Bulimia Nervosa

Eating disorders are a spectrum of illnesses that have serious psychological and medical consequences, both in the short and long term. In the case of bulimia nervosa, the general trend is to binge, or eat profound quantities of food, and then use compensatory measures to remove calories and prevent weight gain. To understand bulimia, a number of topics must be explored, including the clinical definition, epidemiology, the signs and symptoms, treatment, and consequences.

Definition

The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) defines bulimia nervosa with the following four criteria. There are episodes of binge eating with a sense of loss of control. The binge eating is followed by compensatory purging behavior, such as self-induced vomiting, laxative, or diuretic abuse. The binges and compensatory behavior must occur a minimum of two times per week for at least three months. The individual must also have dissatisfaction with his or her body shape and weight.

Bingeing is described as eating, in a defined and self-limited amount of time, an amount of food that is larger than most people would eat during a similar time period and under similar circumstances. During this time, the person feels out of control with his or her eating, as though he or she cannot stop. Purging can take many forms and is an attempt to compensate for the extreme food intake during a binge. Purging can be achieved by self-induced vomiting, using laxatives, diuretics, or with excessive exercise. Bulimia is frequently divided into two subtypes: purging and nonpurging. Purging involves those who induce vomiting, or use laxatives, diuretics or enemas to remove calories, whereas those who use excessive exercise or periods of fasting to compensate for calorie intake fall into the nonpurging type. Nonpurging is more rare and accounts for only 6 to 8 percent of bulimic patients.

Epidemiology

There is great difficulty in accurately evaluating the epidemiology of eating disorders due to changes in diagnostic criteria over time, the reliance on self-reporting, and the tendency for those affected to deny the disorder. Bulimia nervosa was first described in 1977, at the Royal Free Hospital in London and was recognized as an eating disorder by the American Psychiatric Association in 1980. It is estimated that between one and two million women in the United States would meet the criteria for bulimia nervosa. Over 90 percent of bulimic patients are female. There are two peaks in incidence of bulimia, at ages 14 and then at 18, although presentation can be into adulthood.

There is no medical consensus on the etiology of eating disorders including bulimia nervosa. Most models include psychological, biological, family, genetic, environmental, and societal factors. These forces can cause a decreased sense of self-esteem, body image, or self-control. There are several more specific factors that may be influential in the development of bulimia and other eating disorders. For example, some literature suggests that an important predictor of eating disorders is dieting during adolescence. In addition, if there is a preoccupation or obsession with thin body image or if one feels a social pressure to be thin, this may be associated with the development of eating disorders. Activities that emphasize body shape, such as gymnastics, dance, and cheerleading may also influence the development of eating disorders.

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