Bulimia Nervosa
What is Bulimia
Bulimia is a serious and potentially life-threatening eating disorder marked by a repetitive cycle of binge eating followed by compensatory behaviors intended to “undo” the intake of food.
Binge eating episodes often involve consuming large amounts of food in a relatively short period of time, accompanied by a sense of loss of control. In response, individuals may engage in behaviors such as self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise in an attempt to compensate for the binge.
DIAGNOSTIC CRITERIA
According to the DSM-5, the official diagnostic criteria for bulimia nervosa are:
- Recurrent episodes of binge eating. An episode of binge eating is characterized by #2 and #3.
- 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).
- 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.
- The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of anorexia nervosa.
Information provided by the National Eating Disorder Association.
WARNING SIGNS & SYMPTOMS OF ANOREXIA NERVOSA
Emotional and behavioral
• Dramatic weight loss
• Dresses in layers to hide weight loss or stay warm
• Is preoccupied with weight, food, calories, fat grams, and dieting
• Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
• Makes frequent comments about feeling “fat” or overweight despite weight loss
• Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
• Denies feeling hungry
• Develops food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)
• Cooks meals for others without eating
• Consistently makes excuses to avoid mealtimes or situations involving food
• Expresses a need to “burn off” calories taken in
• Maintains an excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury
• Withdraws from usual friends and activities and becomes more isolated, withdrawn, and secretive
• Seems concerned about eating in public
• Has limited social spontaneity
• Resists or is unable to maintain a body weight appropriate for their age, height, and build
• Has intense fear of weight gain or being “fat,” even though underweight
• Has disturbed experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight
• Post-puberty female loses menstrual period
• Feels ineffective
• Has strong need for control
• Shows inflexible thinking
• Has overly restrained initiative and emotional expression
Physical
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
• Dizziness
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Menstrual irregularities—amenorrhea, irregular periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
• Cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dental problems, such as enamel erosion, cavities, and tooth sensitivity
• Dry skin
• Dry and brittle nails
• Swelling around area of salivary glands
• Fine hair on body (lanugo)
• Thinning of hair on head, dry and brittle hair
• Cavities, or discoloration of teeth, from vomiting
• Muscle weakness
• Yellow skin (in context of eating large amounts of carrots)
• Cold, mottled hands and feet or swelling of feet
• Poor wound healing
• Impaired immune functioning
HEALTH CONSEQUENCES OF ANOREXIA NERVOSA
The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.
The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body.