BULIMIA

NERVOSA
By Analesa Dudley

Bulimia Nervosa
By Analesa Dudley
Bulimia Nervosa is an eating disorder characterized by eating large
amounts of food in one sitting (bingeing) followed by inappropriate methods
of ridding oneself of the food to prevent weight gain. People who suffer from
this disorder are usually within a few pounds of what is considered to be a
normal weight for their age and height. Very few people are obese and/or
overweight before engaging in Bulimic behavior.
Bulimia comes from an ancient Greek term meaning the hunger of an
ox. People with Bulimia consume large amounts of food rapidly and in
private they purge. There are many different ways that a person with
Bulimia would purge, use of diuretics, laxatives, fasting, and excessive
exercise name a few. However, 80-90% of people with this disorder use selfinduced vomiting to purge.
Binge eating is defined as an abnormally large amount of food
consumed in two hours or less. This would be more food than a person
would normally eat in the same amount of time. Snacking continuously is
known as grazing and would not be considered to be bingeing.
It is proven that binge eaters usually indulge in sweets and high calorie
foods. However, binge eating doesnt focus on the type of food it revolves
around the amount of food being consumed. During binge episodes a person
feels out of control. A person may also feel disconnected from their
surroundings. Between binges low calorie foods and drinks are used to
control weight.
Bulimia Nervosa Diagnostic Criteria as noted in the DSM-5 reads as
follows:
A. Recurrent episodes of binge eating. An episode of binge eating is
characterised 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).

B. Recurrent inappropriate compensatory behaviour in order to prevent

weight gain, such as self-induced vomiting, misuse of laxatives,
diuretics, or other medications, fasting, or excessive exercise.
C. The binge eating and inappropriate compensatory behaviours both
occur, on average, at least once a week for three months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of Anorexia
Nervosa.

Severity can be labeled as one of the following:

Mild: 1-3 episodes per week

Moderate: 4-7 episodes per week
Severe: 8-13 episodes per week
Extreme: 14 or more episodes per week

Bulimia Nervosa begins usually in adolescence or young adulthood.

Onset before puberty or after the age of 40 would be uncommon.
Experiencing multiple stressful events in life and/or after an episode of
dieting in order to lose weight can cause the onset of Bulimia Nervosa.
Bulimia Nervosa is its own disorder that has symptoms of other
disorders. For example there are other types of eating disorders that
include:
1. Atypical Anorexia Nervosa: All criteria are met, except despite
significant weight loss, the individuals weight is within or above
the normal range.
2. Binge Eating Disorder (of low frequency and/or limited
duration): All of the criteria for BED are met, except at a lower
frequency and/or for less than three months.
3. Bulimia Nervosa (of low frequency and/or limited duration): All
of the criteria for Bulimia Nervosa are met, except that the binge
eating and inappropriate compensatory behaviour occurs at a
lower frequency and/or for less than three months.
4. Purging Disorder: Recurrent purging behaviour to influence
weight or shape in the absence of binge eating

5. Night Eating Syndrome: Recurrent episodes of night eating.

Eating after awakening from sleep, or by excessive food
consumption after the evening meal. The behavior is not better
explained by environmental influences or social norms. The
behavior causes significant distress/impairment. The behavior is
not better explained by another mental health disorder (e.g.
BED).
Normal eating I have found best defined as being able to eat when you
are hungry and continue to eat until you are satisfied. Normal eating is
being able to use some moderate constraint on your food selection. Normal
eating is giving yourself permission to eat sometimes because you are
happy, sad, bored, or just because it feels good.
There are many misconceptions about the causes of eating disorders.
Eating disorders are not necessarily about food or the want/need to be thin.
Suffers of this disorder use, unhealthy dieting, purging, and/or bingeing as a
means to cope with stressful situations in life. The short term effects of this
disorder relieves anxiety and stress. Long term effects of this disorder
increases anxiety and stress while creating other serious complications.
No one single thing can be labeled as the cause of and eating disorder.
People can be underweight, normal weight, and/or overweight and all have
some sort of eating disorder. Some of the following things may contribute to
an eating disorder:

Genetics-Research shows that eating disorders run in families.

Some specific chromosomes have been linked to Anorexia and
Bulimia.
Biochemistry- Individuals with eating disorders may have
abnormal levels of certain chemicals that regulate such
processes as appetite, mood, sleep and stress. People with
bulimia and anorexia have higher levels of the stress hormone
cortisol. Some research also suggests that individuals with
anorexia have too much serotonin, which keeps them in a
constant state of stress.
Psychological-Eating disorders are common in individuals who
struggle with clinical depression, anxiety disorders and
obsessive-compulsive disorder.
Culture- Dieting, body dissatisfaction and wanting to be thin are
all factors that increase the risk for an eating disorder. Society
encourages all three.
Environment-Family or other relationship problems, difficult
childhood, history of physical or sexual abuse are all

environmental factors that can contribute to the onset of an

eating disorder.
Most of the Short Term effects of Bulimia Nervosa are reversible. It
depends on the severity of the Bulimia and the individual also. Short term
effects of Bulimia Nervosa include but are not limited to the following:

Digestive system suffers because of vomiting. People experience

bloating, indigestion, bad taste in the mouth, breath smells,
pains and aches in the stomach, reflux, heart burn and nausea.

Swallowing can be painful if throat gets damaged while vomiting.

Teeth get eroded quickly from the acid during and after vomiting.
Heart problems can become obvious especially in people who
purge often.
Low body temperature which makes people sensitive to cold
weather. Bulimics are cold most of the time.
Muscular tension can bring a lot of suffering. It appears as back
pains, neck pains, tension headaches and aches or pains in other
parts of the body.
Depression and anxiety can be very severe. The more people
think and act bulimic the more depressed they become.
The Immune system can suffer making a person vulnerable to
many infections. They experience colds and flu often.
People become withdrawn and avoid others.
Stress levels increases significantly.
Insomnia is common due to increased stress.
Distorted thoughts: constantly thinking about food, even
dreaming about it.
Menstrual problems can range from painful periods to absence of
periods.
Bone density decreases. Osteoporosis in severe cases of bulimia.
Voice changes due to damaged vocal cords.

Long term effects of Bulimia Nervosa are serious. Some only affect your
appearance and others cause serious health complications. Listed below are
some of the long term effects of Bulimia Nervosa:

Damage to brain
Lazy Bowel Syndrome
Bulimia Teeth
Brittle Bones and Osteoporosis

Premature Ageing
Infertility
Brain Damage and Coma
Cancer

Bulimia often occurs with another condition such as substance abuse or

depression. In these instances treatment will take much long. It is
recommended that an individual be treated for one of these conditions first
then the Bulimia can be addressed. Bulimia Nervosa can be treated with
psychological counseling such as cognitive behavior therapy and medication
which is usually an anti-depressant. This would be a long term treatment
plan but does not in most cases require hospitalization. Reality is that eating
disorders are hard to treat and recovery may take months or years. Relapse
is common but treatment has been proven successful over time.

References:
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Arlington, VA:
American Psychiatric Publishing.
Inaba, Darryl, William E. Cohen, and Michael E. Holstein. Uppers, Downers,
All Arounders: Physical and Mental Effects of Psychoactive Drugs. Ashland,
OR: CNS Productions, 1993. Print
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