wedding, for example, is not necessarily binging. Feasting is an important part of many celebrations. Someone who is binging feels out of control and is unable to stop eating.
- Binge eating is followed by inappropriate compensatory behavior in order to avoid gaining weight. The most common behavior is self-induced vomiting. Other compensatory behaviors include the misuse of laxatives, diuretics, enemas, or other medications; fasting; and excessive exercise.
- Binge eating and compensatory behavior occur at least once a week for 3 consecutive months.
- The patient's identity and self-esteem are heavily dependent on body weight and body image.