People with bulimia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all these forms of purging. Because many individuals with bulimia "binge and purge" in secret and maintain normal or above normal body weight, they can often successfully hide their problem from others for years.
Family, friends, and physicians may have difficulty detecting bulimia in someone they know. Many individuals with the disorder remain at normal body weight or above because of their frequent binges and purges, which can range from once or twice a week to several times a day. Dieting heavily between episodes of binging and purging is also common. Eventually, half of those with anorexia will develop bulimia.
As with anorexia, bulimia typically begins during adolescence. The condition occurs most often in women but is also found in men. Many individuals with bulimia, ashamed of their strange habits, do not seek help until they reach their thirties or forties. By this time, their eating behavior is deeply ingrained and more difficult to change.
Specific Symptoms of this Disorder:
This disorder is characterized by recurrent episodes of binge eating, occurring at least twice a month for a minimum of three months, which consists of:
- 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
- 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)
Individuals who suffer from this disorder often engage in behavior in order to try and prevent themselves from gaining any weight. This behavior may include such things as self-induced vomiting; overusing laxatives, diuretics, enemas, or other medications; refusing to eat (fasting); or excessive exercise.
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. A person's self-image is usually directly correlated with their weight, with a great deal of attention focused on how their body looks.
This disorder can only be diagnosed if it is not better accounted for by anorexia nervosa.
There are two major sub-types of disorders found within bulimia nervosa:
- Purging Type: -- The person regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
- Non-purging Type: -- 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
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
National Institutes of Health, National Institute of Mental Health, NIH Publication No. 94-3477 (1994)