Bulimia nervosa
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Bulimia, or Bulimia Nervosa, is an Eating Disorder in which binge eating and inappropriate behaviors designed to prevent weight gain occur. The diagnostic criteria for this disorder include:
• recurring episodes of binge eating
• recurring and inappropriate behaviors designed to prevent weight gain
• the occurrence of binge eating and related weight control behaviors at least twice weekly and for three months
• self perception and that is preoccupied with body shape and weight
• purging
• fasting
• excessive exercise
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Binge Eating
Binge eating is an episode of eating in which an abnormal quantity of food is consumed that is larger than most people would consume under similar circumstances. Binges occur within a discrete period of time such as hours and are characterized by atypical eating behaviors such as rapid eating, stuffing food into the mouth, eating food without the usual utensils, eating food from packages or eating foods that are typically cooked without cooking.
Binges are characterized by a sense of lack of control in which there is a feeling of being unable to stop or to control how much one is eating, and in what manner one is eating.
Compensatory Behaviors
Behaviors designed to prevent weight gain are used in Bulimia to compensate for binge eating. These are unusual and inappropriate behaviors such as vomiting, use of laxatives, enemas, diuretics, excessive exercise and fasting. These behaviors are typically driven by intense anxiety about the amount of food he and fear the body shape and body weight will become unacceptably altered as a result of binge eating. The compensatory behaviors used in bulimia often have negative health consequences.
Self-Perception
Individuals with bulimia are excessively preoccupied with body shape and body weight and place a high value on appearance. Body shape, body weight and appearance are factors used almost exclusively in self-evaluation by individuals with this disorder to determine self-worth and self-esteem. Body and weight dissatisfaction are consistent concerns often despite normal body shape and normal body weight.
Purging
Purging is the use of behaviors such as vomiting or substances to empty the body of the food and calories consumed during binge eating. Common purging behaviors used are self-induced vomiting and the use of laxatives, diuretics and enemas.
Subtypes of Bulimia Nervosa
The diagnosis Bulimia is given as Bulimia Nervosa Purging Type or Bulimia Nervosa Non-Purging Type. These two subtypes clarify the types of compensatory behaviors used to prevent weight gain. In Bulimia Nervosa Purging Type Individuals use inappropriate behaviors to compensate for binge eating that are designed to empty or purge the body of the food and calories consumed during binge eating. Self-induced vomiting is a common purging behavior in which the gag reflex is stimulated by one's own fingers or instruments placed in the throat to cause the stomach to empty its contents through vomiting.
In Bulimia Nervosa Non-Purging Type individuals predominantly use inappropriate behavior to compensate for binge eating and prevent weight gain that are not self-induced vomiting, use of laxatives, diuretics or other behaviors designed to empty the body of the food and calories consumed during binge eating. Compensatory behaviors in the non-purging subtype of bulimia are behaviors such as fasting and excessive exercise.
Course of Bulimia Nervosa
Some Individuals with Bulimia Nervosa may have active symptoms that persist chronically over a course of years. Others may have intermittent episodes of an active disorder with intervals of remission, or an absence of symptoms, between episodes of the disorder.
-Health Complications=
Purging behaviors can cause significant physical consequences such as damage to teeth, menstrual irregularities, fluid and electrolyte imbalances, vitamin and mineral deficiencies, metabolic disturbances and cardiac problems. Some individuals have died as a direct result of the health consequences of Bulimia Nervosa.
Concurrent Issues
Low self-esteem and mood disturbances such as depression and dysthymia are common in individuals with Bulimia Nervosa. Anxiety symptoms and anxiety disorders are also common. Substance disorders, such as stimulant used to prevent weight gain, or the use so sedating substances to attenuate anxiety symptoms also co-occur in individuals with this disorder. Significant numbers of individuals with Bulimia Nervosa have trauma histories that include childhood sexual abuse, physical abuse and neglect.
Characteristics of Individuals with Bulimia Nervosa
Approximately 90% of individuals with Bulimia Nervosa are female. The majority of affected individuals in the U.S. are white. The onset of Bulimia Nervosa most commonly occurs in late adolescence or early adulthood.
Treatment of Bulimia Nervosa
Treatment for Bulimia Nervosa can occur in both outpatient and inpatient settings. Some individuals with severe health endangering complications will require medical supervision and support in medical facilities.
There are structured, therapeutic and residential programs in which intensive individual and group counseling designed to address recovery from Bulimia and related issues are provided. Outpatient counseling services are also available for primary treatment of the disorder and for follow-up support after residential programs.
Counseling and psychotherapy are typically used to address the behaviors and dynamics of Bulimia as well as any concurrent disorders or problems related to the disorder. Individual, group and family counseling are usual treatment modalities. Self-help support groups, such as programs based upon the 12 Steps, are also widely available and typically encouraged to supplement treatment. Nutritional counseling is used to address the body’s needs, to normalize eating and to restore health. Cognitive behavioral techniques and supportive counseling are typically used to change problematic behaviors and to find coping strategies for related emotional problems. Some individuals with this disorder benefit from the use of medications for depression and anxiety. If concurrent disorders or significant issues exist, recovery from Bulimia may involve a simultaneous treatment of those.
Recovery from Bulimia is usually considered a long-term treatment process with various stages including initial abstinence from bulimic behaviors, addressing emotional and psychological components of the disorder, learning other coping skills, establishing recovery supports and maintenance of recovery. The phenomenon of relapse is widely considered as occurring in a return to use of bulimic behaviors. Relapse prevention planning can therefore be a significant part of the treatment process.
