According to the DSM-5 the criteria for Bulimia Nervosa are:
– Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
– 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.
– Self-evaluation is unduly influenced by body shape and weight.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
This disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Signs and Symptoms of Bulimia Nervosa:
Bulimia is characterized by binge eating followed by some type of purging behavior, typically vomiting, laxative use, diuretics, or excessive exercise. Binge eating is the process of eating an objectively large amount of food in a short period of time, usually less than 2 hours. The central component of binge eating is a feeling of loss of control over eating, the feeling of being compelled to eat well past the point of being full, without the ability to stop. This is very different from normal overeating, which we all do from time to time.
Frequently Bulimia Nervosa begins with a pattern of stringent dieting. The restrictive dieting causes cravings which eventually lead the person to break their diet. Once the person “breaks” their diet they can often feel so defeated that they don’t care what they eat, so then they begin to eat everything they have been avoiding during the diet, eating an excessively large amount of food. Then they panic and attempt to undo the calorie intake by some form of purging, often vomiting.
People suffering from Bulimia Nervosa become obsessed with their weight and shape. They may weigh themselves excessively and engage in checking behavior. They may make disparaging comments about their weight and shape. They may exercise excessively, and lose or gain significant amounts of weight. Frequently, their self-esteem is entirely dependent on their weight and shape. Parents may find evidence of binge eating in terms of food wrappers and disappearing pantry items, as well as evidence of purging in the bathroom. The person struggling with bulimia may use the bathroom frequently after meals. They may hide food and eat in secret. They may eat so much that it is painful.
Some people with Bulimia struggle with binge drinking, depression, or anxiety as well. They may become withdrawn or irritable. There is a great deal of shame associated with Bulimia, and people often have a very hard time asking for help.
Physical Problems that Develop as Bulimia Progresses:
As a person begins to binge and purge regularly they can suffer from significant physical consequences. Often they can experience a headache and a sore throat, as well as stomach or digestive pain and constipation. Often this is due to extensive dehydration. This dehydration can lead to dangerous imbalances in the electrolytes that maintain our heart rhythm. Dental problems can develop after a long habit of vomiting, with the loss of the dental enamel causing tooth loss. Often the face will be puffy from enlarged parotid glands. There is a risk of a life threatening heart problem or a gastric or esophageal rupture.