Bulimia Nervosa

Some people tend to believe that an appropriate diet borders on the concept of starvation. They skip meals during the day, usually breakfast and lunch, even when experiencing intense hunger. However, when evening arrives and hunger becomes unbearable, they engage in binge eating that can last up to several hours. Then, they purge themselves using compensatory behaviors, such as self-induced vomiting and/or the use of laxatives, all in order to prevent gaining a few pounds.

A mental health professional would probably diagnose a person displaying such behaviors with bulimia nervosa. There are certain features characteristic of binge eating associated with this disorder. One is that the individual engages in episodes in which large quantities of food are consumed in a discrete period of time. Another is that the person cannot control the eating impulse until completely satiated.

There are groups that are at higher risk of developing bulimia nervosa. White, middle-class women (mainly teenagers and college students), ballet dancers, gymnasts, wrestlers, and skaters demonstrate a higher rate of this disorder.
Research suggests that the typical onset of bulimia nervosa is during adolescence. In addition, biological theorists indicate that bulimia may have a genetic component and that certain neurotransmitters are crucial in regulating the binge-purge cycle. Psychological factors may also play a part (i.e., low self-esteem or impulsive behaviors). Many individuals with this disorder experience depression and substance abuse issues.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the diagnostic criteria for bulimia nervosa is as follows:

“A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

(1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

(2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.”

Furthermore, the DSM-IV-TR distinguishes between two types of bulimia nervosa:

“Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas”

A large number of people with this disorder do not seek help because they believe they do not have a problem. Others fail to seek treatment because they are ashamed or feel hopeless about their behavior. However, individuals that enter therapy are usually treated with antidepressant medication, since it is not uncommon to see a person with both bulimia nervosa and depression. Cognitive behavioral interventions can also be helpful when treating this population. The goal is usually to establish a normal pattern of eating three meals per day and sometimes snacks between meals.

If you or someone you know is experiencing some of the signs and symptoms described in this disorder, an evaluation from a mental health professional may be the best option. Contact your doctor or mental health provider in your area today.

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