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Characteristics of Bulimia Nervosa

Bridget Engel, Psy.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

The literal translation of bulimia means "hunger like an ox". The diagnostic criteria for bulimia in the DSM are: 1) recurrent episodes of binge eating with a sense of lack of control occurring at least twice per week for at least three months, 2) recurrent, inappropriate compensatory behavior, such as vomiting, in order to prevent weight gain 3) and self-evaluation that is unduly influenced by body shape and weight.

Symptoms/Criteria

As outlined in the DSM, binge eating is one of the primary symptoms of Bulimia Nervosa. A binge involves eating, in a short period of time, an amount of food that is larger than most individuals would eat under similar circumstances. The food consumed during binges varies, but typically includes sweet, high-calorie foods. Binging is often characterized by rapid consumption until the individual is uncomfortably or even painfully full.

Binge episodes are often surrounded by painful emotions. Preceding a binging incident, bulimic individuals often describe depressed moods, stress, or intense hunger following dietary restraint. They try to stay in control and talk themselves into believing that they should not binge, developing increasing levels of anxiety. During the binge, there is typically a sense of lack of control and an increase in self-criticism, as well as justification for the behavior. After the binge, many individuals experience shame, guilt and regret.

Individuals with bulimia fear weight gain and typically believe they have to undo or compensate for the binge episode, so they purge what they consumed by inducing vomiting. Ironically, bingers do not recognize that most of the calories consumed during a binge remain in the body and are not reduced by purging. However, the immediate effects of vomiting include relief from physical discomfort as well as fear reduction related to gaining weight. Other purging behaviors include the misuse of laxatives and diuretics (medications that cause you to urinate), as well as excessive exercising. Individuals with bulimia may also fast and skip meals frequently in order to lose weight. When they do eat meals, they may drink large amounts of fluids, take very small portions, cut food into tiny pieces, or chew their food excessively.

Bulimic individuals believe they need to keep their embarrassing behaviors hidden from their friends and family. These individuals may avoid eating meals with others, or make frequent trips to the bathroom during or after meals. They may have a heightened desire for privacy in the bathroom or run water to conceal the sound of vomiting. Bulimic individuals may also go for unexpected walks or drives at night after meals or go to the kitchen after every one else is in bed. It is not uncommon for these individuals to chew mints or gum to conceal the smell of vomit on their breath, and they might also wear baggy clothing to conceal the size of their body.

 




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