Bulimia

The term bulimia nervosa is an official diagnostic category in DSM-5, (Diagnostic and Statistical Manual of the American Psychiatric Association). Popularly, the word bulimic refers to anyone who binges and purges.

Bulimic Pattern

According to psychologist John Lovern’s “Unified Eating Disorders Theory (l988), “bulimia is only one of the cyclical eating disorders. The pattern and frequency of cycles from undereating to overeating are most dramatic with bulimia, and most peaks of overeating end with a purge. Typically. most of the eating is excessive, and the typical bulimic would gain weight very rapidly if not for the vomiting or other purging behavior. Bulimics might also have periods of moderate or even undereating, which do not usually involve purging.

Bingeing

The root of the word bulimia means “ox appetite,” implying that we are talking about a real “pigging out” kind of binge. Gorging on food is important to this description. It does not include those who nibble (or “graze”) throughout the day.

Purging

Purging is any artificial activity to get rid of binged food or avoid the resulting fat.

The most publicized form of purging behavior is vomiting, though exercise and fasting are probably more common. Bulimics may vomit up to ten or more times a day and spend as much as $50 to $100 or more a day on junk food.

Another form of purging is using or overusing laxatives in an attempt to get rid of what has been consumed in a binge or to lose weight or “inches.” Laxative addicts may use as many as ninety laxatives a day and disrupt their elimination system so that they become dependent on large doses of laxatives.

Some bulimics take diuretics in an attempt to get rid of fat. Weight loss from diuretic use is loss of water, not fat, yet it gives the illusion of quick weight loss.

Excessive exercise to compensate for binges is another form of purging. This may be a supplemental kind of purging or it may be the main way of avoiding Weight gain.

Prolonged fasting or near fasting (more than about a day) for rapid weight loss is also a kind of purging.

Diagnosis

The Diagnostic and Statistical Manual of the American Psychiatric Association is often used as a set of diagnostic criteria. Briefly, to be diagnosed with bulimia nervosa, you must have: '

  • Recurrent episodes of binge eating
    • Eating, in a discrete period of time, an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
    • A sense of lack of control over eating during the episode.
  • Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
  • At least once a week for 3 months.
  • Self-evaluation is unduly influenced by body shape and weight.

The “Nervosa” Part

As in anorexia nervosa, the nervosa part of the name bulimia nervosa has to do with the obsession with body image, weight, fear of fat, and a feeling of loss of control.

Variations

There are many patterns of bulimic behavior that involve differences in bingeing and purging styles. Most bulimics are at or near normal weight, at least in the earlier stages of the disease. Many later stage bulimics panic when, as often happens, the bulimia “stops working” and they start gaining weight despite continuing to purge.

Treatment

Most bulimics respond well to an addiction model for treatment. They may also have substance abuse problems or be in recovery from chemical dependency. Family members may be substance abusers, obese, or have other addiction or codependency problems. Unless there are unusual medical or psychiatric problems, most bulimics do not need inpatient hospitalization.

Special needs All bulimics need to have special solutions for their special needs, especially those related to cognitive distortions (black-and-white thinking), body image and self-esteem improvement, and learning how to eat in a normal, healthy way.

Food planning It is important for bulimics to learn to eat enough when not purging — most are used to starving when they don’t purge. Many bulimics have not eaten a moderate meal in years, and they need some simple instruction on what constitutes a moderate food plan. They also usually have emotional issues surrounding the meal. Reducing the fear of food is important to recovery.

Social hour Usually, the hour following meals is the most critical for the bulimic who wants to stop purging. Most bulimics like the feeling of emptiness (and a flat stomach), and learning to tolerate feeling moderately full is essential.

It may help to insure that some supportive person is with the bulimic during the hour following each meal, especially in the first weeks of recovery The social hour will be effective if they see it as support, not as enforcement.

Dental care If frequent vomiting has continued for more than a year or two, there is a good chance of damage to the enamel of the teeth. This coating is meant to withstand the weak acid of saliva, not the strong acids of the stomach. Damage is permanent and may require reconstructive dental work. Most other consequences of bulimic behavior will repair themselves in time.

Body image Most bulimics are obsessed with their bodies and have distorted body images. Feeling fat is usual, even when it is totally unrealistic. Body image improvement is often slow but effective with adequate intervention techniques (see Body image).

Recovery Recovery involves the restoration of normal eating patterns, elimination of purging, reduction of black-and-white thinking, being honest with feelings, and moving from self-centered obsessions to being able to reach out to others.


Bulimia nervosa, see also: Adolescents, Anorexia nervosa, Binge history, Bingeing, Body image, Constipation, Craving, Diet mentality, Drugs, Eating addiction, Eating plans, Exercise & activity, Family, Fats, Hunger & appetite, Moodifiers, Nutrition, Purging, Recovery, Therapy & treatment, Unmanageability, Weight.

Updated 6 Sep 2015

 

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